انسداد الأمعاء

Definition

Bowel obstruction is failure of passage of food and gas from mechanical blockage or paralytic ileus.

Causes

• Small bowel: post-operative adhesions (most common) and hernias
• Large bowel: colorectal cancer, volvulus and diverticulitis
• Ileus: post-operative, hypokalaemia and opioids

Symptoms

• Colicky pain and distension
• Vomiting (bilious in high obstruction)
• No flatus or stool
• High-pitched bowel sounds early, then silence

Signs of strangulation (emergency)

Constant severe pain, fever, tachycardia and tenderness with rigidity.

Diagnosis

CT scan and electrolytes.

Treatment

• NPO and NG decompression
• IV fluids and potassium replacement
• Surgery for strangulation or failure to improve

Exam point

Continuous gastric suction loses potassium and chloride, so potassium is monitored and replaced.