Small bowel obstruction

Question 1

How common is it?

Answer 1

.

Question 2

What causes it?

Answer 2

The most common cause of small-bowel obstruction (SBO) in developed countries is intra-abdominal adhesions, accounting for approximately 65% to 75% of cases.
Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later.

Question 3

What risk factors are there (and how can they be reduced)?

Answer 3

• previous abdominal or pelvic surgery
• previous radiation therapy
• history of malignancy: particularly ovarian and colonic malignancy
• inflammatory bowel disease.

Question 4

What signs may the patient have on examination?

Answer 4

Abdominal distension
Hyperactive bowel sounds
Gross/occult faecal blood on PR
Abdominal masses
Fever 
Tachycardia
Peritonism (guarding, rigid abdomen, rebound tenderness, pain out of proportion to the examination)

Question 5

Which other conditions might present similarly?

Answer 5

Acute Cholangitis
Acute Cholecystitis and Biliary Colic
Alcoholic Ketoacidosis
Constipation
Diverticulitis
Dysmenorrhea
Early Pregnancy Loss
Endometriosis
Gallstones (Cholelithiasis)
Inflammatory Bowel Disease
Mesenteric Ischemia Imaging

Question 6

How would you investigate this patient?

Answer 6

FBC
Urinalysis
U&Es
Abdo X-ray
Abdo CT

Question 7

what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

Answer 7

• In the absence of signs of strangulation and a history of persistent vomiting or combined computed tomography (CT) scan signs, patients with partial ASBO can be safely managed with nonoperative management; tube decompression should be attempted
• Nonoperative management can be prolonged for up to 72 hours in the absence of signs of strangulation or peritonitis; surgery is recommended after 72 hours of nonoperative management without resolution
• Open surgery is frequently used for patients with strangulating ASBO and after failed conservative management; in appropriate patients, a laparoscopic approach using an open access technique is recommended

Question 8

what treatment/s (surgical, pharmacological and non-pharmacological) would you discuss with
them? What risks and benefits of treatment are there?

Answer 8

.