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Mr Sanjay Purkayastha

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Laparoscopic, General and Bariatric Surgeon

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Bowel obstruction

Bowel (intestinal) obstruction is blockage of free passage of contents at any level of the small and large bowel. Most of the patients have small intestinal obstruction. Significant numbers of colorectal malignancies also present with obstruction.


Causes

There are many factors that lead to obstruction, however, certain conditions cause most of bowel obstruction. Small bowel obstruction is usually caused by adhesions in most cases followed by strangulated hernia, cancer and volvulus. Adhesions are tough fiber bands caused by scarring in the abdomen due to previous operations. Strangulated hernia is the blocked part of bowel devoid of blood supply, which has protruded through weak abdominal wall and got stuck. Volvulus is a condition where bowel abnormally rotates around its axis of attachment and gets short of blood supply.

Large bowel obstruction is often caused by bowel cancer, volvulus, and ileus. The bowel ceases to function temporarily in ileus due to acute medical condition, for example, infection, trauma, post-operation, salt imbalance.

Presentation

The typical clinical symptoms associated with obstruction include nausea, vomiting, dysphagia, abdominal pain and distension, and failure to pass bowel movements. Pain is colicky in nature and intermittent.

If untreated, obstruction of bowel can lead to progressive dilatation of bowel resulting in perforation (hole in the bowel), strangulation (reduced blood supply to bowel) and death of bowel segment. This can leak bowel-contaminated contents inside the abdomen causing fatal spread of infection, widespread pus and infection in blood stream (sepsis). If any of these complications occur, emergency surgery is required.

 

Investigations

Initially, X-rays and blood tests are carried out, followed by a detailed CT scan to find site and cause of obstruction.

Management

A hospital admission is required to manage bowel obstruction. Till the obstruction is resolved, the patient is not allowed to eat or drink. The patient is given fluids, salts, analgesia, and anti-sickness drugs directly through veins with a drip. If the patient is vomiting, a nasogastric tube is inserted through nose into the stomach to drain excess stomach content and relieve sickness. Since patient with obstruction are prone to fluid loss and impact on kidney function, a catheter may be inserted into the bladder to monitor urine output.

In most patients, these initial conservative steps are sufficient to relieve obstruction. If these measures fail, surgery may be required. It may involve resection of affected part of bowel. Treatment of ileus requires resolution of medical condition and does not require surgery. In some cases, like large bowel volvulus, decompression of bowel can be tried by endoscopy, which is telescope insertion through back passage.