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    Bowel Obstruction: Timothy M. Farrell Department of Surgery UNC-Chapel Hill

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    Bheru Lal
    This document discusses bowel obstruction, including small bowel obstruction and large bowel obstruction. It outlines the signs, symptoms, etiologies, diagnostic evaluations, and treatment approaches for each. Key points include the risks of closed loop obstruction or ischemia with complete small bowel obstruction and the importance of evaluating bowel viability. Surgical intervention is often needed for complete or complicated cases.

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    Bowel Obstruction: Timothy M. Farrell Department of Surgery UNC-Chapel Hill

    Uploaded by

    Bheru Lal
    33 views27 pages
    This document discusses bowel obstruction, including small bowel obstruction and large bowel obstruction. It outlines the signs, symptoms, etiologies, diagnostic evaluations, and treatment approaches for each. Key points include the risks of closed loop obstruction or ischemia with complete small bowel obstruction and the importance of evaluating bowel viability. Surgical intervention is often needed for complete or complicated cases.

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    Intestinal Obstruction

    Original Title

    Intestinal Obstruction

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    This document discusses bowel obstruction, including small bowel obstruction and large bowel obstruction. It outlines the signs, symptoms, etiologies, diagnostic evaluations, and treatment approaches for each. Key points include the risks of closed loop obstruction or ischemia with complete small bowel obstruction and the importance of evaluating bowel viability. Surgical intervention is often needed for complete or complicated cases.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    33 views27 pages

    Bowel Obstruction: Timothy M. Farrell Department of Surgery UNC-Chapel Hill

    Uploaded by

    Bheru Lal
    This document discusses bowel obstruction, including small bowel obstruction and large bowel obstruction. It outlines the signs, symptoms, etiologies, diagnostic evaluations, and treatment approaches for each. Key points include the risks of closed loop obstruction or ischemia with complete small bowel obstruction and the importance of evaluating bowel viability. Surgical intervention is often needed for complete or complicated cases.

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    © All Rights Reserved
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    Bowel Obstruction

    Timothy M. Farrell
    Department of Surgery
    UNC-Chapel Hill
    Small Bowel Obstruction
    Small Bowel Obstruction
    Signs & Symptoms
    • Intermittent, Crampy Abdominal Pain
    • Nausea / Emesis
    • Distension
    • Obstipation
    • Peristaltic Rushes on Auscultation
    • Focal Tenderness
    • Diffuse Peritonitis
    Small Bowel Obstruction
    Etiologies
    • Adhesions
    • Malignancy
    • External or Internal Hernia
    • Volvulus
    • Crohn’s Disease
    • Intra-abdominal Abscess
    Small Bowel Obstruction
    Etiologies (Cont.)
    • Radiation Stricture
    • Foreign Body
    • Gallstone Ileus
    • Meckel’s Diverticulum
    • Intramural Hematoma
    • Mesenteric Ischemia
    • Intussusception
    Intestinal Ileus
    Etiologies
    • Postoperative State
    • Sepsis
    • Electrolyte Imbalance
    • Drugs
    • Ureteral and Biliary Colic
    • Retroperitoneal Hemorrhage
    • Spinal Cord Injury
    • Myocardial Infarction
    • Pneumonia
    Small Bowel Obstruction
    Partial vs. Total

    • Why Not Just Wait??

    – Potential for Closed Loop Obstruction


    – Risk of Ischemia / Perforation (4-6 hrs)
    Small Bowel Obstruction
    Radiologic Evaluation

    • Xrays: ? AFLs, ? Free Air, ? Distal Gas

    • UGI / SBFT: Identify mechanical obstruction

    • Enteroclysis: Independent of gastric emptying

    • CT Scan: ? Free Air, ? Pneumatosis, ? Tumor


    Small Bowel Obstruction
    Laboratory Evaluation
    • May see hypochloremic, hypokalemic
    metabolic alkalosis if having frequent
    emesis (proximal obstruction).
    • May see evidence of contraction alkalosis
    – Increased H/H, BUN.
    • WBC usually normal early.
    Small Bowel Obstruction
    Treatment
    • Correct intravascular volume deficit
    • NGT vs. Miller-Abbott or Cantor Tubes
    • Serial Exams
    • Operation if no improvement or if signs of
    complete (closed loop) obstruction or
    incarceration.
    • Evaluation of Bowel Viability
    Small Bowel Obstruction
    Special Cases
    • Early Postoperative SBO
    – <1% risk in first month
    – Must be considered after 7 days of “ileus” since
    adhesions become dense in 2-3 weeks.
    • Recurrent SBO (5-15%)
    • Malignant Obstruction
    • Radiation Fibrosis
    Large Bowel Obstruction
    Large Bowel Obstruction
    Etiologies
    • Colon Cancer
    • Diverticulitis
    • Extrinsic Cancer
    • Fecal Impaction
    • Intussusception
    • Volvulus
    • Incarcerated Hernias
    Large Bowel Obstruction
    Colon Cancer
    • 20% of colon cancers present with
    obstruction
    • Left-sided lesions are more prone to
    obstruct (more narrow lumen, more solid
    fecal stream)
    Large Bowel Obstruction
    Diagnosis
    • Crampy Pain
    • Onset may be acute or insidious
    • Distension (50-60% have competent ileo-
    cecal valve and develop severe distension)
    • Xrays: 12-14 cm cecum, perforation risk
    • Contrast enema: Obstruction vs Oglive’s
    • Consider rigid sigmoidoscopy to r/o and
    treat sigmoid volvulus
    Large Bowel Obstruction
    Treatment
    • IVF
    • NGT
    • Operation
    – Emergently if signs of peritonitis / perforation
    – Prep bowel if possible
    • Is an ostomy necessary?
    – Right vs. Left-sided Lesions
    – Traditional vs. Newer Attitudes
    Oglive’s Syndrome
    (Colonic Pseudo-Obstruction)
    • May mimic mechanical obstruction
    • Associated Conditions
    • Treatment:
    – Rectal tube / enemas /exams (work in most)
    – Colonoscopic decompression (80-90% eff.)
    – Surgery (Cecostomy vs. Resection) - cecum
    >12 cm or peritoneal signs

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