small intestinal obstruction
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Etiology
- postoperative adhesion (most common cause)
- hernia: inguinal, femoral, umbilical, ventral or incisional
- neoplasm, most likely extension from an intra-abdominal primary: colon, pancreas, stomach, gynecologic cancer
- intussusception
- volvulus
- gallstones
- foreign body
- trichobezoar
- inflammatory bowel disease
- intestinal helminths
- trauma
- radiation injury
- meconium in newborns
- congenital intrinsic lesions
Clinical manifestations
Laboratory
Radiology
Management
- medical management of partial obstruction
- NG tube decompression may be of no benefit[4]
- IV fluids
- two strategies
- nothing by mouth (76% managed without surgery)[2]
- magnesium oxide to stimulate bowel movement, simethicone to accelerate gas passage, Lactobacillus acidophilus to promote digestion of undigested food in the bowel lumen (91% managed without surgery)[2]
- surgery may lower risk for recurrence with adhesive small bowel obstruction[5]
- early surgery benefits some patients with malignant small bowel obstruction[6]
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 337-38
- ↑ 2.0 2.1 2.2 Chen SC, Yen ZS, Lee CC, Liu YP, Chen WJ, Lai HS, Lin FY, Chen WJ. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ. 2005 Nov 8;173(10):1165-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16275967
- ↑ 3.0 3.1 Millet I et al. Adhesive small-bowel obstruction: Value of CT in identifying findings associated with the effectiveness of nonsurgical treatment. Radiology 2014 Nov; 273:425 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24991990
- ↑ 4.0 4.1 Berman DJ, Ijaz H, Alkhunai M et al. Nasogastric decompression not associated with a reduction in surgery or bowel ischemia for acute small bowel obstruction. Am J Emerg Med 2017 Aug 15 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28912083 <Internet> http://www.ajemjournal.com/article/S0735-6757(17)30676-9/fulltext
- ↑ 5.0 5.1 Behman R, Nathens AB, Mason S et al. Association of surgical intervention for adhesive small bowel obstruction with the risk of recurrence. JAMA Surg 2019 May; 154:413. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30698610 https://jamanetwork.com/journals/jamasurgery/fullarticle/2722649
- ↑ 6.0 6.1 Krouse RS et al. Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): A pragmatic comparative effectiveness trial. Lancet Gastroenterol Hepatol 2023 Oct; 8:908. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37541263 PMCID: PMC10530384 (available on 2024-10-01) https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00191-7/fulltext