Intestinal obstruction March 2018 | by EMauthor Bowel obstruction is mechanical or functional obstruction of the gastrointestinal tract. Classic symptoms are abdominal pain, distension, vomiting, and absolute constipation. The exact nature of the symptoms depends upon the cause and site of obstruction. Abdominal X-ray — this is one of the few acute abdominal presentations where an abdominal X-ray may be helpful. Films are initially performed supine but may be repeated erect if the film is inconclusive-looking for evidence of multiple fluid levels in the bowel. •Small bowel obstruction: dilated loops of small bowel are seen centrally. The valvulae conniventes should be visible across the whole width of the dilated bowel wall. Small bowel loops greater than 3 cm in diameter are abnormal. The sensitivity of an abdominal X-ray for small bowel obstruction is approximately 70 % . •Large bowel obstruction: peripheral, loops of bowel greater than 5 cm suggest large-bowel obstruction. The haustra do not cross the full diameter of the bowel. Unless the ileocaecal valve is incompetent the dilatation should not extend into the small bowel. Sensitivity approximately 90 % . •Functional bowel obstruction: typically air is seen in both the small and large bowel. There is no evidence of a ‘cut-off ’ as it is bowel peristalsis, not obstruction that is the problem. •Volvulus: a sigmoid volvulus results in an extremely dilated single loop of sigmoid colon on the left side with both ends down in the pelvis. In a caecal volvulus the caecum is displaced to the left-upper quadrant and is seen as one large, dilated loop. Key point: plain abdominal radiography has a poor negative predictive value for intestinal obstruction. In particular, one study showed that AXR has only a 35% NPV for SBO, so if there is any suspicion, a surgical consultation is required for a period of admission and observation. ED MANAGEMENT •Fluid resuscitation. •Intravenous analgesia and anti-emetic. •Nasogastric tube •Surgical referral for further management, either conservative or surgical |
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