Bowel Obstruction (Small and Large)
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Basics
Description
- Obstruction of normal intestinal flow from either mechanical or nonmechanical causes, affecting either the small or large intestine
- Can be classified into small bowel obstruction (SBO), large bowel obstruction (LBO), and nonmechanical or functional causes
- Also classified as either partial, complete, or closed-loop obstruction
- Obstruction leads to proximal dilatation of intestines due to swallowed air and accumulated GI secretions, leading to increased intraluminal pressures and vomiting
- Distended bowel becomes progressively edematous, and additional intestinal secretions cause further distention and third spacing of fluid into the intestinal lumen
- Obstruction may lead to intestinal wall ischemia (strangulated obstruction), resulting in increased aerobic and anaerobic bacteria possibly leading to peritonitis, sepsis, and possibly death
- Closed loop obstruction: Distal and proximal obstruction leading to more rapid increase in intraluminal pressures and arterial/venous congestion making higher risk for bowel infarction
- Mortality is 100% in untreated strangulated obstruction, 8% if treated surgically within 36 hr, but 25% if surgery delayed after 36 hr
Etiology
- SBO:
- 20% of acute surgical admissions
- More common than LBO
- Adhesions: Most common cause (60%)
- Neoplasms
- Hernias
- Strictures: Inflammatory bowel disease
- Trauma: Bowel wall hematoma
- Miscellaneous (e.g., ascaris infection)
- LBO:
- Disease primarily of the elderly
- Carcinoma (60%)
- Diverticular disease (20%)
- Volvulus (5%)
- Colitis (e.g., ischemic, radiation)
- Crohn disease
- Foreign bodies
- Functional, nonmechanical:
- Paralytic ileus (e.g., electrolyte abnormalities, injury)
- Pseudo-obstruction (i.e., Ogilvie syndrome [e.g., operative and nonoperative trauma] 11%)
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Obstruction of normal intestinal flow from either mechanical or nonmechanical causes, affecting either the small or large intestine
- Can be classified into small bowel obstruction (SBO), large bowel obstruction (LBO), and nonmechanical or functional causes
- Also classified as either partial, complete, or closed-loop obstruction
- Obstruction leads to proximal dilatation of intestines due to swallowed air and accumulated GI secretions, leading to increased intraluminal pressures and vomiting
- Distended bowel becomes progressively edematous, and additional intestinal secretions cause further distention and third spacing of fluid into the intestinal lumen
- Obstruction may lead to intestinal wall ischemia (strangulated obstruction), resulting in increased aerobic and anaerobic bacteria possibly leading to peritonitis, sepsis, and possibly death
- Closed loop obstruction: Distal and proximal obstruction leading to more rapid increase in intraluminal pressures and arterial/venous congestion making higher risk for bowel infarction
- Mortality is 100% in untreated strangulated obstruction, 8% if treated surgically within 36 hr, but 25% if surgery delayed after 36 hr
Etiology
- SBO:
- 20% of acute surgical admissions
- More common than LBO
- Adhesions: Most common cause (60%)
- Neoplasms
- Hernias
- Strictures: Inflammatory bowel disease
- Trauma: Bowel wall hematoma
- Miscellaneous (e.g., ascaris infection)
- LBO:
- Disease primarily of the elderly
- Carcinoma (60%)
- Diverticular disease (20%)
- Volvulus (5%)
- Colitis (e.g., ischemic, radiation)
- Crohn disease
- Foreign bodies
- Functional, nonmechanical:
- Paralytic ileus (e.g., electrolyte abnormalities, injury)
- Pseudo-obstruction (i.e., Ogilvie syndrome [e.g., operative and nonoperative trauma] 11%)
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