Bowel obstruction surgery

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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:
  • History of pain lasting > 4 days
  • Guarding on physical examination
  • Elevated CRP above 75 mg/L
  • Elevated WBC
  • Presence of free intraabdominal fluid on CT > 500 ml of
  • Reduced bowel wall contrast enhancement on CT

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.

References

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