Bowel obstruction

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}} Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. It can occur at any level in the digestive tract, and is a medical emergency. Although many cases are not treated surgically, it is a surgicalproblem.

Causes

Small bowel obstruction

Causes of small bowel obstruction include:

• Adhesionsfrom previous abdominal surgery
• Herniascontaining bowel
• Neoplasms, benign or malignant
• Inflammatory bowel diseasecausing adhesions or inflammatory strictures
• Intussusceptionin children
• Volvulus
• Ischaemicstrictures
• Foreign bodies(e.g. gallstonesin gallstone ileus, swallowed objects)

Large bowel obstruction

Causes of large bowel obstruction include:

• Neoplasms
• Hernias
• Inflammatory bowel disease
• Sigmoid or caecal volvulus
• Faecal impaction

Differential diagnosis

Differential diagnosesof bowel obstruction include:

• Ileus
• Pseudo-obstruction, or Ogilvie's syndrome
• Intra-abdominal sepsis
• Pneumoniaor other systemic illness.

Signs, symptoms and causes

Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomitingand constipation.

Obstruction may be due to causes within the bowel lumen, within the wall of the bowel, or external to the bowel (such as compression, entrapment or volvulus).

Bowel obstruction may be complicated by dehydrationand electrolyte abnormalitiesdue to vomiting; respiratory compromise from pressure on the diaphragmby a distended abdomen, or aspirationof vomitus; bowel ischaemiaor perforation from prolonged distension or pressure from a foreign body.

In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.

In large bowel obstruction the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.

Diagnosis

The main diagnostic tools are blood tests, X-raysof the abdomen, CT scanningand/or ultrasound. If a mass is identified, biopsymay determine the nature of the mass.

Radiologicalsigns of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs.

Contrast enemaor small bowel series or CT scancan be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction. Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopyare other diagnostic options.

Treatment

Some causes of bowel obstruction may resolve spontaneously; many require operative treatment.

Treatment, involves insertion of a nasogastric tube(particularly for small bowel obstruction), correction of dehydration and electrolyteabnormalities, and treating the cause of the obstruction. Adhesive obstructions often settle without surgery, but if prolonged may require surgical intervention.

Treatment includes (but not limited to):

• Nasogastric tube(NG tube)
• Laparotomy

External links

• eMedicineemerg/66
• eMedicineemerg/65pl:Niedrożność jelit

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Bowel+obstruction Wikipedia article Bowel obstruction.