Bowel obstruction surgery
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Bowel obstruction Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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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.
Surgery
- Open abdominal surgery is commonly performed in small bowel obstruction.[1][2][3][4][5][6][7][8][9]
- Laparoscopic adhesiolysis is another viable option that has proven to be of lower morbidity, less recovery time, less complications and less risk of wound infection.
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:
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 instances 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.
Bowel obstruction in cancer patients
- Patients with malignancy experience bowel obstruction due to:
- Internal or external compression by a tumor
- Adhesions
- Postradiational fibrosis
- On average, one third of patients have been found to experience bowel obstruction because of benign adhesions, otherwise the obstructions are often inoperable.
- If a cancer patient is in remission then the likelihood of a benign adhesion increases.
- If a cancer patient is not in remission then the likelihood of recurrent cancer increases, meaning that the obstruction is inoperable.
- A cancer patient may undergo a trial of non-operative management if they do not meet the indications for surgery.
Palliative surgery
- Palliative surgery aims to relieve symptoms in those that have an inoperable malignancy.
- Palliative surgeries include bowel resection, or a bypass surgery which includes:
- Enteroenterostomy
- Enterocolostomy
- Colocolostomy
Alternatives to surgery
- Stent:
- A duodenal stent may be placed proximal to a small bowel tumor to relieve an obstruction in those that are not fit for surgery.
References
- ↑ Chen JH, Huang TC, Chang PY, Dai MS, Ho CL, Chen YC, Chao TY, Kao WY (2014). "Malignant bowel obstruction: A retrospective clinical analysis". Mol Clin Oncol. 2 (1): 13–18. doi:10.3892/mco.2013.216. PMC 3915666. PMID 24649301.
- ↑ Butler JA, Cameron BL, Morrow M, Kahng K, Tom J (1991). "Small bowel obstruction in patients with a prior history of cancer". Am. J. Surg. 162 (6): 624–8. PMID 1727026.
- ↑ Tang E, Davis J, Silberman H (1995). "Bowel obstruction in cancer patients". Arch Surg. 130 (8): 832–6, discussion 836–7. PMID 7632142.
- ↑ Dalal KM, Gollub MJ, Miner TJ, Wong WD, Gerdes H, Schattner MA, Jaques DP, Temple LK (2011). "Management of patients with malignant bowel obstruction and stage IV colorectal cancer". J Palliat Med. 14 (7): 822–8. doi:10.1089/jpm.2010.0506. PMID 21595546.
- ↑ Oyasiji T, Angelo S, Kyriakides TC, Helton SW (2010). "Small bowel obstruction: outcome and cost implications of admitting service". Am Surg. 76 (7): 687–91. PMID 20698371.
- ↑ Diaz JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen MM, Mayberry JC, Jerome R (2008). "Guidelines for management of small bowel obstruction". J Trauma. 64 (6): 1651–64. doi:10.1097/TA.0b013e31816f709e. PMID 18545135.
- ↑ Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML (2014). "Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review". JAMA Surg. 149 (4): 383–92. doi:10.1001/jamasurg.2013.4059. PMC 4030748. PMID 24477929.
- ↑ Richards WO, Williams LF (1988). "Obstruction of the large and small intestine". Surg. Clin. North Am. 68 (2): 355–76. PMID 3279551.
- ↑ Ripamonti C, De Conno F, Ventafridda V, Rossi B, Baines MJ (1993). "Management of bowel obstruction in advanced and terminal cancer patients". Ann. Oncol. 4 (1): 15–21. PMID 8435356.