![]() ![]() Clinical features may be less severe than in complete bowel obstruction.Partial obstruction of the intestinal lumen, allowing a small amount of air and fluid to pass through.Can be associated with obstipation (complete inability to pass stool or gas).Total obstruction of the intestinal lumen, preventing the passage of air and fluid.The severity and progression of clinical features differ according to the site and severity of the obstruction. The cardinal signs of mechanical bowel obstruction are abdominal pain, vomiting, constipation, abdominal distention, and decreased bowel sounds, regardless of the underlying etiology. ![]() Congenital strictures and bands (e.g., Ladd bands in intestinal malrotation).Intussusception (e.g., secondary to Meckel diverticulum).Congenital intestinal atresia (e.g., duodenal atresia, jejunal atresia).Strictures (e.g., inflammatory bowel disease, congenital strictures).Adhesions (e.g., caused by prior abdominal surgery).Ascariasis (most commonly at the level of the ileocecal valve).May be congenital or acquired as a result of sudden, extreme weight loss.Bowel obstruction due to compression of the third portion of the duodenum, between the aorta and the superior mesenteric artery.Malignant tumors (e.g., colorectal carcinoma): most common cause of LBO.Incarcerated hernias: second most common cause of SBO.Abdominal x-ray shows dilation of several small bowel loops.Etiology: history of abdominal surgery, abdominal tuberculosis.Bowel adhesions : fibrous intraperitoneal strands of connective ( scar ) tissue between organs and tissues that are not usually physiologically connected. ![]() The underlying cause of bowel obstruction should be sought for and managed appropriately. Surgery is indicated for complicated bowel obstruction, closed-loop bowel obstruction, or if there is no clinical improvement following NOM for simple bowel obstruction. A trial of nonoperative management (NOM), which includes bowel rest and supportive care (such as IV fluids, analgesics, antiemetics, and, if needed, antibiotics) can be considered in patients with simple bowel obstruction with no evidence of complications. Laboratory tests are needed to assess severity (e.g., metabolic acidosis and elevated serum lactate suggest bowel ischemia) and identify acid-base and electrolyte imbalances. Typical findings include dilated bowel loops proximal to the obstruction, collapse of bowel loops distal to the obstruction, and multiple air-fluid levels. A diagnosis of bowel obstruction should be confirmed on imaging (e.g., CT abdomen and pelvis). The symptoms of bowel obstruction are typically less severe in partial bowel obstruction than in total bowel obstruction. Bowel distention leads to third-space volume loss, resulting in dehydration and electrolyte abnormalities. Bowel sounds are increased and high-pitched in the early phases of bowel obstruction and decreased or absent in the later stages. Regardless of the cause, bowel obstruction typically manifests with nausea, vomiting, abdominal pain, abdominal distention, and constipation or obstipation. ![]() Postoperative bowel adhesion is the most common cause of SBO and malignancy is the most common cause of LBO. Mechanical bowel obstruction can be classified as either a small bowel obstruction ( SBO) or large bowel obstruction ( LBO) according to its location, and, depending on the extent of the obstruction, as either partial or complete. Mechanical bowel obstruction is the interruption of normal passage through the bowel due to a structural barrier. Functional bowel obstruction, or paralytic ileus, is a temporary disturbance of peristalsis in the absence of mechanical obstruction (see “ Paralytic ileus”). Bowel obstruction refers to the interruption of the normal passage of bowel contents through the bowel, either due to a functional or mechanical obstruction. ![]()
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