Obstruction

The Three Causes

  • Adhesions (scar tissue from previous surgery causing a kink in the bowel – think watering hose kinking)
  • Hernias
  • Malignancy

 

Signs and Symptoms

  • Increasing abdominal distention and diffuse pain
  • Absolute constipation and lack of flatulence
  • Vomiting

 

Initial management “drip and suck”

  • Nil by mouth
  • IV fluids
  • NG tube on free drainage (to allow stomach contents to freely drain and prevent the need for vomiting)

 

Investigations

  • Abdominal plain film xray
    • Distended loops of bowel
    • Upper limits of normal are: 3 cm small bowel, 6 cm colon, 9 cm caecum
      • Small bowel can be distinguished from large bowel by the presence of valvulae conniventes and haustra.
      • Valvulae conniventes are present in small bowel, and are mucosal folds that form lines that extend the full width of the small bowel.
      • Haustra are like pouches formed by the muscles in the walls of the large bowel, and form lines that do not extend the full width of the bowel.
  • CT scan can confirm diagnosis and cause and guide surgical intervention

 

Surgical Intervention

Correct underlying cause:

  • Exploratory laparotomy in patients with unclear underlying cause
  • Adhesiolysis to treat adhesions (either by laparoscopy / open laparotomy)
  • Repair of hernia
  • Emergency resection of tumour (for example emergency right hemicolectomy for caecal tumour)
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