Obstruction

Question 1

What is intussusception?

Answer 1

Bowel telescopes in on itself via ICV

Question 2

How does intussusception typically present?

Answer 2

• severe crampy abdo pain alternating with episodes of no pain
• N+V
• fever symptoms
• red currant jelly faeces (neonatal)

Question 3

What are the causes of intussusception?

Answer 3

Causes

• associated with polyps, tumour, adhesions, CF, viruses, Meckel’s diverticulum
• bullseye on CT
• self resolving/therapeutic enema/surgical correction

Question 4

How does LBO present?

Answer 4

• abdo pain/cramping
• bloating
• absolute constipation (faeces & flatus)
• N+V later

Question 5

What are the most common causes of LBO?

Answer 5

• colonic tumour
• strictures (diverticular disease, IBD, post-surgical anastomosis)
• volvulus (sigmoid/caecal)
• hernias
• adhesions

Question 6

How is LBO investigated?

Answer 6

• AXR (diagnosis)
• CT abdo (cause, transition point, distinguishing volvulae)

Question 7

How is LBO managed?

Answer 7

‘Drip & suck’ method:

Supportive: analgesia, IV fluids, anti-emetics
Decompression (sigmoid volvulus - sigmoidoscopy)
Surgery (70%): lap/open colonic resection -> 1ry anastomosis/stoma
PC: stenting (malignancy)