Bowel obstruction
From Wikipedia, the free encyclopedia
| ICD-10 | K56. |
|---|---|
| ICD-9 | 560 |
| DiseasesDB | 15838 |
| MedlinePlus | 000260 |
Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. It can occur at any level in the digestive tract, and is a medical emergency. Although many cases are not treated surgically, it is a surgical problem.
Contents |
[edit] Causes
[edit] Small bowel obstruction
Causes of small bowel obstruction include:
- Adhesions from previous abdominal surgery
- Hernias containing bowel
- Crohn's disease causing adhesions or inflammatory strictures
- Neoplasms, benign or malignant
- Intussusception in children
- Volvulus
- Malrotation in infants
- Ischaemic strictures
- Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects)
- Intestinal atresia
- Carcinoid rare, preferred location: ileum
[edit] Large bowel obstruction
Causes of large bowel obstruction include:
- Neoplasms
- Hernias
- Inflammatory bowel disease
- Colonic volvulus (sigmoid, caecal, transverse colon)
- Faecal impaction
- Colon atresia
- Benign strictures (Diverticular Disease)
[edit] Differential diagnosis
Differential diagnoses of bowel obstruction include:
- Ileus
- Pseudo-obstruction or Ogilvie's syndrome
- Intra-abdominal sepsis
- Pneumonia or other systemic illness.
[edit] Signs, symptoms and causes
Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, fecal vomiting, and constipation.
Obstruction may be due to causes within the bowel lumen, within the wall of the bowel, or external to the bowel (such as compression, entrapment or volvulus).
Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischaemia or perforation from prolonged distension or pressure from a foreign body.
In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.
In large bowel obstruction the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.
[edit] Diagnosis
The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass.
Radiological signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs.
Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.
According to a meta-analysis of prospective studies by the Cochrane Collaboration, the appearance of water-soluble contrast in the cecum on an abdominal radiograph within 24 hours of oral administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 96% and specificity of 96%. PMID 15674958
Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy are other diagnostic options.
[edit] Treatment
Some causes of bowel obstruction may resolve spontaneously; many require operative treatment.
Treatment for a small bowel obstruction can involve insertion of a nasogastric tube, correction of dehydration and electrolyte abnormalities, and treating the cause of the obstruction. Adhesive obstructions often settle without surgery, but if prolonged may require surgical intervention. Opioid pain relievers may be used for patients with severe pain. Antiemetics may be administered if the patient is vomiting.
Fetal and neonatal bowel obstuctions are often caused by an intestinal atresia where there is a narrowing or absence of a part of the intestine. These atresias are often discovered before birth via a sonogram and treated with using laparotomy after birth. If the area affected is small then the surgeon may be able to remove the damaged portion and join the intestine back together. In instantances where the narrowing is longer, or the area is damaged and cannot be used for a period of time, a temporary stoma may be placed. In adults, frequently the need for surgical intervention and the treatment of the causative lesion is required. In malignant large bowel obstruction, endoscopically placed self-expanding metal stents may be used to temporary relieve the obstruction as bridge to surgery, or as palliation.
[edit] See also
[edit] External links
- eMedicine emerg/66
- eMedicine emerg/65
- UCSF Fetal Treatment Center: Bowel Obstructions
- Intestinal Obstruction in Adults
