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intestinal obstruction

Clinical manifestations: 1) abdominal pain a) cramping, localized or diffuse b) constant pain suggests strangulation 2) nausea/vomiting 3) obstipation: feces distal to the obstruction may still pass 4) bloat 5) abdominal distension 6) bowel sounds may be high-pitched or absent 7) lower GI bleeding 8) fever suggests strangulation or perforation 9) dehydration may accompany obstruction Laboratory: - blood work generally of no value Radiology: 1) plain abdominal radiograph (KUB) supine & upright a) dilated loops of bowel b) air-fluid levels c) gas is usually absent distal to the obstruction d) double-bubble sign: distended stomach & proximal duodenum [2] e) free air under the diaphragm indicates bowel perforation 2) CT of abdomen (first line in patients with ovarian cancer) - more sensitive & specific than plain radiograph [4] 3) barium or Gastrografin (water soluble) enema - water soluble agents are safer if perforation occurs Differential diagnosis: 1) large vs small bowel obstruction a) symptoms of small bowel obstruction are slower to develop b) abdominal films show dilated colon in large bowel obstruction 2) paralytic ileus a) pain is generally constant & mild b) abdominal distension c) radiographs show gas in both small & large bowel 3) pseudo-obstruction 4) mesenteric ischemia Management: 1) nasogastric tube decompression 2) intravenous fluids 3) surgical consultation 4) broad-spectrum antibiotic coverage a) gram-negative bacteria b) gram-positive bacteria c) anaerobes 5) avoid cathartics or stimulants to GI motility 6) nothing by mouth (NPO) - parenteral nutrition for surgical candidates with complete or partial bowel obstruction [3] 7) palliative care - see management of bowel obstruction without a tube

Related

ileus intestinal pseudo-obstruction management of bowel obstruction without a tube obstipation

Specific

colon obstruction fecal impactation intussusception peritoneal band; Ladd's band small intestinal obstruction volvulus

General

intestinal disease

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 337-38
  2. Correia-Pinto J and Ribeiro A Congenital Duodenal Obstruction and Double-Bubble Sign. N Engl J Med 2014; 371:e16. September 11, 2014 PMID: 25207787 http://www.nejm.org/doi/full/10.1056/NEJMicm1313374
  3. NEJM Knowledge+
  4. Mooney SJ, Winner M, Hershman DL et al Bowel obstruction in elderly ovarian cancer patients: a population-based study. Gynecol Oncol. 2013 Apr;129(1):107-12. PMID: 23274561 PMCID: PMC3731031 Free PMC article.