Bowel obstruction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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 surgical problem.

Differential Diagnosis of Causes of Bowel Obstruction

By Localization

Small bowel obstruction

• Adhesions from previous abdominal surgery
• Carcinoid rare, preferred location: ileum
• Crohn's disease causing adhesions or inflammatory strictures
• Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects)
• Hernias containing bowel
• Intestinal atresia
• Intussusception in children
• Ischaemic strictures
• Neoplasms, benign or malignant
• Volvulus

• 

  Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.

Large bowel obstruction

Causes of large bowel obstruction include:

• Neoplasms
• Hernias
• Inflammatory bowel disease
• Colonic volvulus (sigmoid, caecal, transverse colon)
• Faecal impaction
• Colon atresia
• Benign strictures (Diverticular Disease)

• 

  Upright abdominal X-ray of a patient with a large bowel obstruction showing multiple air fluid levels and dilated loops of bowel.

By organ system

• Miscellaneous syndromes

• Pseudo-obstruction or Ogilvie's syndrome
• Paralytic Ileus

• Chromosomal abnormalities

• Down syndrome

• Autosomal dominant conditions

• Neurofibromatosis type 1

• Malignant neoplastic conditions

• Carcinoid tumours and carcinoid syndrome
• Colorectal cancer
• Ovarian cancer
• Pseudomyxoma peritonei
• Small bowel lymphoma
• Stomach cancer

• Trauma, mechanical and physical conditions

• Bowel strangulation
• Femoral hernia
• Ileus
• Inguinal hernia
• Intestinal stricture
• Intestinal volvulus
• Intussusception of intestine
• Large bowel obstruction
• Obturator hernia
• Peritoneal adhesions
• Small bowel obstruction

• Infectious disorders

• Intra-abdominal sepsis
• Pneumonia or other systemic illness
• Ascariasis

By mechanism

Mechanical Obstruction

• Adenomatous polyps
• Adhesions
• Adhesive bands
• Annular pancreas
• Ascariades
• Atresia
• Biliary calculus
• Bowel duplication
• Carcinomatosis
• Colon Cancer
• Congenital megacolon
• Crohn's Disease
• Cysts
• Diverticular stricture
• Diverticulitis
• Endometriosis
• Foreign body
• Gallstone ileus
• Hematoma of the bowel wall
• Hernia
• Hirschprung's disease
• Iatrogenic
• Imperforate anus
• Incarcerated hernia
• Inflammatory
• Intrabdominal abscess
• Intrabdominal hematoma
• Invagination, intussisception
• Ischemia
• Malrotation
• Meckel's Diverticulum
• Megacolon
• Multiple polyposis syndromes
• Neoplasm
• Ovarian Cancer
• Pneumatosis intestinalis
• Postoperative
• Pregnancy
• Radiation induced stenosis
• Sarcoma
• Scleroderma
• Surgical anastomosis
• Therapy with dietary fiber
• Trauma
• Tuberculosis
• Ulcerative colitis
• Volvulus

Non-Mechanical Obstruction

• Acid-base imbalance
• Acute pancreatitis
• Anticholinergics
• Antihistamines
• Apoplexy
• Brain tumor
• Cancer
• Catecholamines
• Cholecystolithiasis
• Connective tissue disease
• Diabetic coma
• Empyema
• Hyperparathyroidism
• Hypokalemia
• Lead poisoning
• Lymphoma
• Mechanical ventilation
• Mesenteric infarction
• Morphine
• Narcotics
• Osteomyelitis of the spine
• Ovarian torsion
• Pancreatitis
• Penetrating wounds
• Perinephric abscess
• Peritoneal carcinomatosis
• Peritonitis
• Pneumonia
• Porphyria
• Postoperative
• Psoas abscess
• Pyelonephritis
• Renal colic
• Retroperitoneal hematoma
• Spinal cord inflammation
• Spinal cord injury
• Spinal cord trauma
• Systemic infection
• Testicular torsion
• Ulcer perforation
• Uremia
• Urosepsis
• Vitamin deficiency

Pseudo-Obstruction

• Aerophagia
• Functional bowel disease

Signs, symptoms and causes

Depending on the level of obstruction, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, fecal vomiting, and constipation.

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).

Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischaemia or perforation from prolonged distension or pressure from a foreign body.

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.

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.

Diagnosis

The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass.

• 

  CT demonstrate a cardiac myxoma in the left atrium Image courtesy of RadsWiki and copylefted

• 

  CT demonstrate a cardiac myxoma in the left atrium Image courtesy of RadsWiki and copylefted

• 

  CT demonstrate a cardiac myxoma in the left atrium Image courtesy of RadsWiki and copylefted

• 

  CT demonstrate a cardiac myxoma in the left atrium Image courtesy of RadsWiki and copylefted

• 

  CT demonstrate a cardiac myxoma in the left atrium Image courtesy of RadsWiki and copylefted

• File:==Treatment==
• File:Some causes of bowel obstruction may resolve spontaneously; many require operative treatment.
• File:===Small bowel obstruction===
• File:Treatment for a small bowel obstruction is both non-surgical (conservative) and surgical.
• File:===Bowel obstruction in children===
• File:==Pathological Findings==
• 

  Intestine: Ileus Newborn Cause Unknown: Gross natural color opened body with protruding grossly dilated loops of bowel there was no evidence of necrotizing enteritis

• 

  Intestine: Ileus Newborn Cause Unknown: Gross natural color close-up view of distended gut loops

See also

• Ileus
• Colorectal cancer

de:Darmverschluss it:Ileo (intestinale)