Bowel Obstruction (Small and Large)
Bowel Obstruction (Small and Large) is a topic covered in the 5-Minute Emergency Consult.
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Basics
Description
Description
- Obstruction of normal intestinal flow from mechanical or nonmechanical causes
- Small-bowel obstruction (SBO):
- 20% of acute surgical admissions
- Adhesions: Most common cause (60%)
- Neoplasms
- Hernias
- Strictures: Inflammatory bowel disease
- Trauma: Bowel wall hematoma
- Miscellaneous (e.g., ascaris infection)
- Large-bowel obstruction (LBO):
- Disease primarily of the elderly
- Carcinoma (60%)
- Diverticular disease (20%)
- Volvulus (5%)
- Colitis (e.g., ischemic, radiation)
- Crohn's 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%)
Etiology
Etiology
- Obstruction leads to proximal dilatation of intestines due to swallowed air and accumulated GI secretions, leading to increased intraluminal pressures.
- Retrograde peristalsis causes vomiting.
- Distended bowel becomes progressively edematous, and additional intestinal secretions cause further distention and 3rd spacing of fluid into the intestinal lumen.
- Obstruction may lead to intestinal wall ischemia (strangulated obstruction), resulting in increased aerobic and anaerobic bacteria, and methane and hydrogen production. Peritonitis, sepsis, and death may follow.
- Mortality is 100% in untreated strangulated obstruction, 8% if treated surgically within 36 hr, but 25% if surgery delayed after 36 hr.
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Citation
Rosen, Peter, et al., editors. "Bowel Obstruction (Small and Large)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_.
Bowel Obstruction (Small and Large). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_. Accessed December 9, 2019.
Bowel Obstruction (Small and Large). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_
Bowel Obstruction (Small and Large) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_.
* Article titles in AMA citation format should be in sentence-case
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