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    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

    • 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

    • 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

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    TY - ELEC T1 - Bowel Obstruction (Small and Large) ID - 307668 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -