Bowel Obstruction (Small and Large)
- 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
- 20% of acute surgical admissions
- More common than LBO
- Adhesions: Most common cause (60%)
- Strictures: Inflammatory bowel disease
- Trauma: Bowel wall hematoma
- Miscellaneous (e.g., ascaris infection)
- 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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Schaider, Jeffrey J., 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: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_. Accessed June 2, 2023.
Bowel Obstruction (Small and Large). (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307668/all/Bowel_Obstruction__Small_and_Large_
Bowel Obstruction (Small and Large) [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 02]. 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
TY - ELEC T1 - Bowel Obstruction (Small and Large) ID - 307668 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, 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 -