Surgery

Surgical and Medical Treatment of Small Bowel Obstruction



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A small bowel obstruction is a serious medical condition in which the normal flow of digested food and intestinal secretions is blocked.  The most frequent causes of small bowel obstruction are hernias and adhesions, though tumors and strictures can cause blockage.  The interrupted flow of intestinal contents causes dilation of the stomach and the part of the small intestine prior to the blockage.

Patients with a complete small bowel obstruction frequently require surgical treatment.  In contrast, patients with a partial small bowel obstruction sometimes have resolution of their condition with medical management only, thereby avoiding an operation.  The nonoperative management of partial small bowel obstruction includes placement of a nasogastric tube, making the patient NPO (nothing by mouth), and supplying IV fluids to maintain their fluid status.  

A nasogastric tube is placed in the nose, down the throat and esophagus all the way to the bottom of the stomach.  The tube is then placed on intermittent or continuous low wall suction in order to decompress the stomach and intestines.

Dehydration is one of the main complications in patients presenting with small bowel obstructions due to the vomiting and increased sequestration of intestinal secretions inside the lumen of the bowel.  Intravenous fluids are started and electrolytes levels are checked, including sodium, potassium, magnesium, calcium and chloride.   Electrolytes are replaced intravenously as needed.  Electrolyte management will continue while the patient has the nasogastric (NG) tube suctioning their gastric contents.  

Partial small bowel obstructions that can be managed medically only if small bowel strangulation has been ruled out.  Once medical management has started, the patient must be reassessed frequently to ensure that he or she is not developing any signs of strangulation such as increasing pain, increasing distension, fever and tachycardia, and/or persistently high NG tube output.

Repeat CT scans can be helpful with patients in whom strangulated bowel is suspected.  The CT can detect early signs of ischemic bowel such as:
-Thickening of small bowel and/or mesentery
-Air in the intestinal wall, known as pneumatosis
-Ascitic fluid (free liquid in the abdominal cavity) from transudative loss of fluid through edematous bowel wall

A strangulated bowel is a surgical problem that may require an operation as minimal as removing the obstruction and restoring normal blood flow to the intestine via an incision in the abdomen, or as complex as removing sections of the intestine that have died from lack of nutrient and oxygen-rich blood flow.  

Partial and complete small bowel obstructions are serious medical problems that require prompt medical care.  Individuals with signs and symptoms of small bowel obstructions should seek immediate medical care.

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