RISK FACTORS: Previous abdominal and/or pelvic surgery, Hernia, Chronic constipation, Cholelithiasis, Inflammatory bowel disease, Ingested foreign bodies - pica, enteric potassium
tablets, etc., Diverticular disease
APPROPRIATE HEALTH CARE
. Inpatient
. Treatment directed at early gastrointestinal decompression, correction of fl uid and electrolyte abnormalities,
timely operative intervention, surgical/GI consultation required
GENERAL MEASURES
. Nasogastric suction
. Foley catheter
. Swan-Ganz catheter or other central monitor, if required
. Intravenous fl uids: Normal saline/Ringers solution with potassium supplementation as required
. Antibiotic use controversial in absence of sepsis, but prophylactic antibiotics probably appropriate
SURGICAL MEASURES
. Timing of operative intervention critical, must correct electrolytes, volume quickly prior to surgery
. Surgical procedures:
. Closed bowel procedures: lysis of adhesions, reduction of intussusception, reduction of volvulus, reduction of incarcerated hernia
. Enterotomy for removal of bezoars, foreign bodies, gallstones
. Resection of bowel for obstructing lesions, strangulated bowel
. Bypasses of intestine around obstruction
. Enterocutaneous fi stulae proximal to obstruction: colostomy, cecostomy
PATIENT MONITORING Follow weekly postoperatively for 2-8 weeks
POSSIBLE COMPLICATIONS
β’ Slow return of bowel function
β’ Higher risk of subsequent obstruction
β’ Sepsis
EXPECTED COURSE/PROGNOSIS
Usually excellent prognosis. In general, mortality from intestinal obstruction ranges from < 1% to > 20%
depending upon etiology, bowel viability, co-morbidities, etc
AGE-RELATED FACTORS
Pediatric:
. Different etiologies of obstruction in childhood
. Duodenal malformations
. Jejunoileal atresia
. Malrotation and midgut volvulus
. Meconium ileus
. Necrotizing enterocolitis
. Hirschsprung disease
. Intussusception
. Duplications
. Meckel diverticulum
. Imperforate anus
Geriatric:
. Colon neoplasms more common
. Chronic constipation/impactions more common