Bowel obstruction surgery: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment for bowel obstruction is surgical. Surgery is specifically indicated for complicated bowel obstruction. Complications include: complete obstruction, closed-loop obstruction, bowel ischemia, necrosis, and perforation. | The mainstay of treatment for bowel obstruction is surgical. [[Surgery]] is specifically indicated for complicated bowel obstruction. Complications include: complete obstruction, closed-loop obstruction, [[bowel ischemia]], [[necrosis]], and [[perforation]]. | ||
==Indications== | ==Indications== | ||
===Indications based upon complicated clinical presentation=== | ===Indications based upon complicated clinical presentation=== | ||
*Fever | *[[Fever]] | ||
*Leukocytosis | *[[Leukocytosis]] | ||
*Tachycardia | *[[Tachycardia]] | ||
*Continuous or worsening abdominal pain | *Continuous or worsening [[abdominal pain]] | ||
*Metabolic acidosis | *[[Metabolic acidosis]] | ||
*Peritonitis | *[[Peritonitis]] | ||
*Systemic inflammatory response syndrome (SIRS) | *[[Systemic inflammatory response syndrome]] ([[SIRS]]) | ||
===Indications based upon image findings=== | ===Indications based upon image findings=== | ||
*Free air on x-ray or CT | *Free air on [[x-ray]] or [[CT]] | ||
**Indicates a perforation | **Indicates a [[perforation]] | ||
*Signs of ischemia. | *Signs of [[ischemia]]. | ||
**Such as pneumatosis intestinalis and portal venous gas | **Such as [[pneumatosis intestinalis]] and [[portal venous gas]] | ||
*Complete or closed loop obstruction | *Complete or closed loop obstruction | ||
**Such as U-shaped or triangular loop, distended and fluid-filled loops, and a pair of collapsed loops near the obstruction site. | **Such as U-shaped or triangular loop, distended and fluid-filled loops, and a pair of collapsed loops near the obstruction site. | ||
*Abnormal route of a mesenteric vessel | *Abnormal route of a [[mesenteric]] [[vessel]] | ||
*Fluid in the peritoneum | *Fluid in the [[peritoneum]] | ||
*Presence of a transition point | *Presence of a transition point | ||
===Indications based on a point system=== | ===Indications based on a point system=== | ||
*A score of more than or equal to 3 indicates surgery, each criterion is allotted one point: | *A score of more than or equal to 3 indicates [[surgery]], each criterion is allotted one point: | ||
**History of pain lasting > 4 days | **History of pain lasting > 4 days | ||
**Guarding on physical examination | **[[Guarding]] on [[physical examination]] | ||
**Elevated CRP above 75 mg/L | **Elevated [[CRP]] above 75 mg/L | ||
**Elevated WBC | **Elevated [[WBC]] | ||
**Presence of free intraabdominal fluid on CT > 500 ml of | **Presence of free intraabdominal fluid on CT > 500 ml of | ||
**Reduced bowel wall contrast enhancement on CT | **Reduced bowel wall [[contrast]] enhancement on [[CT]] | ||
==Surgery== | ==Surgery== | ||
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis. | *The feasibility of [[surgery]] depends on the stage of [malignancy] at diagnosis. | ||
OR | OR | ||
*Surgery is the mainstay of treatment for [disease or malignancy]. | *Surgery is the mainstay of treatment for [disease or malignancy]. | ||
==Contraindications== | ==Contraindications== | ||
Revision as of 22:07, 7 February 2018
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Bowel obstruction Microchapters |
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Bowel obstruction surgery On the Web |
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American Roentgen Ray Society Images of Bowel obstruction surgery |
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Risk calculators and risk factors for Bowel obstruction surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
The mainstay of treatment for bowel obstruction is surgical. Surgery is specifically indicated for complicated bowel obstruction. Complications include: complete obstruction, closed-loop obstruction, bowel ischemia, necrosis, and perforation.
Indications
Indications based upon complicated clinical presentation
- Fever
- Leukocytosis
- Tachycardia
- Continuous or worsening abdominal pain
- Metabolic acidosis
- Peritonitis
- Systemic inflammatory response syndrome (SIRS)
Indications based upon image findings
- Free air on x-ray or CT
- Indicates a perforation
- Signs of ischemia.
- Such as pneumatosis intestinalis and portal venous gas
- Complete or closed loop obstruction
- Such as U-shaped or triangular loop, distended and fluid-filled loops, and a pair of collapsed loops near the obstruction site.
- Abnormal route of a mesenteric vessel
- Fluid in the peritoneum
- Presence of a transition point
Indications based on a point system
- A score of more than or equal to 3 indicates surgery, each criterion is allotted one point:
Surgery
- The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
- Surgery is the mainstay of treatment for [disease or malignancy].
Contraindications
Bowel obstruction in Children
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 may be placed.