Intestinal obstruction

Question 1

Define

Answer 1

Obstruction to free passage of contents of the gut
Ileus: Reduced bowel motility causes functional obstruction (no pain and bowel sounds present)
- Simple obstructed bowel: One obstructing point, no vascular compromise
- Closed loop obstructed bowel: Obstruction at 2 points forming a loop of grossly distended bowel at risk of perforation
- Strangulated obstructed bowel

Question 2

Aetiology/risk factors

Answer 2

Small bowel:
- Hernias and adhesions
- Malignancy
- Volvulus
Large bowel:
- Colon cancer
- Constipation
- Diverticular stricture
- Volvulus
Rare:
- Crohn's stricture
- Gallstone ileus

Question 3

epidemiology

Answer 3

• Most are small bowel obstruction

- Many colorectal malignancies will present with obstruction

Question 4

symptoms

Answer 4

• Vomiting, nausea and anorexia
• Colicky pain
• Constipation: absolute if no flatus passed
• Distension

Question 5

signs

Answer 5

• Severe tenderness suggesting ischaemia or perforation
• Dehydration, poor peripheral perfusion, tachycardia, hypotension
• Tinkling bowel sounds, absent bowel sounds in ileus
• Distension
• Visible peristalsis
• Hernias may be present
• Fever

Question 6

investigations

Answer 6

• Erect CXR: for intestinal perforation
• AXR Small bowel: central gas shadows, no gas in large bowel
• AXR Large bowel: Gas shadows proximal to obstruction, not in rectum, large bowel haustra

Question 7

management

Answer 7

Drip & Suck: NG tube + catheter and IV fluids

• Analgesia

Question 8

complications

Answer 8

Gangrene
bowel perforation
peritonitis
toxaemia

Question 9

prognosis

Answer 9

• Proper diagnosis and early treatment, good outcome

- 15% of partial small bowel obstructions need surgery