EM · Bowel obstruction

Bowel obstruction

Also known as Small bowel obstruction · Large bowel obstruction · Intestinal obstruction · Sigmoid volvulus · Closed-loop obstruction · Strangulated bowel

Bowel obstruction — the mechanical blockage of the intestinal lumen, split into the small bowel (the adhesions, the hernia, the malignancy) and the large bowel (the colorectal cancer, the sigmoid volvulus, the diverticular stricture). The colicky abdominal pain, the distension, the vomiting and the constipation or the obstipation; the tinkling bowel sounds early then absent. The plain film shows the dilated loops, the air-fluid levels and the step-ladder pattern of the SBO and the coffee-bean sign of the sigmoid volvulus. The CT defines the transition point, the closed-loop and the ischaemia signs — the bowel wall thickening, the mesenteric oedema, the pneumatosis and the portal venous gas. The management is the NBM, the nasogastric tube for the decompression, the IV fluid resuscitation with the 0.9 per cent saline and the potassium replacement, the surgical referral, and the laparotomy for the strangulation, the perforation or the ischaemia. The morphine 5 mg IV, the ondansetron 4 mg IV and the ceftriaxone 2 g IV for the surgical prophylaxis. ACEM-primary, globally tagged.