S09C86 - Bowel obstruction and volvulus

Question 1

Common causes of bowel obstruction

Answer 1

Duodenum:
-stenosis, FB, stricture, superior mesenteric arteyr syndrome

Small bowel:
-adhesions, hernia, intussusception, lymphoma, stricture

Colon:
-carcinoma, fecal impaction, UC, volvulus, diverticulitis, intussusception, pseudo-obstruction

Question 2

SBO

Answer 2

• most common cause: adhesions
• 2nd most common: incarceration of groin hernia
• blunt abdo trauma can cause a duodenal hematoma

Question 3

LBO

Answer 3

-most common cause: neoplasms
-fecal impaction common cause in elderly
-2nd most common cause: diverticulitis
-3rd most common: sigmoid volvulus
RF for volvulus: elderly, bedridden, psyc pts on anticholinergics, constipation
-higher incidence of cecal volvulus in gravid pts

Question 4

Sigmoid volvulus

Answer 4

coffee bean

Question 5

Cecal volvulus

Answer 5

kidney bean

Question 6

DDX: bowel obstruction and high white count

Answer 6

• perf
• abscess
• necrosis/gangrene
• peritonitis

> 40 = vascular occlusion (mesenteric ischemia)

Question 7

CT for obstruction

Answer 7

-use IV and oral contrast - most ideal

Question 8

Obstruction: Tx

Answer 8

• if true mechanical obstruction–> surgery
• insert NGT for symptom relief if vomiting
• IV fluids ++
• pre-op Abx = piptaz, ampicillin-sulbactam

-if ileus - IV fluids and observation

Question 9

Pseudo-obstruction

Answer 9

ogilvie syndrome

• mimcs bowel obstruction
• often low colonic obstruction with large amounts of gas in large intestine
• AXR: dilated colon with well-defined septa and haustral markings and very little fluid w/o air-fluid levels
• RF: age, anticholinergics, TCA,
• do not give barium
• colonoscopy can identify bowel lesions and provide therapeutic decompression
• tx: neostigmine if conservative means don’t work