![]() ![]() The definitive management of bowel obstruction is dependent on the aetiology and the presence of any specific complications, such as bowel ischaemia or perforation. *Patients with bowel obstruction may have abdominal tenderness, however should not have features of guarding or rebound tenderness, unless ischaemia is developing Percussion may give a tympanic sound and auscultation may reveal ‘tinkling’ bowel sounds, both signs characteristic of bowel obstruction. Palpate for focal tenderness* (including guarding and rebound tenderness on palpation). Ensure to assess the patient’s fluid status, as significant third-spacing can occur in bowel obstruction. ![]() surgical scars, cachexia from malignancy, or obvious hernia) or abdominal distension. On examination, patients may show evidence of the underlying cause (e.g. Absolute constipation – occurring early in distal obstruction and late in proximal obstruction.Vomiting – occurring early in proximal obstruction and late in distal obstruction.Abdominal pain – colicky or cramping in nature (secondary to the bowel peristalsis).Patients with bowel obstruction will present with the cardinal features of bowel obstruction (to varying degrees): Table 1 – Causes of bowel obstruction *especially in Crohn’s patients ** most common in children Hernias, adhesions, peritoneal metastasis, volvulus Gallstone ileus, ingested foreign body, faecal impactionĬancer, inflammatory strictures*, intussusception**, diverticular strictures, Meckel’s diverticulum, lymphoma The full list of causes of bowel obstruction can otherwise be divided into extramural, intramural, and intraluminal causes (Table 1) Large bowel – malignancy, diverticular disease, or volvulus.The most common causes of bowel obstruction depend on location: a large bowel obstruction with a competent ileocaecal valve), this is termed closed-loop obstruction.Ī closed-loop obstruction is a surgical emergency as if not corrected, the bowel will continue to distend within a closed segment of bowel, stretching the bowel wall until it becomes ischaemic and this can further lead to perforation. In patients with a mechanical bowel obstruction, if there is a second separate obstructing point proximally (e.g.
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