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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Bowel obstruction |
| | {{DiseaseDisorder infobox |
| ICD10 = {{ICD10|K|56||k|55}} |
| | | Name = Bowel Obstruction |
| ICD9 = {{ICD9|560}} |
| | | Image = bob2.jpg |
| ICDO = |
| | | Caption = Red arrow denotes intestinal obstruction. Source: commons.wikimedia by Hellerhoff - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=61892130}} |
| Image = Bowel obstruction.jpg |
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| Caption = Bowel obstruction |
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| OMIM = |
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| MedlinePlus = 000260 |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| DiseasesDB = 15838 |
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| }} | |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| | {{Bowel obstruction}} |
| | {{CMG}};{{AE}}{{HM}} |
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| {{SI}} | | {{SK}}Intestinal obstruction; Partial bowel obstruction; Small bowel obstruction. |
| {{CMG}}
| | ==[[Bowel obstruction overview|Overview]]== |
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| ==Overview== | | ==[[Bowel obstruction historical perspective|Historical Perspective]]== |
| '''Bowel obstruction''' is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the [[duodenum]] of the [[small intestine]] and is a [[medical emergency]]. Although many cases are not treated surgically, it is a [[surgery|surgical]] problem.
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| ==Differential Diagnosis of Causes of Bowel Obstruction==
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| ===By Localization=== | | ==[[Bowel obstruction classification|Classification]]== |
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| ====Small bowel obstruction==== | | ==[[Bowel obstruction pathophysiology|Pathophysiology]]== |
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| * [[Adhesion (medicine)|Adhesions]] from previous abdominal surgery
| | ==[[Bowel obstruction causes|Causes]]== |
| * [[Carcinoid]] rare, preferred location: ileum
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| * [[Crohn's disease]] causing adhesions or inflammatory strictures
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| * [[Foreign body|Foreign bodies]] (e.g. [[gallstone]]s in [[Ileus|gallstone ileus]], swallowed objects)
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| * [[Hernia]]s containing bowel
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| * [[Intestinal atresia]]
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| * [[Intussusception (medical disorder)|Intussusception]] in children
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| * [[Ischaemia|Ischaemic]] strictures
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| * [[Neoplasia|Neoplasms]], benign or malignant
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| * [[Volvulus]]
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| <div align="left">
| | ==[[Bowel obstruction differential diagnosis|Differentiating Bowel obstruction from other Diseases]]== |
| <gallery heights="175" widths="175">
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| Image:Bowel Obstrution2008.jpg|Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.
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| </gallery>
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| </div>
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| ====Large bowel obstruction==== | | ==[[Bowel obstruction epidemiology and demographics|Epidemiology and Demographics]]== |
| Causes of [[large bowel]] obstruction include:
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| * [[neoplasia|Neoplasm]]s
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| * [[Hernia]]s
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| * [[Inflammatory bowel disease]]
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| * Colonic [[volvulus]] (sigmoid, caecal, transverse colon)
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| * [[Constipation|Faecal impaction]]
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| * [[Intestinal atresia|Colon atresia]]
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| * Benign strictures (Diverticular Disease)
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| | ==[[Bowel obstruction risk factors|Risk Factors]]== |
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| <div align="left">
| | ==[[Bowel obstruction natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| <gallery heights="175" widths="175">
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| Image:LargeBowelObsUp2008.jpg|Upright abdominal X-ray of a patient with a large bowel obstruction showing multiple air fluid levels and dilated loops of bowel.
