Small Bowel Obstruction - Dr. Robertson

Basics

• Account for approximately 20% of all admissions for acute abdominal pain
• Mortality approaches 5% for non-strangulated obstructions and 30% for strangulated obstructions
• 90% with abd surg get adhesions, 25% will develop SBO

• Causes  to consider = duodenum stenosis, stricture (adhesion, bezoars), gallstone ileus, femoral hernia, parastomal hernia, internal hernia. Also SB volvulus, intussusception (mech in adults)

Type

•    Mechanical closed loop- twisting, increased likelihood of vascular compromise

•    Neurogenic- disturbance in movt, ileus. Panc, metabolic disturb, mess, any bowel inflamm, trauma, infection

•    Pseudo obstruction- decreased motility due to systemic medical condition

Patho

•     Distention, poor absorption, edema--- intraperitoneal sequestration.

•     Closed loops- venous congestion, source of hemorrhage - Risk of strangulation dramatically increased with closed loop obstructions

Presentation

• Intermittent pain, change to constant concern for strangulation (ischemia, perf)
• Constipation OR diarrhea
• Difficult to predict strangulation

Risk factors

• Prior SBO - Greatest risk factor.
  
• Abd surg
• Hernia

Diagnosis

• Labs generally unhelpful, but help with resusc
  
• CT abd specificity = 94, sensitivity = 56  for strangulation

Therapy

• NPO
• IVF
  
• Antibiotics (?) - depending on severity and possibility of going to the OR
• NGT (?) - Need to weigh Risks vs Benefits.
  

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