The Three Causes
- Adhesions (scar tissue from previous surgery causing a kink in the bowel – think watering hose kinking)
Signs and Symptoms
- Increasing abdominal distention and diffuse pain
- Absolute constipation and lack of flatulence
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)
- 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
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)