Evaluation and management of small-bowel obstruction

Maung, Adrian A.; Johnson, Dirk C.; Piper, Greta L.; Barbosa, Ronald R.; Rowell, Susan; Bokhari, Faran; Collins, Jay; Gordon, Joseph R.; H., Jin; Kerwin, Andrew J.

doi:10.1097/ta.0b013e31827019de

Cited by 215 publications

(104 citation statements)

References 129 publications

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“…Pyrexia is often an ominous sign heralding mucosal ischemia and sepsis. Attention is directed in the medical history on prior abdominal surgeries, indications for the prior abdominal surgeries, prior SBO, its treatment, prior abdominal radiation, and narcotic use [3,32].…”

Section: Clinical Presentationmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

167

111

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SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

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Section: Clinical Presentationmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

167

111

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“…In the early stages of the disease, the diagnosis remains a challenge as signs and symptoms overlap with other entities. 1 Plain radiography, although traditionally recommended as the initial diagnostic imaging modality of choice, 2 has a sensitivity of only 59 to 77%. 2,3 When clinical and radiographic assessment is indeterminate, computed tomography (CT) becomes the test of choice due to its superior resolution and increased ability to identify both obstruction and its etiology.…”

mentioning

confidence: 99%

“…1 Plain radiography, although traditionally recommended as the initial diagnostic imaging modality of choice, 2 has a sensitivity of only 59 to 77%. 2,3 When clinical and radiographic assessment is indeterminate, computed tomography (CT) becomes the test of choice due to its superior resolution and increased ability to identify both obstruction and its etiology. 2 However CT scanning is expensive, confers long-term risks associated with radiation, and is not available 24 hours a day at many centres.…”

mentioning

confidence: 99%

“…2,3 When clinical and radiographic assessment is indeterminate, computed tomography (CT) becomes the test of choice due to its superior resolution and increased ability to identify both obstruction and its etiology. 2 However CT scanning is expensive, confers long-term risks associated with radiation, and is not available 24 hours a day at many centres. In recent years, point-of-care ultrasonography (POCUS) has been described as a potential imaging modality for the diagnosis of SBO.…”

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confidence: 99%

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Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department

Guttman

Stone

Kimberly

et al. 2015

CJEM

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Small bowel obstruction (SBO) is a common cause of acute abdominal pain presenting to the emergency department (ED). Although the literature is limited, point-of-care ultrasonography (POCUS) has been found to have superior diagnostic accuracy for SBO compared to plain radiography; however, it is rarely used in North America for this. We present the case of a middle-aged man who presented with abdominal pain where POCUS by the emergency physician early in the hospital course expedited the diagnosis of SBO and led to earlier surgical consultation. The application of POCUS for SBO is easily learned and applied in the ED. POCUS for SBO may obviate the need for plain radiography and expedite patient care.

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“…Due to the mass effect of the distended bowel, the stomach is usually displaced laterally and anteriorly 4,6 . Computed tomography (CT) is the optimal imaging technique when assessing SBO and has been shown to be 83%-94% accurate in the diagnosis of this condition 2,8 . Unfortunately, there is limited literature that describes CT findings of hernias through the foramen of Winslow 2 .…”

Section: Introductionmentioning

confidence: 99%

Ileal Herniation Through the Foramen of Winslow: Overeating as a Risk Factor for Internal Herniation

Kirigin

Nikolić

Kruljac

et al. 2016

ACC

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SUMMARY -Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention.

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Evaluation and management of small-bowel obstruction

Cited by 215 publications

References 129 publications

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Point-of-care ultrasonography for the diagnosis of small bowel obstruction in the emergency department

Ileal Herniation Through the Foramen of Winslow: Overeating as a Risk Factor for Internal Herniation

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