James Zeng. Bowel Obstruction A blockage of bowel lumen prohibiting the passage of materials[1] 8% of abdo pain in ED (3 rd leading cause)[2] 24% require.

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Presentation transcript:

James Zeng

Bowel Obstruction A blockage of bowel lumen prohibiting the passage of materials[1] 8% of abdo pain in ED (3 rd leading cause)[2] 24% require surgery[3] 300,000 admissions, 800,000 in-pt days, $1.3bil[4]

Causes Extrinsic (extraluminal) Intrinsic (luminal) Intraluminal

Extrinsic Causes Adhesions Hernias Volvulus

Intrinsic Neoplastic Inflammatory Congenital

Intraluminal Faeces Gallstones Intussception Bezoar

Bowel Obstruction Small v. Large Acute v. subacute

Differential Paralytic -ileus Pseudo-obstruction Constipation

Diagnosis Clinical Radiological

Symptoms Pain Distension Obstructive symptoms Vomiting Inability to pass motions/slowing Inability to pass flatus

Past history Past abdominal surgery Past obstructions Hernias Crohn’s Malignancy

Signs Volume status Scars, volume Guarding, peritonitis “Tinkling” bowel sounds, no BS Hernias PR

Investigations Abdo pain bloods Lactate

Radiology (AxR)

Large bowel obs

Radiology (AxR) Size Walls Distal collapse Empty rectum

Radiology (AxR) SmallLarge Central Smaller calibre Valvulae coniventes More loops Long fluid levels Peripheral Larger calibre Haustra 1-2 loops Short fluid levels

Radiology (CT) Inconclusive XR Systemically unwell, local peritonitis Helps to determine cause >2.5cm with distal collapse High accuracy

Conservative Management Fluids NBM Analgesia NG tube

Complications Electrolytes

Specific Management Adhesions - conservative ± gastrograffin Perforation, hernia – urgent theatre Strictures, colitis – surgical resection Sigmoid volvulus – rectal tube Beware of ischaemia – test intraoperatively

Obstruction in Cancer Patients Various opinions Depends on when last operation was Trial of conservative treatment Gastrograffin/CT Consider early resection, stent+resection Non-operative candidates

References Lewis LM et al. Etiology and clinical course of abdominal pain in senior patients: a prospective, multicenter study. Gerontol A Biol Sci Med Sci :8 (1071-6). 3. Foster NM; McGory ML; Zingmond DS; Ko CY. Small bowel obstruction: a population-based appraisal. J Am Coll Surg :2 (170-6). 4. Ray NF; Denton WG; Thamer M; Henderson SC; Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in J Am Coll Surg :1 (1- 9).