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| </gallery>
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| </div>
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| ===By organ system===
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| *Miscellaneous syndromes
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| :* [[Intestinal pseudoobstruction|Pseudo-obstruction]] or [[Ogilvie's syndrome]]
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| :* Paralytic [[Ileus]]
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| *Chromosomal abnormalities
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| :* [[Down syndrome]]
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| *Autosomal dominant conditions
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| :* [[Neurofibromatosis]] type 1
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| *Malignant neoplastic conditions
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| :* [[Carcinoid tumours]] and [[carcinoid syndrome]]
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| :* [[Colorectal cancer]]
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| :* [[Ovarian cancer]]
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| :* [[Pseudomyxoma peritonei]]
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| :* [[Small bowel lymphoma]]
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| :* [[Stomach cancer]]
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| *Trauma, mechanical and physical conditions
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| :* Bowel strangulation
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| :* Femoral [[hernia]]
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| :* [[Ileus]]
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| :* Inguinal [[hernia]]
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| :* Intestinal stricture
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| :* Intestinal [[volvulus]]
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| :* [[Intussusception]] of intestine
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| :* Large bowel obstruction
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| :* Obturator [[hernia]]
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| :* Peritoneal [[adhesions]]
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| :* Small bowel obstruction
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| *Infectious disorders
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| :* Intra-abdominal [[sepsis]]
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| :* [[Pneumonia]] or other systemic illness
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| :* [[Ascariasis]]
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| ===By mechanism===
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| ==== Mechanical Obstruction ====
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| * Adenomatous polyps
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| * Adhesions
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| * Adhesive bands
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| * Annular [[pancreas]]
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| * Ascariades
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| * [[Atresia]]
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| * Biliary calculus
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| * Bowel duplication
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| * [[Carcinomatosis]]
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| * [[Colon Cancer]]
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| * Congenital [[megacolon]]
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| * [[Crohn's Disease]]
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| * Cysts
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| * Diverticular stricture
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| * [[Diverticulitis]]
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| * [[Endometriosis]]
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| * Foreign body
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| * [[Gallstone]] ileus
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| * Hematoma of the bowel wall
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| * [[Hernia]]
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| * Hirschprung's disease
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| * Iatrogenic
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| * Imperforate anus
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| * Incarcerated hernia
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| * Inflammatory
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| * Intrabdominal abscess
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| * Intrabdominal hematoma
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| * Invagination, intussisception
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| * [[Ischemia]]
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| * Malrotation
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| * [[Meckel's Diverticulum]]
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| * Megacolon
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| * Multiple polyposis syndromes
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| * Neoplasm
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| * [[Ovarian Cancer]]
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| * Pneumatosis intestinalis
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| * Postoperative
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| * [[Pregnancy]]
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| * [[Radiation]] induced stenosis
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| * [[Sarcoma]]
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| * [[Scleroderma]]
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| * Surgical anastomosis
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| * Therapy with dietary fiber
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| * [[Trauma]]
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| * [[Tuberculosis]]
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| * [[Ulcerative colitis]]
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| * [[Volvulus]]
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| ==== Non-Mechanical Obstruction ====
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| * Acid-base imbalance
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| * Acute [[pancreatitis]]
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| * Anticholinergics
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| * Antihistamines
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| * Apoplexy
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| * [[Brain tumor]]
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| * [[Cancer]]
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| * [[Catecholamines]]
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| * [[Cholecystolithiasis]]
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| * Connective tissue disease
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| * Diabetic [[coma]]
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| * [[Empyema]]
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| * [[Hyperparathyroidism]]
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| * [[Hypokalemia]]
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| * [[Lead poisoning]]
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| * [[Lymphoma]]
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| * [[Mechanical ventilation]]
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| * [[Mesenteric infarction]]
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| * [[Morphine]]
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| * Narcotics
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| * [[Osteomyelitis]] of the spine
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| * [[Ovarian torsion]]
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| * [[Pancreatitis]]
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| * Penetrating wounds
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| * Perinephric [[abscess]]
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| * Peritoneal [[carcinomatosis]]
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| * [[Peritonitis]]
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| * [[Pneumonia]]
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| * [[Porphyria]]
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| * Postoperative
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| * Psoas [[abscess]]
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| * [[Pyelonephritis]]
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| * [[Renal colic]]
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| * [[Retroperitoneal hematoma]]
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| * Spinal cord inflammation
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| * Spinal cord injury
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| * Spinal cord trauma
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| * Systemic [[infection]]
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| * [[Testicular torsion]]
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| * Ulcer perforation
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| * [[Uremia]]
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| * Uro[[sepsis]]
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| * Vitamin deficiency
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| ==== Pseudo-Obstruction ====
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| * Aerophagia
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| * Functional bowel disease
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| ==Signs, symptoms and causes==
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| Depending on the level of obstruction, bowel obstruction can present with [[abdominal pain]], [[abdominal distension]], [[vomiting]], [[fecal vomiting]], and [[constipation]].
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| Obstruction may be due to causes within the bowel lumen, within the wall of the bowel, or external to the bowel (such as compression, entrapment or [[volvulus]]).
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| Bowel obstruction may be complicated by [[dehydration]] and [[Electrolyte disturbance|electrolyte abnormalities]] due to vomiting; respiratory compromise from pressure on the [[diaphragm (anatomy)|diaphragm]] by a distended abdomen, or [[aspiration]] of vomitus; bowel [[ischaemia]] or perforation from prolonged distension or pressure from a foreign body.
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| In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.
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| In large bowel obstruction the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.
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| ==Diagnosis== | | ==Diagnosis== |
| The main diagnostic tools are [[blood test]]s, [[X-ray]]s of the abdomen, [[Computed axial tomography|CT scanning]] and/or [[medical ultrasonography|ultrasound]]. If a mass is identified, [[biopsy]] may determine the nature of the mass.
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Small bowel obstruction 001.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Small bowel obstruction 002.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Small bowel obstruction 003.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Small bowel obstruction 004.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
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| Image:Small bowel obstruction 005.jpg|Small bowel obstruction <small>Image courtesy of RadsWiki and copylefted</small>
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| </gallery>
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| </div>
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| [[Radiology|Radiological]] signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal [[Radiography|radiographs]].
