1 / 27

Bowel Obstruction

Bowel Obstruction. Timothy M. Farrell Department of Surgery UNC-Chapel Hill. Small Bowel Obstruction. Small Bowel Obstruction Signs & Symptoms. Intermittent, Crampy Abdominal Pain Nausea / Emesis Distension Obstipation Peristaltic Rushes on Auscultation Focal Tenderness

latika
Download Presentation

Bowel Obstruction

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bowel Obstruction Timothy M. Farrell Department of Surgery UNC-Chapel Hill

  2. Small Bowel Obstruction

  3. Small Bowel ObstructionSigns & Symptoms • Intermittent, Crampy Abdominal Pain • Nausea / Emesis • Distension • Obstipation • Peristaltic Rushes on Auscultation • Focal Tenderness • Diffuse Peritonitis

  4. Small Bowel ObstructionEtiologies • Adhesions • Malignancy • External or Internal Hernia • Volvulus • Crohn’s Disease • Intra-abdominal Abscess

  5. Small Bowel ObstructionEtiologies (Cont.) • Radiation Stricture • Foreign Body • Gallstone Ileus • Meckel’s Diverticulum • Intramural Hematoma • Mesenteric Ischemia • Intussusception

  6. Intestinal IleusEtiologies • Postoperative State • Sepsis • Electrolyte Imbalance • Drugs • Ureteral and Biliary Colic • Retroperitoneal Hemorrhage • Spinal Cord Injury • Myocardial Infarction • Pneumonia

  7. Small Bowel ObstructionPartial vs. Total • Why Not Just Wait?? • Potential for Closed Loop Obstruction • Risk of Ischemia / Perforation (4-6 hrs)

  8. Small Bowel ObstructionRadiologic Evaluation • Xrays: ? AFLs, ? Free Air, ? Distal Gas • UGI / SBFT: Identify mechanical obstruction • Enteroclysis: Independent of gastric emptying • CT Scan: ? Free Air, ? Pneumatosis, ? Tumor

  9. Small Bowel ObstructionLaboratory Evaluation • May see hypochloremic, hypokalemic metabolic alkalosis if having frequent emesis (proximal obstruction). • May see evidence of contraction alkalosis • Increased H/H, BUN. • WBC usually normal early.

  10. Small Bowel ObstructionTreatment • Correct intravascular volume deficit • NGT vs. Miller-Abbott or Cantor Tubes • Serial Exams • Operation if no improvement or if signs of complete (closed loop) obstruction or incarceration. • Evaluation of Bowel Viability

  11. Small Bowel ObstructionSpecial Cases • Early Postoperative SBO • <1% risk in first month • Must be considered after 7 days of “ileus” since adhesions become dense in 2-3 weeks. • Recurrent SBO (5-15%) • Malignant Obstruction • Radiation Fibrosis

  12. Large Bowel Obstruction

  13. Large Bowel ObstructionEtiologies • Colon Cancer • Diverticulitis • Extrinsic Cancer • Fecal Impaction • Intussusception • Volvulus • Incarcerated Hernias

  14. Large Bowel ObstructionColon Cancer • 20% of colon cancers present with obstruction • Left-sided lesions are more prone to obstruct (more narrow lumen, more solid fecal stream)

  15. Large Bowel ObstructionDiagnosis • Crampy Pain • Onset may be acute or insidious • Distension (50-60% have competent ileo-cecal valve and develop severe distension) • Xrays: 12-14 cm cecum, perforation risk • Contrast enema: Obstruction vs Oglive’s • Consider rigid sigmoidoscopy to r/o and treat sigmoid volvulus

  16. Large Bowel ObstructionTreatment • IVF • NGT • Operation • Emergently if signs of peritonitis / perforation • Prep bowel if possible • Is an ostomy necessary? • Right vs. Left-sided Lesions • Traditional vs. Newer Attitudes

  17. Oglive’s Syndrome(Colonic Pseudo-Obstruction) • May mimic mechanical obstruction • Associated Conditions • Treatment: • Rectal tube / enemas /exams (work in most) • Colonoscopic decompression (80-90% eff.) • Surgery (Cecostomy vs. Resection) - cecum >12 cm or peritoneal signs

More Related