Overview
Definition
A mechanical blockage of the small intestines preventing the normal transit of its contents.
Epidemiology
A very common surgical admission. The most common cause in developed countries is post-operative adhesions.
Etiology & Risk Factors
- Adhesions (from previous abdominal surgeries - #1 cause)
- Hernias (incarcerated)
- Neoplasms (Tumors)
- Intussusception or Volvulus
Clinical Symptoms
- Colicky (cramping) abdominal pain
- Nausea and bilious (green) vomiting
- Abdominal distension
- Obstipation (absolute inability to pass stool or flatus) - a late sign
Clinical Approach
Diagnosis
- Abdominal X-ray (Initial): Dilated loops of small bowel with air-fluid levels, and a paucity of air in the colon
- CT Abdomen/Pelvis with IV contrast (Gold Standard): Can identify the exact transition point, cause of obstruction, and signs of ischemia (e.g., pneumatosis intestinalis)
Management
- Initial (Conservative): NPO (nothing by mouth), IV fluid resuscitation, Nasogastric (NG) tube decompression
- Surgical (Exploratory Laparotomy): Indicated if there are signs of strangulation/ischemia (fever, tachycardia, severe continuous pain, leukocytosis) or failure to resolve with conservative management after 3-5 days
Complications
- Bowel ischemia and necrosis
- Perforation leading to peritonitis and sepsis
- Severe hypovolemia and electrolyte derangements