Bowel obstruction

Last Updated on by FRCEM Intermediate

Symptoms

  • colicky abdominal pain
  • abdominal distension
  • Nausea Vomiting
  • intolerant of enteral feeding
  • constipation
  • absent bowel sounds

Causes for Bowel Obstruction

Large Bowel Obstruction

  • Tumor (usually sigmoid carcinoma)
  • Volvulus (sigmoid, cecal)
  • Fecal impaction
  • Benign stricture (e.g. post-operative, inflammatory bowel disease)
  • Abscess

Causes for Small Bowel Obstruction

  • Adhesions (postoperative)
  • intussusception(paediatric group)
  • Hernias (external)
  • Malignancy (peritoneal)
  • Crohn disease

Functional causes

  • Hypokalaemia
  • Hyponatremia
  • Hypothermia
  • Hypoxia
  • Diabetic ketoacidosis
  • Uraemia
  • Drugs (eg anticholinergics)
  • General anesthesia
  • Dehydration
  • Sepsis (acute pancreatits)
  • Trauma (head injury, spinal injury, pelvic surgery)
  • Intra-abdominal infection / peritonitis
  • Postoperative (ileus)

Investigations

  • Blood tests FBC, U+Es, LFTs, glucose, amylase, group and save. Clotting screen if septic or on anticoagulants
  • Plain film x-ray erect chest x-ray and supine abdominal x-ray
  • ECG
  • ABG if signs of sepsis or strangulated bowel
  • Urinalysis

Specific Imaging

  • CT
  • Small bowel follow-through
  • Water-soluble contrast enema

X-ray Finding

Small Bowel

  • dilated bowel loops that are central (>3cm in diameter)
  • the valvulae conniventes

Large bowel

  • dilated bowel loops that are peripheral(dilatation to 6cm)
  • contain haustra and contain faeces.

Management in ED

  • Insert an IV cannula taking and send blood for FBC, U+Es, LFTs, Lactate, glucose, amylase, group and save
  • Start an IV 1l of 0.9% Saline
  • O2 and fluid resuscitation if the patient is haemodynamically unstable
  • Move the patient to an appropriate area of the department and involve an ED senior in their management
  • Titrate IV analgesia with an antiemetic
  • Insert a naso-gastric tube and declare the patient nil by mouth (NBM)
  • Insert a urinary catheter
  • REFER TO THE SURGICAL TEAM

Treatment

  • decompressionn using a colonoscopy

Complications

  • Perforation
  • Bowel ischaemia
  • Peritonitis
  • Sepsis
  • Intra-abdominal abscess
  • Fluid and electrolyte imbalance

More Reading
https://www.radiologymasterclass.co.uk/gallery/abdo/abdominal_xray/normal

Abdominal X-ray and CT

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