Small Bowel Obstruction

Question 0

What are the other causes of SBO?

Answer 0

Hernia is second most common cause, followed tumors as third. Other causes include intussusception, bezoar, gallstone ileus, Crohn’s disease, and volvulus

Question 1

What is the most common cause

SBO?

Answer 1

Postoperative adhesions

Question 2

How soon will obstruction manifest?

Answer 2

1/3 of obstructions due to adhesive disease will manifest within 1 year following initial laparotomy

Question 3

What percentage of pts with sbo will need an operation during the first admission?

Answer 3

Approximately 25%. Pts who undergo initial operative management have fewer recurrent obstructive episodes

Question 4

What are the usual symptoms of SBO?

Answer 4

Nausea, vomiting, distention, crampy abdominal pain, decreased flatus and bowel movements.

Question 5

What is initial imaging? And findings?

Answer 5

Abdominal series (upright cxr, flat plate and erect axr). Findings include air-fluid levels, dilated loops of intestine and absence of colonic gas

Question 6

Why is CT scan important in sbo?

Answer 6

Can assess the degree obstruct, elucidate cause, high sensitivity for detecting strangulation and pneumoperitoneum. Also useful for identifying recurrent malignancy and subtle signs of bowel ischemia (wall thickening, free peritoneal fluid or pneumatosis intestinalis).

Question 7

What is the nonoperative management of sbo?

Answer 7

Fluid resuscitation, electrolyte correction, Foley catheter, GI decompression

Question 8

What is the reason for GI decompression in sbo?

Answer 8

Unabated intraluminal distension leads to mucosal ischemia

Question 9

What effect does NGT have on the esophagus?

Answer 9

It renders the lower and upper esophageal sphincters incompetent and increases the risk of aspiration

Question 10

Which pts should have a trial of nonoperative management?

Answer 10

Pts with low grade partial sbo, pts with an early postoperative obstruction following abdominal surgery, pts with multiple prior episodes of bowel obstruction, blunt trauma pts causing sbo

Question 11

How does blunt abdominal trauma cause sbo?

Answer 11

Intramural hematoma (most commonly duodenum involved). Usually resolves in 2-4 weeks, may need surgery if persists past 4 weeks

Question 12

In which pts should surgical management of sbo be considered?

Answer 12

Pts with complete or high grade partial obstruction (less than 20% successfully managed nonoperatively), sbo caused by incarcerated hernia, tumor or Crohn’s disease stricture

Question 13

What percentage of adult pts with intussusception harbor a malignancy as the lead point?

Answer 13

50%

Question 14

What is the management of gallstone ileus?

Answer 14

Perform an enterotomy proximal to the stone and milk the stone retrograde to extract the stone. Also perform a cholecystectomy and repair of the biliary-enteric fistula

Question 15

What maneuvers can be done to ensure bowel viability?

Answer 15

First irrigate with warm saline and keep wound covered for 10 mins. If viability still in question, Doppler or fluorescein with woods lamp can be used

Question 16

Are there absolute contraindications to laparoscopy in sbo?

Answer 16

No. The relative contraindications include massive dilated bowel, multiple prior laparotomies, early postoperative obstruction and obvious peritonitis