Intestinal obstruction

Question 1

What is intestinal obstruction?

Answer 1

Surgical emergency where a mechanical interruption (either complete or partial) occurs to the flow of intestinal contents, with multiple potential causes (e.g., malignant colorectal disease, colonic volvulus, benign stricture).

Question 2

What are the risk factors for obstruction?

Answer 2

older age
female gender
institutionalisation
mental illness
Megacolon

Question 3

What is the epidemiology of obstruction?

Answer 3

Large bowel obstruction is a common symptom of colorectal cancer, with an incidence range of 15% to 29%.

Common indication for surgery

Question 4

What are the signs and symptoms of obstruction?

Answer 4

colicky abdominal pain
abdominal distention
tympanic abdomen
change in bowel habits
tenesmus
nausea and vomiting
fever
Abdominal rigidity
Weight loss
constipation
Palpable mass

Question 5

What are the appropriate investigations for intestinal obstruction?

Answer 5

Bloods
> FBC (leukocytosis/ anaemia)
> Serum electrolytes (deranged)
> Renal Function (elevated creatinine/ urea)
> Serum amylase/ lipase (elevated)
> Coagulation studies

Erect CXR (no pneumoperitoneum)

AXR (Gas distension of large bowel, kidney bean shape volvulus)

CT Abdo Pelvis

Question 6

What are the complications of obstruction?

Answer 6

Bowel perforation
Sepsis
Death

Question 7

What is the prognosis of a patient with obstruction?

Answer 7

Different causes result in different mortality and morbidity (e.g. cancer is bad, volvulus may reoccur)

Question 8

What is the management of intestinal obstruction?

Answer 8

Supportive- oxygen, blood, NG decompensation

Surgery

Flexi sig