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| Contrast enema or small bowel series or [[CT scan]] can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.
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| According to a [[meta-analysis]] of prospective studies by the [[Cochrane Collaboration]], the appearance of water-soluble contrast in the cecum on an abdominal radiograph within 24 hours of oral administration predicts resolution of an adhesive small bowel obstruction with a pooled [[sensitivity (tests)|sensitivity]] of 96% and [[specificity (tests)|specificity]] of 96%. PMID 15674958
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| [[Colonoscopy]], small bowel investigation with ingested camera or push [[endoscopy]], and [[laparoscopy]] are other diagnostic options. | | [[Bowel obstruction history and symptoms|History and Symptoms]] | [[Bowel obstruction physical examination|Physical Examination]] | [[Bowel obstruction laboratory findings|Laboratory Findings]] | [[Bowel obstruction electrocardiogram|Electrocardiogram]] | [[Bowel obstruction x ray|X Ray]] | [[Bowel obstruction here CT|CT]] | [[Bowel obstruction MRI|MRI]] | [[Bowel obstruction echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Bowel obstruction other imaging findings|Other Imaging Findings]] | [[Bowel obstruction other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Some causes of bowel obstruction may resolve spontaneously; many require operative treatment.
| | [[Bowel obstruction medical therapy|Medical Therapy]] | [[Bowel obstruction surgery|Surgery]] | [[Bowel obstruction primary prevention|Primary Prevention]] | [[Bowel obstruction secondary prevention|Secondary Prevention]] | [[Bowel obstruction cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Bowel obstruction future or investigational therapies|Future or Investigational Therapies]] |
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| In adults, frequently the surgical intervention and the treatment of the causative lesion are required. In malignant large bowel obstruction, endoscopically placed self-expanding metal [[stents]] may be used to temporarily relieve the obstruction as a bridge to surgery, or as palliation.
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| ===Small bowel obstruction===
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| In the management of small bowel obstructions it is often said that "[n]ever let the sun rise or set on small-bowel obstruction"<ref>{{cite journal |author=Maglinte DD, Kelvin FM, Rowe MG, Bender GN, Rouch DM |title=Small-bowel obstruction: optimizing radiologic investigation and nonsurgical management |journal=Radiology |volume=218 |issue=1 |pages=39-46 |year=2001 |pmid=11152777 |doi=}}[radiology.rsnajnls.org/cgi/reprint/218/1/39.pdf Free Full Text]. Accessed on: July 19, 2007.</ref> because they are sometimes fatal if treatment is delayed.
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| Treatment for a small bowel obstruction is both non-surgical (conservative) and surgical.
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| Conservative treatment involves insertion of a [[Nasogastric intubation|nasogastric tube]], correction of dehydration and [[electrolyte]] abnormalities. [[Opioid]] pain relievers may be used for patients with severe pain. [[Antiemetic]]s may be administered if the patient is vomiting. Adhesive obstructions often settle without surgery. If obstruction is complete a surgery is required.
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| Small bowel obstruction caused by [[Crohn's disease]], peritoneal [[carcinomatosis]], sclerosing [[peritonitis]], [[Radiation enteropathy|radiation enteritis]] and postpartum bowel obstruction are typically treated conservatively, i.e. without surgery. Conversely, a small bowel obstruction in a "virgin abdomen" (an abdomen that has not seen an operation) is almost never treated conservatively.
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| ===Bowel obstruction in children===
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| Fetal and neonatal bowel obstructions are often caused by an [[intestinal atresia]] where there is a narrowing or absence of a part of the intestine. These atresias are often discovered before birth via a [[sonogram]] and treated with using [[laparotomy]] after birth. If the area affected is small then the surgeon may be able to remove the damaged portion and join the intestine back together. In instantances where the narrowing is longer, or the area is damaged and cannot be used for a period of time, a temporary [[stoma (medicine)|stoma]] may be placed.
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| ==Pathological Findings==
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| [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Bowel obstruction 1.jpg|Intestine: Ileus Newborn Cause Unknown: Gross natural color opened body with protruding grossly dilated loops of bowel there was no evidence of necrotizing enteritis
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| Image:Bowel obstruction 2.jpg|Intestine: Ileus Newborn Cause Unknown: Gross natural color close-up view of distended gut loops
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| </gallery>
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| </div>
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| ==References== | | ==Case Studies== |
| <references/>
| | [[Bowel obstruction case study one|Case #1]] |
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| ==See also== | | ==Related Chapters== |
| *[[Ileus]] | | *[[Ileus]] |
| *[[Colorectal cancer]] | | *[[Colorectal cancer]] |
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Signs and symptoms]] | | [[Category:Disease]] |
| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
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