DEFINITION. INTERRUPTION IN THE ABORAL PASSAGE OF INTESTINAL CONTENTS. The common Scenario. A 50 year old man presents with abdominal pain, distension, obstipation and constipation, with repeated episodes of vomiting.
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INTERRUPTION IN THE ABORAL PASSAGE OF INTESTINAL CONTENTS
A 50 year old man presents with abdominal pain, distension, obstipation and constipation, with repeated episodes of vomiting.
His vital sign were stable, abdomen distended with diffuse tenderness. Bowel Sounds are hyperactive.
Gas diffusely through intestine, incl. colon
May have large diffuse Air/fluid levels
No obvious transition point on contrast study
Distended small bowel loops, no air in colon
Laddered Air/fluid levels
Obvious transition point on contrast study
Upright Abdominal Film
Air - Fluid Levels
Dilated Small Bowel
- oliguria, hypotension, hemoconcentration
Site – Small Bowel
May occur at any point in length of small bowel
4. Others: Incisional and Internal H.
Gall stone Ileus
Unlike SBO, adhesions very unlikely to
Residual colonic gas above peritoneal reflection
60-80% resolve with non-operative Tx
Must show objective improvement, if none by 48h consider OR
No residual colonic gas on AXR
SBFT may differentiate early complete from high-grade partial
Almost all should be operated on within 24h
Barium should not be used in
a patient with peritonitis
NEVER LET THE SUN RISE OR FALL ON A PATIENT WITH BOWEL OBSTRUCTION
- afeb, nontender abd, wcc 5000
- High NGT output
- No classic signs of strangulation
Hard palpable mass in RUQ. Distended abdomen, high pitched BS, no tenderness. No palpable hernias. No scars. Black stool.