Bowel Obstruction

In developed countries, approximately 50% of all small bowel obstructions are caused by adhesions, 15% by incarcerated or strangulated hernias, and 15% by neoplasms.

Causes

Causes of bowel obstruction include:

• Hernias containing bowel
• Neoplasms , benign
• Foreign bodies (e.g. gallstones in gallstone ileus)
• Intestinal atresia
• Adhesions from previous abdominal surgery
• Inflammatory bowel disease
• Sigmoid or caecal volvulus
• Faecal impaction
• The most common cause of SBO is postsurgical adhesions.
• Postoperative adhesions can be the cause of acute obstruction within 4 weeks of surgery or of chronic obstruction decades later.
• The incidence of SBO parallels the increasing number of laparotomies performed in developing countries.

Symptoms

• Abdominal pain +++++
• Nausea ++++
• Vomiting ++++
• No flatus or stool passage
• Bloating ++++
• Inguinal pain or a bulge or mass in the scrotum if an incarcerated hernia is the cause of the obstruction

Signs

• Abdominal distention ++++
• Abdominal tenderness ++++
• Fever ++
• Tender palpable mass if hernia is present
• Peritonitis if hernia is strangulated

Treatment

Nonsurgical treatments may help relieve symptoms, clear a bowel obstruction. These treatments may include:

• Using enemas of air, barium, or a product such as Gastrografin usually can clear an obstruction that occurs when one part of the intestine folds like a telescope into another part.
• In some cases of obstruction, doctors may place expandable metal tubes called stents in the large or small intestine to help intestinal contents move forward. If you need surgery, a doctor may place stents to help you gain strength before surgery. Stents may also provide an alternative to surgery, allowing you to avoid a colostomy and a colostomy bag .
• Medicines, which can help relieve pain, nausea, and vomiting or help reduce the amount of stomach secretions.