Small bowel obstruction Flashcards
How common is it?
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What causes it?
The most common cause of small-bowel obstruction (SBO) in developed countries is intra-abdominal adhesions, accounting for approximately 65% to 75% of cases.
Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later.
What risk factors are there (and how can they be reduced)?
- previous abdominal or pelvic surgery
- previous radiation therapy
- history of malignancy: particularly ovarian and colonic malignancy
- inflammatory bowel disease.
What signs may the patient have on examination?
Abdominal distension Hyperactive bowel sounds Gross/occult faecal blood on PR Abdominal masses Fever Tachycardia Peritonism (guarding, rigid abdomen, rebound tenderness, pain out of proportion to the examination)
Which other conditions might present similarly?
Acute Cholangitis Acute Cholecystitis and Biliary Colic Alcoholic Ketoacidosis Constipation Diverticulitis Dysmenorrhea Early Pregnancy Loss Endometriosis Gallstones (Cholelithiasis) Inflammatory Bowel Disease Mesenteric Ischemia Imaging
How would you investigate this patient?
FBC Urinalysis U&Es Abdo X-ray Abdo CT
what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?
- In the absence of signs of strangulation and a history of persistent vomiting or combined computed tomography (CT) scan signs, patients with partial ASBO can be safely managed with nonoperative management; tube decompression should be attempted
- Nonoperative management can be prolonged for up to 72 hours in the absence of signs of strangulation or peritonitis; surgery is recommended after 72 hours of nonoperative management without resolution
- Open surgery is frequently used for patients with strangulating ASBO and after failed conservative management; in appropriate patients, a laparoscopic approach using an open access technique is recommended
what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?
.