What is Surgery – Bowel Obstruction Treatment
Obstruction of the bowel / intesinte DEFINITION
The usual movement of bowel contents is obstructed. Site-specific classification: SBO (small bowel obstruction) or LBO (large bowel obstruction), partial or complete, simple or strangulated
Obstruction of the intestine without vascular compromise (simple obstruction): The intestine distal to the occlusion quickly empties and compresses, while the gut above it dilates with gas and fluid. Distension reduces the blood supply to the intestinal wall, which can lead to mucosal ulcers and bowel perforation.
Strangulated obstruction: The blood supply to the affected segment is disrupted, causing impairment of the normal mucosal barrier, bacterial transudation into the peritoneal cavity, and peritonitis, as well as gangrene and perforation of the unrelieved bowel.
The following are the different types of obstructions: Hernias, adhesions, bands, volvulus, and external compression by a space-occupying lesion are examples of extramural lesions.
Tumors, inflammatory strictures, such as in Crohn's disease or diverticulitis, and intussusception are all examples of intramural conditions.
Intraluminal: Pedunculated tumours, foreign substances such as bezoars and gallstones; infection such as worms and constipation/faecal impaction.
Common. Adhesions, hernias, and cancer are becoming more common among the elderly.
Colicky discomfort that is severe and gripping, with times of relief, in the middle (small intestine) or lower abdomen (large intestine). Distension in the abdomen. Early in SBO or late with faeculent vomiting in distal SBO or LBO, frequent vomiting of greenish bile-stained vomit. Absolute constipation is defined as the inability to pass stool or flatus.
Abdominal distension and discomfort all over. It's possible to see peristalsis. ↑ Bowel sounds (in character, 'tinkling'). Peritonitis has developed, as evidenced by guarding and rebound, and bowel sounds may be lacking. Examine for hernias. Any abdominal scarring increases the risk of adhesions. Examine your abdomen for any abdominal masses (such as intussusception, cancer, a tumour in the Douglas pouch, or faecal impaction).
Lactic acidosis may indicate intestinal ischaemia and imminent perforation in the blood. Microcytic anaemia could be a sign of cancer in the large intestine. Dehydration and electrolyte imbalance caused by vomiting can be treated with urea and electrolytes.
AXR: Assists with blockage diagnosis and localization. SBO is indicated by a central ladder pattern of dilated loops with valvulae conniventes spanning the full breadth of the bowel. This suggests LBO if the inflated gut is more peripheral, with haustrations that do not overlap the intestine breadth. It is possible to see the fluid levels. To exclude perforation, considered erect CXR. In LBO, a water-soluble contrast enema can be used to show the obstruction site. Follow-up with a water-soluble contrast: To determine the degree of impediment. CT scan: Enables pre-operative identification of the source and/or degree of obstruction, as well as management strategy. It could show signs of metastasis or perforation.
General: Resuscitation involves intravenous fluids and electrolyte replacement, insertion of a nasogastric tube, and careful monitoring of vital signs, fluid balance, urine output, and clinical condition For adhesional blockage, gastrografin follow-through may be both therapeutic and diagnostic. The hyperosmotic contrast is hypothesised to ease the blockage by reducing oedema in the gut wall. If the results of the investigation point to a different diagnosis, an early procedure can be planned.
Conservative therapy may resolve an acute obstruction; however, if the obstruction does not resolve or there are indicators of complications, operational intervention should be performed.
Surgical: To treat the reason, a laparotomy or laparoscopy is performed.
Adhesiolysis, band division, or bowel resection +/–stoma may be used.
In small-bowel resection, primary anastomosis, Hartmann's surgery, or hemicolectomy with a defuncting stoma are used.
In large-bowel resection, hemicolectomy with a defunctioning stoma is used. It's possible that post-operative treatment in an HDU or ITU is required.
Endoscopic: Obstructing colonic tumours can be stented endoscopically either before surgery or as a palliative therapy to avoid emergency surgery. Endoscopically, obstruction caused by a sigmoid volvulus can be addressed with a flexible sigmoidoscope or the passage of a flatus tube.
COMPLICATIONS Dehydration, intestinal perforation, peritonitis, toxaemia, and gangrene of the ischemic gut wall are all possible complications.
PROGNOSIS Variable. Dependent on the patients' overall health and the frequency of problems.
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