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    Bowel Obstruction: Abdulqader Taha Almuallim, MBBS General Surgery Resudent

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    Muath
    A 37-year-old man presents with abdominal pain, nausea, and vomiting for 1 day. His symptoms started after dinner and he has woken up 4 times vomiting bilious material. He has not passed flatus or stool. On examination, his abdomen is distended with mild tenderness but no peritonitis. His white blood cell count is elevated. The next step is to perform abdominal x-ray to evaluate for bowel obstruction.

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    Bowel Obstruction: Abdulqader Taha Almuallim, MBBS General Surgery Resudent

    Uploaded by

    Muath
    49 views19 pages
    A 37-year-old man presents with abdominal pain, nausea, and vomiting for 1 day. His symptoms started after dinner and he has woken up 4 times vomiting bilious material. He has not passed flatus or stool. On examination, his abdomen is distended with mild tenderness but no peritonitis. His white blood cell count is elevated. The next step is to perform abdominal x-ray to evaluate for bowel obstruction.

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    Bowel Obstruction

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    A 37-year-old man presents with abdominal pain, nausea, and vomiting for 1 day. His symptoms started after dinner and he has woken up 4 times vomiting bilious material. He has not passed flatus or stool. On examination, his abdomen is distended with mild tenderness but no peritonitis. His white blood cell count is elevated. The next step is to perform abdominal x-ray to evaluate for bowel obstruction.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views19 pages

    Bowel Obstruction: Abdulqader Taha Almuallim, MBBS General Surgery Resudent

    Uploaded by

    Muath
    A 37-year-old man presents with abdominal pain, nausea, and vomiting for 1 day. His symptoms started after dinner and he has woken up 4 times vomiting bilious material. He has not passed flatus or stool. On examination, his abdomen is distended with mild tenderness but no peritonitis. His white blood cell count is elevated. The next step is to perform abdominal x-ray to evaluate for bowel obstruction.

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    Bowel obstruction

    Abdulqader Taha Almuallim, MBBS


    General Surgery Resudent
    Case3:

    37-year-old man presents with 1-day history of abdominal pain, nausea, and
    vomiting. The patient reports that the pain was colicky in nature at the onset
    but has become dull and persistent over the past few hours. He stated that the
    symptoms started shortly after dinner. He wakes up 4 time vomiting large
    amount of bilious material. Since the start of the complaint he did not passed
    flatus or stool. PSHx revealed laparotomy for perforated duodenal ulcer 5-
    years ago.
    Case3:

    O/E:
    V/S: P: 105, T:38.5, BP: 130/84, RR: 28.
    Abdomen is severely distended with mild tenderness throughout, without
    peritonitis, exaggerated bowel sounds, and PR showed empty rectum.
    WBC: 16, the rest of labs are within normal ranges.
    Abdominal X-Ray.
    What is the next step?
    Case3:
    What is the next step?
    INTESTINAL
    OBSTRUCTION
    Intestinal obstruction

    • Can be:
    • Dynamic:
    • Intraluminal: Fecal impaction, Foreign body, Gallstone.
    • Intramural: Stricture, Malignancy, Intussusception,
    Volvulus.
    • Extramural: Bands, adhesions, Hernia.
    • Adynamic:
    • Paralytic ileus, pseudo-obstruction.
    Presentation

    • Cardinal features of bowel obstruction:


    • Abdominal pain.
    • Distension.
    • Vomiting.
    • Absolute constipation.
    • In Large bowel obstruction:
    • The early symptoms is abdominal distension.
    • Vomiting and dehydration are late.
    Other manifestation

    • Dehydration.
    • Hypokalemia.
    • Pyrexia.
    • Abdominal tenderness.
    • High pitched bowel sounds.
    • Scanty or absent bowel sounds.
    Clinical features of strangulation.

    • Constant sever pain.


    • Tenderness with rigidity and peritonism.
    • Shock.
    • If hernia: Irreducible, Change in skin color. No cough impulse.
    Small VS Large bowel obstruction.

    • Small: • Large:
    • Adhesion, neoplasm, • Tumor and Volvulus.
    hernia, crohn’s. • AXR: Dilatation ( >6cm in
    • AXR: Dilatation Lt. colon, >8cm in
    (>3cm) with collapsed transverse colon, >10cm
    large bowel, central, in Rt. colon), no air in
    rectum, peripheral,
    air-fluid level, Plaicae haustration, and can
    cercularis and can not follow.
    follow.
    Small VS Large bowel obstruction.
    Management

    ØAcute intestinal obstruction:


    • NGT.
    • Fluid and electrolyte replacement.
    • Relief of obstruction.
    • Surgical management.
    Management

    ØAdhesive intestinal obstruction:


    • Conservative management:
    • NGT
    • Fluid and electrolyte replacement.
    • Relief of obstruction.
    • Surgical management.
    Management

    ØIndication of early surgical management:


    • Rapidly progressing pain or distention.
    • Peritonitis, Fever, Decrease urine OP, Leukocytosis and
    acidosis.
    • Failure to resolve after 48 hours.
    • Obstructed external hernia.
    • Suspicion of intestinal strangulation.
    • Obstruction in virgin abdomen.
    volvulus
    Management

    ØTreatment of cecal volvulus.


    • Surgery.
    ØTreatment of sigmoid volvulus.
    • Decompression by sigmoidoscopy.
    • Elective sigmoid colectomy.
    MCQs

    A 36-year-old woman who has had open appendectomy 6 years back surgery presents
    with intermittent abdominal distension and pain of 1 week’s duration and persistent
    vomiting for the past 1 day. Her physical examination does not reveal any hernias and is
    consistent with that of distal small bowel obstruction. She is afebrile. Her WBC count is
    4000/mm2. Which of the following is the most appropriate next step?
    a) Attempt nonoperative treatment for 48 hours.
    b) Perform upper gastrointestinal tract endoscopy.
    c) Proceed with an immediate exploration laparotomy.
    d) Obtain a serum carcinoembryonic antigen (CEA).
    e) Perform a CT scan.
    MCQs

    A 36-year-old woman who has had open appendectomy 6 years back surgery presents
    with intermittent abdominal distension and pain of 1 week’s duration and persistent
    vomiting for the past 1 day. Her physical examination does not reveal any hernias and is
    consistent with that of distal small bowel obstruction. She is afebrile. Her WBC count is
    4000/mm2. Which of the following is the most appropriate next step?
    a) Attempt nonoperative treatment for 48 hours.
    b) Perform upper gastrointestinal tract endoscopy.
    c) Proceed with an immediate exploration laparotomy.
    d) Obtain a serum carcinoembryonic antigen (CEA).
    e) Perform a CT scan.
    Abdulqader T. Almuallim
    Mobile: 0505505595
    Email: [email protected]
    Twitter: @ATMuallim

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