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Bowel Obstruction

Bowel Obstruction. James Zeng. Bowel Obstruction. A blockage of bowel lumen prohibiting the passage of materials[1] 8% of abdo pain in ED (3 rd leading cause)[2] 24% require surgery[3] 300,000 admissions, 800,000 in-pt days, $1.3bil[4]. Causes. Extrinsic (extraluminal)

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Bowel Obstruction

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  1. Bowel Obstruction James Zeng

  2. Bowel Obstruction • A blockage of bowel lumen prohibiting the passage of materials[1] • 8% of abdo pain in ED (3rd leading cause)[2] • 24% require surgery[3] • 300,000 admissions, 800,000 in-pt days, $1.3bil[4]

  3. Causes • Extrinsic (extraluminal) • Intrinsic (luminal) • Intraluminal

  4. Extrinsic Causes • Adhesions • Hernias • Volvulus

  5. Intrinsic • Neoplastic • Inflammatory • Congenital

  6. Intraluminal • Faeces • Gallstones • Intussception • Bezoar

  7. Bowel Obstruction • Small v. Large • Acute v. subacute

  8. Differential • Paralytic -ileus • Pseudo-obstruction • Constipation

  9. Diagnosis • Clinical • Radiological

  10. Symptoms • Pain • Distension • Obstructive symptoms • Vomiting • Inability to pass motions/slowing • Inability to pass flatus

  11. Past history • Past abdominal surgery • Past obstructions • Hernias • Crohn’s • Malignancy

  12. Signs • Volume status • Scars, volume • Guarding, peritonitis • “Tinkling” bowel sounds, no BS • Hernias • PR

  13. Investigations • Abdo pain bloods • Lactate

  14. Radiology (AxR)

  15. Radiology (AxR) • Large bowel obs

  16. Radiology (AxR) • Size • Walls • Distal collapse • Empty rectum

  17. Radiology (AxR)

  18. Radiology (CT) • Inconclusive XR • Systemically unwell, local peritonitis • Helps to determine cause • >2.5cm with distal collapse • High accuracy

  19. Conservative Management • Fluids • NBM • Analgesia • NG tube

  20. Complications • Electrolytes

  21. Specific Management • Adhesions - conservative ± gastrograffin • Perforation, hernia – urgent theatre • Strictures, colitis – surgical resection • Sigmoid volvulus – rectal tube • Beware of ischaemia – test intraoperatively

  22. Obstruction in Cancer Patients • Various opinions • Depends on when last operation was • Trial of conservative treatment • Gastrograffin/CT • Consider early resection, stent+resection • Non-operative candidates

  23. References • www.medical-dictionary.com • Lewis LM et al. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. Gerontol A Biol Sci Med Sci. 2005. 60:8 (1071-6). • Foster NM; McGory ML; Zingmond DS; Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg. 2006. 203:2 (170-6). • Ray NF; Denton WG; Thamer M; Henderson SC; Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998. 186:1 (1-9).

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