S.Bowel Obstruction

Question 1

Definition

Answer 1

Mechanical disruption in the patency of the GI tract resulting in a combination of emesis, obstipation & abdo pain

Question 2

Prevalence & patient demographics

Answer 2

Up to 60% in surgical patients, uncommon in no n-surgical patients, 25% Crohn’s

Question 3

Causes

Answer 3

Previous surgery (formation of intra-abdo adhesions-COMMONEST!!
Inguinal hernia w/incarceration, ventral, incisional, umbilical, parastomal
Crohn’s
Intestinal malignancy
Appendicitis

Question 4

Risk factors

Answer 4

Crohn’s
Hernia
Prev abdo surgery
Malrotation
Appendicitis
Intestinal Ca
Volvulus
Intussusception
Intenstinal atresia
Foreign body ingestion

Question 5

Clinical presentation & signs

Answer 5

Failure to pass stool or flatus, abdo pain, vomiting, obstipation, fever, nausea, severe lethargy
Peritonitis, abdo tenderness & distension, palpable abdo/rectal mass, tachycardia, hypoT

Question 6

Differentials

Answer 6

Ileus
Infectious gastroenteritis
L. Bowel obstruction
Appendicitis
Intestinal pseudo-obstruction
Pancreatitis

Question 7

Investigations

Answer 7

Abdo X-ray: Air-fluid levels, dilated intestinal loops, absence of gas in the rectum, pneumoperitoneum
Bloods: FBC, urea, electrolyte panel,
Consider: Abdo CT/USS/MRI, laparotomy, maparoscopy

Question 8

Management

Answer 8

ACUTE: Emergency laparotomy plus fluid resus, pre-op Abx prophylaxis, analgesics
SURGERY CI: Fluid resus, nasogastric decompression, antispasmodics, anti-emetics

Question 9

Prognosis

Answer 9

Universally fatal if untreated

Question 10

Complications

Answer 10

Intestinal necrosis/ischaemia, perforation, sepsis, multi-organ failure