Decision Making in Bowel Obstruction: A Review

Abstract

IntRoductIonOver the last 100 years, the anatomical location of Bowel Obstruction (BO) has remained unchanged; however, the aetiological factors in small and large BO have changed significantly. With advance of time more and more elderly patients are presenting with BO [1]. But still, BO continues to be one of the most common surgical emergencies [2] encountered in general surgery units and it continues to be a major cause of morbidity and financial expenditure [3]. Peritoneal adhesions and hernia were the most common causes of BO and contributing 42.3% [4]. All patients of BO are potential candidates for major abdominal surgery with long term morbidity and possible mortality. Hence, the decision of surgery and its timing is vital.Various factors are considered for taking the decision on operative or non-operative management. The factors considered are age of the patients, duration of obstruction, volume of nasogastric aspirate, findings on the radiological imaging, previous abdominal surgeries and malignancy. decision in Small Bowel obstruction (SBo)Clinical presentation of pain, vomiting, distension and constipation, laboratory and radiographic factors should all be considered when making a decision about treatment of BO [5]. One must rule out an abdominal wall hernia as a cause of BO, which is seen in 26.8% of cases in virgin abdomen [4]. Plain radiograph should be an integral part of management of patients with clinical suspicion of BO and gastrointestinal perforation [6] [Table/ Fig-1]. The diagnosis in most cases will be confirmed by further imaging studies such as ultrasound, contrast studies or most commonly in contemporary practice, the Computed Tomography (CT) [7].The CT scan, besides confirming the diagnosis of BO, it gives information on partial or complete obstruction, it location, it also provides specific type like closed loop type and helps in deciding early surgery. Contrast Enhanced Computed Tomography (CECT) give enough information on ischemic bowel and bowel oedema, which requires emergency surgery and luminal gastrograffin helps in relieving the BO [8,9].Surgeons find coronal images more helpful than axial images for management [10]. The radiographic transition zone alone does not increase the likelihood of surgical intervention or identify patients who will fail non-operative management [11]. The four cardinal features -intra peritoneal free fluid, mesenteric oedema, presence of the "small bowel faeces sign" and history of vomiting -are predictive of requiring immediate emergency operative intervention [5]. decision in large bowel obstructionIn Indian scenario, two common types of Large Bowel Obstructions (LBO) are seen. They are: (a) Acute obstruction due to Sigmoid volvulus (SV); and (b) Sub-acute or chronic obstruction due to cancer of colon. In suspected volvulus, plain X-rays may help with diagnosis but MRI is more reliable. However, flexible endoscopy is always diagnostic as well as therapeutic [12]. Once diagnosed flatus tube, hydrostatic enema or colonoscopic reduction attempt is th...

Treatment Outcome of Acute Intussusception in Children Under Two Years of Age: A Prospective Cohort Study

“…Recently, the patients are often hospitalized in an early stage with minimal symptoms, including abdominal pain and vomiting. Thus, the confirmed diagnosis is mainly based on ultrasound findings, and a pediatric surgeon should decide whether to take the infant for an enema pneumatic reduction or close surveillance [10][11]. Besides, choosing an intervention between saline-enema and pneumatic reduction for the treatment of acute intussusception is under debate due to the varied success rate of 83%-88% [12][13][14][15].…”

Bacterial translocation and mortality on rat model of intestinal ischemia and obstruction

“…In humans, enterectomy of damaged intestinal segment followed by anastomosis is recommended as a surgical treatment 11 . Rasslan et al 12 performed enterectomy and anastomosis 24 hours after induction of intestinal ischemia and obstruction in an experimental model.…”

The Clinical Presentations and Patterns of Management of Bowel Obstruction in Northern Saudi Arabia

“…Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management [16].…”

“…Methodology: About 92 files referring to patients presented with obstructive bowel conditions during the period from 2013 to 2017 were retrieved from department of surgery at King Khalid Hospital, Hail, Northern Saudi Arabia. Results: Most of cases of bowel obstruction were found in 2014, followed by 2013, 2016, and 28 of the patients presented with pain, constipation, vomiting, abdominal distention, bowel sound and accompanied disease, respectively. Conclusion: Laparotomy was the most common methods of bowel obstruction management in Northern Saudi Arabia.…”