1 / 10

Grand Round Case Presentation Sub Acute Obstruction

Grand Round Case Presentation Sub Acute Obstruction. Causes of SBO. Adhesions (70%) – usually from previous surgery but TB infection can cause them Hernia (20%) Pressure from extrinsic structures (eg. tumour) Gallstones Inflammatory bowel disease

paiva
Download Presentation

Grand Round Case Presentation Sub Acute 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. Grand Round Case PresentationSub Acute Obstruction

  2. Causes of SBO • Adhesions (70%) – usually from previous surgery but TB infection can cause them • Hernia (20%) • Pressure from extrinsic structures (eg. tumour) • Gallstones • Inflammatory bowel disease • Intussusception (especially in young children – it can kill quickly so beware!) • Volvulus • Gynaecological causes in women • 20% of all Surgical admissions

  3. Small Bowel Obstruction Adhesions – what do they look like?

  4. Initial Management of ?SBO • Full history including details of past surgery • Full abdominal exam including PR • Don’t forget hernial orifices (or end up in court)! • Imaging (CXR, AXR, CT, barium) & all bloods • Conservative management unless: • Perforation (imaging) and/or overt peritonism • Irreducible hernia • Palpable mass

  5. Conservative Management • NBM, NG tube and close observations • Patient must have adequate resuscitation before surgery: IV fluids & monitor urine output • Imaging studies: CXR, AXR, CT & barium studies • Closely monitor patient bowel habits!! A SBO can rapidly change from incomplete to complete • Be ready for any deterioration: pain, distension, peritonism, dehydration, sepsis or absolute constipation

  6. Small bowel obstruction: AXR • Dilated loops of small bowel • Central position • Valvulae conniventes • Distal collapse • Barium studies show location of obstruction • ?Absolute indication for surgery

  7. Take home points: SBO • Common surgical emergency • Good history, good examination, appropriate investigations • Conservative management? • Close monitoring for deterioration • Repeat imaging • Peritonism or sepsis = surgery!

  8. TB: Profs Prophecy • Suspect TB in any foreign national with: • Mediastinal/hilar lymphadenopathy • Persistent cervical lymphadenopathy • Pleural effusion • Monoarthritis • Chronic discharging sinus • Small bowel obstruction (7% of all Indian SBO’s!) • 50% of TB presentations are extra-pulmonary! • TB is a notifiable disease: need to trace all contacts for assessment and prophylactic therapy

  9. References • Wysocki A. Pozniczek M. Kulawik J. Krzywon J. Peritoneal adhesions as cause of small bowel obstruction. Przeglad Lekarski. 60 Suppl 7:32-5, 2003. • Vijay K. Anindya C. Bhanu P. Mohan M. Rao PL. Adhesive small bowel obstruction (ASBO) in children--role of conservative management. Medical Journal of Malaysia. 60(1):81-4, 2005 Mar. • Fevang BT. Fevang J. Lie SA. Soreide O. Svanes K. Viste A. Long-term prognosis after operation for adhesive small bowel obstruction. Annals of Surgery. 240(2):193-201, 2004 Aug. • Ellis H. Adhesions: the early history. Historical Article. Hospital Medicine (London). 65(6):328-9, 2004 Jun • Corfitsen MT. Hantho AF. Nilsson T. Conservative treatment of ileus caused by adhesions, with a Miller-Abbott tube. Ugeskrift for Laeger. 146(18):1360-2, 1984 Apr 30. • Totikov VZ. Kalitsova MV. Amrillaeva VM. Diagnostic and treatment program in acute adhesive obturative obstruction of the small bowel.Khirurgiia. (2):38-43, 2006.

  10. Thanks for listening! Any Questions?

More Related