Intestinal obstruction

Question 1

Define

Answer 1

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

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

Question 2

Causes

Answer 2

Small bowel → hernias or adhesions

Large bowel →

 Colon cancer

 Constipation

 Diverticular stricture

 Volvulus (sigmoid/caecal)

Rare → Crohn’s stricture, gallstone ileus, intussusception, TB, foreign body

Question 3

Epidemiology

Answer 3

COMMON

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

Question 4

Symptoms

Answer 4

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

Constipation may not be absolute (e.g. flatus passed) if obstruction is high – although will be absolute in distal

Question 5

Signs

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

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

Water-Soluble Contrast Enema

Barium follow through

Question 7

Management

Answer 7

General

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

Surgical

• Emergency laparotomy in acute obstruction

Question 8

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