Small Bowel Obstruction (SBO)

A small-bowel obstruction happens when the small intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way. The blockage may cause severe pain that comes and goes. (SBO) is caused by a variety of pathologic processes. The leading cause of SBO in industrialized countries is postoperative adhesions (60%), followed by malignancy, Crohn disease, and hernias.

SIGNS & SYMPTOMS

Obstruction can be characterized as either partial or complete versus simple or strangulated. Abdominal pain, often described as crampy and intermittent, is more prevalent in simple obstruction. Usually, pain that occurs for a shorter duration of time and is colicky and accompanied by bilious vomiting may be more proximal. Pain that lasts as long as several days, is progressive in nature, and is accompanied by abdominal distention may be typical of a more distal obstruction.

Some signs and symptoms associated with SBO include the following:

- Nausea. - Vomiting - Associated more with proximal obstructions. - Diarrhea - An early finding. - Constipation - A late finding, as evidenced by the absence of flatus or bowel movements. - Fever and tachycardia - Occur late and may be associated with strangulation. - Previous abdominal or pelvic surgery, previous radiation therapy, or both - May be part of the patient's medical history. - History of malignancy - Particularly ovarian and colonic malignancy.

DIAGNOSIS

Lab Test

The following are adjunctive lab tests used in the evaluation of SBO: - Serum chemistries

- Blood urea nitrogen (BUN) level - Creatinine - Complete blood count (CBC) - Lactate dehydrogenase tests - Urinalysis - Type and crossmatch

Laboratory tests to exclude biliary or hepatic disease are also needed; they include the following: - Phosphate level - Creatine kinase level - Liver panels

Imaging Tests

- Obtain plain radiographs first for patients in whom SBO is suspected. At least 2 views, supine or flat and upright, are required. Plain radiographs are diagnostically more accurate in cases of simple obstruction.

- Enteroclysis is valuable in detecting the presence of obstruction and in differentiating partial from complete blockages. This study is useful when plain radiographic findings are normal in the presence of clinical signs of SBO or when plain radiographic findings are nonspecific.

- Computed tomography (CT) scanning is the study of choice if the patient has fever, tachycardia, localized abdominal pain, and/or leukocytosis.

- Ultrasonography is less costly and invasive than CT scanning and may reliably exclude SBO in as many as 89% of patients; specificity is reportedly 100%.

COMPLICATIONS

- Sepsis - Intra-abdominal abscess - Wound dehiscence

- Aspiration - Short-bowel syndrome (as a result of multiple surgeries) - Death (secondary to delayed treatment)

By: Amir Janah