Intussusception
Sherif Emil in Clinical Pediatric Surgery: A Case-Based Interactive Approach, 2019
Evaluation of a patient with possible intussusception should mimic evaluation of any patient with a presumed bowel obstruction, in addition to focusing on some specific issues particularly pertinent to intussusception. Ultrasound may delineate whether the intussusception is ileocolic or in the small bowel and may demonstrate additional lesions such as a mesenteric mass or a lead point within the intussusceptum, prompting the surgeon to proceed to operative reduction without a radiologic attempt. Laparoscopy has been shown to be effective and safe for reduction of intussusception. It allows for a complete survey of the intestine and abdominal organs but is limited by the inability to palpate the bowel for potential endoluminal lead points. Intussusception is the most common cause of pediatric bowel obstruction, accounting for approximately half of all bowel obstructions in children outside the neonatal period. An intussusception consists of an intussusceptum, which telescopes into an intussuscipiens.
Bowel obstruction
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
Colicky abdominal pain, distension, vomiting, and absolute constipation are the cardinal features of bowel obstruction. The features will vary according to the site of the obstruction and the underlying pathology. Abdominal distension is dependent on the level of the obstruction, and will be greater in distal lesions, particularly of the large bowel. Visible peristalsis may also be present. Adhesions are the commonest cause of obstruction (50–60% of cases). Approximately 5% of all patients undergoing laparotomy will develop symptomatic postoperative adhesions. In simple bowel obstruction there is bowel dilatation proximal to the obstruction, which results in gas and fluid accumulation within the bowel wall and lumen. Localised guarding and rebound tenderness suggest strangulation or perforation of the bowel. The chapter describes the principles of management of bowel obstruction.
Bowel obstruction
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley in Symptom Relief in Palliative Care, 2018
Intravenous hydration and nasogastric suction will fail to control the symptoms of inoperable bowel obstruction in approximately 90% of patients. Medical management will keep the majority of patients free of nausea and pain, achieving a comfortable phase with the option of doing this at home. Recurrent abdominal cancer causes multiple blockages, especially with small bowel blockage in ovarian carcinoma. Absent motility or abnormal bowel motility can cause obstructive symptoms. Dysmotility is common in cancer and can be caused by retroperitoneal disease, antimuscarinic drugs or autonomic failure. Benign adhesions may occur in up to 20% of patients with recurrent abdominal cancer, and are the commonest cause of small bowel obstruction. Nasogastric suction or drainage has a place in feculant or fecal vomiting. Feculant vomiting is not the vomiting of feces, but of small bowel contents colonized by colonic bacteria in obstructions lasting a week or more.
A review of the radiological imaging modalities of non-traumatic small bowel obstruction
Published in South African Family Practice, 2015
Narisha Maharaj, Bhugwan Singh
Small bowel obstruction is a common clinical presentation that presents a diagnostic conundrum. Over the last 2 decades, there has been a paradigm shift in the radiological investigation of small bowel obstruction (SBO) and in the indication for and timing of surgical intervention. Cross-sectional imaging (predominantly computed tomography) has largely replaced the widespread use of radiographic small bowel follow-through studies as the imaging modality of choice for SBO. This article illustrates the current imaging modalities available for diagnosis of small bowel obstruction.
Small Bowel Obstruction in Patients Previously Operated on for Colorectal Cancer
Published in The European Journal of Surgery, 1998
Tom-Harald Edna, Tormod Bjerkeset
Objective: To find out the incidence, aetiology, and outcome of patients operated on for small bowel obstruction after previous operation for colorectal cancer. Design: Retrospective cohort study. Setting: District hospital serving a defined population, Norway. Subjects: 472 consecutive patients operated on for colorectal cancer, followed up for a median of 5.5 years (range 2.0-16.8) or until death; 351 had had a resection with curative intent, and 121 a palliative operation. Main outcome measures: Incidence and aetiology of small bowel obstruction, postoperative mortality, and long term survival. Results: Small bowel obstruction necessitated operation in 36/351 (10%) after resection with curative intent, and in 5/121 (4%) after a palliative operation. The causes of obstruction were benign adhesions (n ≥ 21), local recurrence (n ≥ 17) and peritoneal carcinomatosis (n ≥ 3). One patient died of a myocardial infarction and six of cancer within 30 days of the operation for small bowel obstruction. The estimated median survival after the operation for small bowel benign obstruction was 1.9 years (SE ≥ 0.6) compared with 0.36 years (SE ≥ 0.04) for malignant obstruction (p ≥ 0.0007, logrank test). Late small bowel obstruction by adhesions was associated with higher blood loss during the primary operation (p ≥ 0.02). None of the 62 patients who took thiazide diuretics at the time of the primary operation later developed obstructive adhesions. Conclusion: 41/472 patients (9%) developed small bowel obstruction after the primary operation for colorectal cancer. The aetiology was benign in 21 and malignant in 20 patients. Survival after operation for the obstruction was far better with benign than with malignant obstruction.
Small Bowel Obstruction during Pregnancy
Published in Acta Chirurgica Belgica, 2004
J. Hauspy, N. Roofthooft, P. Meulyzer, P. Leyman
The authors report the case of a 28-year old pregnant woman with abdominal pain and contractions at 37 weeks of gestation. After labour and delivery, abdominal pain persisted and laparoscopy was performed. A bowel obstruction was diagnosed and surgically corrected. The authors discuss the clinical and therapeutic consequences of bowel obstruction during pregnancy.
Related Knowledge Centers
- Cancer
- Duodenum
- Abdominal Distension
- Abdominal Pain
- Vomiting
- Constipation
- Medical Emergency