Intestinal Obstruction

Question 1

Definition

Answer 1

• Obstruction of the normal movement of bowel contents. Classified according to the
site:

o Small or Large bowel
o Partial or Complete obstruction
o Simple or Strangulated

Question 2

Aetiology

Answer 2

• Extramural
o Hernia
o Adhesions
o Bands
o Volvulus

• Intramural
o Tumours
o Inflammatory strictures (e.g. Crohn’s strictures, diverticulitis)

• Intraluminal
o Pedunculated tumours
o Foreign body (e.g. bezoars, gallstones)

Question 3

Epidemiology

Answer 3

• COMMON
• More common in the ELDERLY due to increasing incidence of adhesions, hernias and
malignancy

Question 4

Presenting symptoms

Answer 4

• Severe gripping colicky pain with periods of ease
• Abdominal distension
• Frequent vomiting (it may be bile-stained or faeculent)
• Absolute constipation

Question 5

Signs on physical examination

Answer 5

• Abdominal distension with generalised tenderness
• May see visible peristalsis
• Tinkling bowel sounds
• Peritonitis - absent bowel sounds, guarding and rebound tenderness
• Inspect for hernias
• Look for abdominal scars - previous abdominal surgery increases the risk of adhesions
• Inspect for abdominal mass (e.g. intussusception, carcinoma)

Question 6

Investigations

Answer 6

• AXR
o Assists diagnosis and localisation
o Check for valvulae conniventes (small bowel) or haustra (large bowel)

• Water-Soluble Contrast Enema
• Barium follow through

Question 7

Management plan

Answer 7

• General
o Gastric aspiration via NG tube if the patient is vomiting
o IV fluids
o Electrolyte replacement
o Monitor vital signs, fluid balance and urine output

• Surgical
o Emergency laparotomy in acute obstruction

Question 8

Possible complications

Answer 8

• Dehydration
• Bowel perforation
• Peritonitis
• Toxaemia
• Gangrene of ischaemic bowel wall

Question 9

Prognosis

Answer 9

• Variable

* Dependent on the general state of the patient and the prevalence of complications