Bowel Obstruction

Question 1

What are the 3 causes of bowel obstruction?

Answer 1

• Adhesions (scar tissue from previous surgery causing a kink in the bowel – think watering hose kinking)
• Hernias
• Malignancy

Question 2

What are signs and symptoms?

Answer 2

• Increasing abdominal distention and diffuse pain
• Absolute constipation and lack of flatulence
• Vomiting

Question 3

What is the initial management?

Answer 3

“drip and suck”
•Nil by mouth
•IV fluids
•NG tube on free drainage (to allow stomach contents to freely drain and prevent the need for vomiting)

Question 4

Investigations

Answer 4

•Abdominal plain film xray
◦Distended loops of bowel
◦Upper limits of normal are: 3 cm small bowel, 6 cm colon, 9 cm caecum

◾Small bowel can be distinguished from large bowel by the presence of valvulae conniventes and haustra.

◾Valvulae conniventes are present in small bowel, and are mucosal folds that form lines that extend the full width of the small bowel.

◾Haustra are like pouches formed by the muscles in the walls of the large bowel, and form lines that do not extend the full width of the bowel.

•CT scan can confirm diagnosis and cause and guide surgical intervention

Question 5

What are the surgical interventions?

Answer 5

Correct underlying cause:

• Exploratory laparotomy in patients with unclear underlying cause
• Adhesiolysis to treat adhesions (either by laparoscopy / open laparotomy)
• Repair of hernia
• Emergency resection of tumour (for example emergency right hemicolectomy for caecal tumour)