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Small bowel obstruction
Discussion in 'All Categories' started by Yolanda Mangum - Nov 15th, 2011 1:41 am.
Yolanda Mangum
Yolanda Mangum
81/2 months postsurgical small bowel obstruction/adhesion in a 79yo African American female.
She has a defibulator by not other assistive devices and not other surgeries, other than a citrus tumor remove from her food over 30 years ago. Fluid(bile) retention in stomach and is not passing through into her intestine. The doctors are starting to consider surgery after two weeks of waiting. Please help!
re: Small bowel obstruction by Dr M.K. Gupta - Nov 17th, 2011 10:30 pm
Dr M.K. Gupta
Dr M.K. Gupta
Dear Yolanda Mangum

A small-bowel obstruction is caused by a number of pathologic processes. The leading reason for in industrialized countries is postoperative adhesions (60%), then malignancy, Crohn disease, and hernias, even though some studies have reported Crohn disease like a greater etiologic factor than neoplasia. Surgeries most closely related to SBO are appendectomy, colorectal surgery, and gynecologic and upper gastrointestinal procedures.

Vomiting occurs when the level of obstruction is proximal. Increasing small-bowel distention results in increased intraluminal pressures. This can cause compression of mucosal lymphatics, resulting in bowel wall lymphedema. With even higher intraluminal hydrostatic pressures, increased hydrostatic pressure within the capillary beds results in massive third spacing of fluid, electrolytes, and proteins in to the intestinal lumen. The fluid loss and dehydration that ensue may be severe and bring about increased morbidity and mortality.

Strangulated SBOs are most commonly related to adhesions and occur whenever a loop of distended bowel twists on its mesenteric pedicle. The arterial occlusion results in bowel ischemia and necrosis. If left untreated, this progresses to perforation, peritonitis, and death.

Obstruction could be characterized as either partial or complete versus simple or strangulated. No accurate clinical picture exists to detect early strangulation of obstruction.

Abdominal pain, often referred to as crampy and intermittent, is more prevalent in simple obstruction. Often, the presentation may provide clues to the approximate location and nature from the obstruction. Usually, pain that occurs for any shorter duration of time and is colicky and combined with bilious vomiting might be more proximal. Pain that lasts so long as several days, is progressive anyway, and it is accompanied by abdominal distention may be usual for a far more distal obstruction.

Changes in the smoothness from the pain may indicate the development of a more serious complication. A strangulated obstruction is a surgical emergency. In patients with a complete small-bowel obstruction, the risk of strangulation is high and early surgical intervention is warranted. Patients with simple complete obstructions in whom nonoperative trials fail likewise need surgical treatment but experience no apparent problem with delayed surgery.

Laparoscopy has been shown to be safe and good at selected cases of SBO. Overview of retrospective clinical trials showed that laparoscopy showed better leads to relation to stay in hospital and mortality reduction versus open surgery, but prospective, randomized, controlled trials to evaluate all outcomes are still needed.

With regards
M.K. Gupta
re: Small bowel obstruction by SadlygalBligo - Dec 10th, 2011 3:30 am
re: Small bowel obstruction by Earnenrodia - Dec 12th, 2011 9:59 pm
i want buy panasonic camera. What is your recommendation model?
re: Small bowel obstruction by SadlygalBligo - Dec 22nd, 2011 10:00 pm
re: Small bowel obstruction by PemyunDunny - Jan 6th, 2012 5:43 am
Thank you for good site.
Very helpful.
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