Bowel obstruction
| Headline | |
|---|---|
| Etiology | Closed vs open loop Extramural: strangulated hernia, adhesions mural: cancer, strictures due to IBD/Crohn’s, diverticulitis, volvulus intramural (rare): gallstone ileus, constipation functional: ileus, pseudo-obstruction. Most common in SBO: adhesions, hernias; LBO: cancer |
| Epidemiology | |
| Clinical presentation | colicky abdo pain, N&V, constipation (SBO: earlier, more vomiting) May not have significant vomiting if LBO with incompetent ileocecal valve |
| Pathogenesis | |
| Diagnostic investigations | CT AP, Gastrograffin (osmotic laxative - ONLY give if NGT in place) |
| Management | NBM, Ryles tube to decompress stomach and minimise aspiration, IV fluids Surgical interventions: - Emergency decompression required for strangulation, ‘closed loop obstruction’, SBO in pts without hx surgery, not responding after 48h. - Malignant: defunctioning stoma, resection, endoscopic stenting - Volvulus: flatus tube |