Bowel obstruction
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Bowel Obstruction. Tintinalli’s Ch 86. Definition. The inability of the intestinal tract to allow for regular passage of food and bowel contents secondary to mechanical obstruction or adynamic ileus. Causes. SBO Most common cause is adhesions after abdominal surgery

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Bowel obstruction

Bowel Obstruction

Tintinalli’s Ch 86


Definition
Definition

  • The inability of the intestinal tract to allow for regular passage of food and bowel contents secondary to mechanical obstruction or adynamic ileus


Causes
Causes

  • SBO

    • Most common cause is adhesions after abdominal surgery

    • #2 MCC is incarceration of groin hernia

    • Then inflammatory bowel disease, bariatric surgery, blunt trauma

  • LBO

    • Neoplasm MCC


Pathophysiology
Pathophysiology

  • Intraluminal accumulation of gastric contents  vomiting/decreased PO intake volume depletion electrolyte imbalance  renal failure/shock

  • Mortality approached 70% if bowel obstruction progresses to shock


Clinical features
Clinical Features

  • Diffuse, crampy, intermittent abdominal pain

  • Abdominal distention

  • N/V

  • Constipation

  • High pitched bowel sounds in obstruction

  • Hypoactive BS in adynamic ileus


Work up
Work Up

  • CBC, BMP

    • WBC >20K bowel gangrene/peritonitis

  • Lactic Acid

  • Plain films

    • CXR for free air

    • Flat, upright, decub view

  • CT with IV and ORal


Treatment
Treatment

  • If true mechanical obstuction  Surgery

  • NG tube often unnecessary, but consider if severe distention and vomiting

  • IVF

  • Broad-spectrum Abx

  • If adynamic ileus  conservative measures

    • IVF, observation

  • Dc any meds that inhibit bowel motility


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