Updated: 5/5/2018

Bowel Obstruction

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Snap Shot
  • A 65-year-old women presents with diffuse abdominal pain and vomiting. She has not had a bowel movement in three days. Physical exam reveals hyperstasis, tympany to percussion, no rebound tenderness, and a temperature of 38 deg C. Abdominal XR reveals distended loops of bowel with a step ladder pattern of differential air-fluid levels.
Introduction
  • Small bowel is more commonly obstructed than the large bowel
    • due to smaller lumen diameter
  • Causes include
    • post-operative adhesions (most common cause of all bowel obstructions)
    • hernias (indirect and femoral)
      • femoral has highest risk of bowel incarceration
    • neoplasms
    • duodenal atresia
      • high association with Down syndrome
      • bile-containing vomitus early after feeding
    • gallstone illeus
      • most commonly seen in elderly women with chronic gallbladder disease
      • formation of a gallbladder-small intestine fistula
        • allows direct passage of a stone into the bowel
      • stone travels through the small intestine and blocks the ileocecal valve
  • Associated conditions
    • Hirchsprung's disease
    • meconium ileus
    • intussusception/volvulus
Presentation
  • Labs show
    • Dehydration
      • Elevated BUN, Hermatocrit, LDH, Creatinine, CK
    • CBC
      • Increased WBC count if bowel obstruction is strangulated
  • Physical exam
    • crampy/colicky abdominal pain
    • lack of flatus
    • constipation
    • nausea/vomiting
    • abdominal distention
    • high pitched "tinkly" bowel sounds
    • tympanetic to percussion
    • tenderness
    • hernias
Evaluation
  • Radiograph
    • dilated loops of small bowel with continuous circular folds
    • ladder like appearance due to air-fluid levels
  • Consider barium enema
 

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