Most people think of diverticulitis or cancerous polyps growing inside the intestinal walls, as causing the bowel obstruction. However, Dr. Richard A. Desi, MD, a gastroenterologist at Mercy Medical Center in Baltimore says, “A bowel obstruction is not really anything on the inside of the bowel.” He explains that most commonly, bowel obstruction can twist “the bowel into a funny position, thus closing it or clamping it off.”
They make up 2-4% of emergency department visits annually in the US, and 15% of hospital admissions.
Bowel obstruction is a common surgical presentation. It can be categorised into small and large bowel obstruction, with key implications for management.
Within ten minutes of being jolted awake by severe abdominal cramping, my gastrointestinal system began running itself in reverse in an attempt to alleviate the pressure building up. I lost the last meal I would eat for the next 5 days.
In 90% of cases, small bowel obstruction is caused by adhesions, hernias, and neoplasms. Adhesive small bowel obstruction represents 55–75% of small bowel obstruction cases while hernias and small bowel tumors account for the remainder. Large bowel obstruction is provoked by cancer in about 60% of cases; volvulus and diverticular disease are responsible of other 30%.
Of course there are limitations with this small study. There was a disproportionately high prevalence of SBO in the study population (33 out of 76 patients – 43%), bringing into question its external validity. The doctors performing the US exams volunteered themselves, indicating they were enthusiasts – potentially introducing what the authors describe as ‘ultrasound-interest’ bias.
More than one in 10 (11%) of those having emergency bowel surgery die within 30 days, according to an audit of the treatment received by 21,000 patients at 192 hospitals in England and Wales.
But the death rate is higher than it should be because of the widespread failure of hospitals to ensure that patients whose lives are under threat – from vital organ failure and an obstructed bowel caused by cancer – get the right care before, during and after their operation.
Oh cool, just the nightmare we needed today.
A history of surgeries, hernia, or cancer is important to know about. A doctor’s examination accompanied by blood tests and an x-ray or computed tomography (CT) scan can confirm the diagnosis.
Most obstructions resolve by allowing the small bowel to rest and shrink back to its normal size, thus making the adhesions less problematic. This is accomplished by inserting a nasogastric (NG) tube (a thin plastic tube that goes through a nostril and into the stomach) that suctions fluid from the stomach.
Most of the incidents involve young children, but there was also a rise among older ones, including teens. But why the uptick in magnets being swallowed by teens? Shouldn't they know better?
It turns out they're not gobbling magnets like younger kids. Instead, she says, they're mostly using them to mimic body piercings, like, say, a nose or tongue stud. And while these older kids are out looking cool, sometimes those little round magnets come loose. Next thing you know they're in the stomach or lower. Definitely not cool.
Small bowel obstruction (SBO) is a very common problem for patients; treated by many different types of medical providers, including primary care, emergency medicine, internal medicine, and surgery. In the United States alone, there are an estimated 300,000 laparotomies performed annually for SBO, and about one third of these obstructions are complicated by intestinal ischemia, with significantly higher morbidity and mortality resulting.
About 20% of people admitted to hospital with an acute abdomen (or an abdomen that quickly becomes firm, is tender to touch and painful), have an obstruction of their bowel. Of these 20%, the majority (80%) will have a small bowel obstruction.
The problem causing the blockage can be inside or outside the intestine. Inside the intestine, a tumor or swelling can fill and block the inside passageway of the intestine. Outside the intestine, it is possible for an adjacent organ or area of tissue to pinch, compress or twist a segment of bowel.
Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain medications; or strictures from an inflamed intestine caused by certain conditions, such as Crohn's disease or diverticulitis.
An intestinal obstruction occurs when food or stool cannot move through the intestines. The obstruction can be complete or partial. There are many causes. The most common are adhesions, hernias, cancers, and certain medicines.
A bowel obstruction can either be a mechanical or functional obstruction of the small or large intestines. Obstruction frequently causes abdominal pain, nausea, vomiting, constipation, obstipation, and distention. This activity explains the pathophysiology, classification, evaluation, and management in patients with bowel obstruction. It highlights the role of the interprofessional team in treating and decreasing long term morbidity in patients with bowel obstruction.