Author: Anushka Pradhan
Editor: Alida Fernandes
Overview
Intestinal obstruction can be a mechanical or functional obstruction which can be found in either the small or large intestine (Smith, Kashyap, & Nehring, 2020). They account for 15% of hospital admission for acute abdominal pain in the USA (Catena et al., 2019), Small intestinal obstructions are more common (Schick, Kashyap, & Meseeha, 2020) while large intestinal abstractions account only for 10-15% of all intestinal obstructions (Smith, Kashyap & Nehring, 2020). Obstruction occurs when the lumen of the bowel becomes partially or completely blocked (Smith et al., 2020). This prevents the normal movement of chyme through the digestive system and can be a cause of morbidity and mortality (Catena et al., 2019).
Epidemiology
Bowel obstructions have similar incidence rates in men and women(Smith et al., 2020). There is a higher incidence with increased age and the number of intra-abdominal procedures conducted on the patient (Schick et al., 2020)
Etiology
Post-surgical adhesions is the most common cause of intestinal obstruction as it causes an entanglement of the bowel (Smith et al., 2020). Cancer is another cause of obstruction as it causes compression of the small intestine (Smith et al., 2020). Less common causes include inguinal and umbilical hernias. Intrinsic disease may also cause bowel obstruction if thickening of the intestinal wall occurs (Smith et al., 2020).
Symptoms
Common symptoms of Intestinal Obstruction include the following:
- Abdominal pain,
- Cessation of bowel movements,
- Distention,
- Nausea,
- Vomiting (Jackson & Vigiola, 2018).
Risk Factors
Risk factors include prior abdominal surgery, colon or metastatic cancer, chronic intestinal inflammatory disease, existing abdominal wall and/or an inguinal hernia, previous irradiation, and foreign body ingestion (Smith et al., 2020).
Diagnosis
Clinical Features
A detailed medical history is recommended to identify risk factors of this condition. Tenderness to palpation is present in both small and large intestinal obstruction (Smith et al., 2020).
Pathological Features
Conducting an abdominal CT scan with oral contrast can confirm the diagnosis of this condition (Smith et al., 2020). A CT scan allows for visualization of the transition point, severity of obstruction, and potential etiology (Smith et al., 2020). Laboratory evaluation is recommended to search for any leukocytosis or electrolyte derangements (Smith et al., 2020). Alternate imaging studies in order to diagnose and assess additional information on the bowel obstruction include a plain abdominal X-ray or abdominal ultrasound (Markogiannakis et al., 2007)
Treatment Protocol
Pharmacological Treatment
It is recommended that intravenous isotonic fluid be administered and oral intake restricted. If the obstruction is bacterial in nature, antibiotics may be used to treat intestinal overgrowth of bacteria and translocation across the bowel wall (Jackson & Vigiola, 2018).
Non-Pharmacological Treatment
Stable patients presenting with low-grade obstruction can be treated with nasogastric tube decompression (Smith et al., 2020). Patients presenting with reducible hernias will require surgical intervention in order to prevent future recurrence (Jackson & Vigiola, 2018). Operative laparotomic surgery is the treatment of choice for cases that require emergent surgical exploration, such as perforation or bowel ischemia (Catena et al., 2019).
Articles on Misdiagnosis
Saverio, S.D., Tugnoli, G., Ansaloni, L., Catena, F., Biscardi, A., Jovine, E., & F. Baldoni. (2010). Concomitant intestinal obstruction: a misleading diagnostic pitfall. BMJ Case Reports, bcr0820092177. DOI: 10.1136/bcr.08.2009. 2177.
Nishie, H., Suzuki, T., Ichikawa, H., & H. Kataoka. (2019). Intestinal obstruction caused by small bowel adenocarcinoma misdiagnosed as psychogenic disorder. BMJ Case Reports, 12(1), bcr-2018-227326. Retrieved from https://casereports.bmj.com/content/12/1/bcr-2018-227326.citation-tools.
Wilson, H.M. (2009). Chronic subacute bowel obstruction caused by carcinoid tumour misdiagnosed as irritable bowel syndrome: a case report. Cases Journal, 2(78). DOI: 10.1186/1757-1626-2-78.
References
Catena, F., De Simone, B., Coccolini, F., Di Saverio, S., Sartelli, M., & Ansaloni, L. (2019). Bowel obstruction: a narrative review for all physicians. World Journal of Emergency Surgery, 14(1), 20. DOI: 10.1186/s13017-019-0240-7.
Jackson, P., & Vigiola Cruz, M. (2018). Intestinal obstruction: Evaluation and management. American Family Physician, 98(6), 362–367.
Schick, M. A., Kashyap, S., & Meseeha, M. (2020). Small Bowel Obstruction. In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK448079/.
Smith, D. A., Kashyap, S., & Nehring, S. M. (2020). Bowel Obstruction. In StatPearls. Treasure Island (FL): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441975/.
Markogiannakis, H., Messaris, E., Dardamanis, D., Pararas, N., Tzertzemelis, D., Giannopoulos, P., Larentzakis, A., Lagoudianakis, E., Manouras, A., & Bramis, I. (2007). Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World journal of gastroenterology, 13(3), 432–437. DOI: 10.3748/wjg.v13.i3.432.
Di Saverio, S., Tugnoli, G., Ansaloni, L., Catena, F., Biscardi, A., Jovine, E., & Baldoni, F. (2010). Concomitant intestinal obstruction: a misleading diagnostic pitfall. BMJ case reports, 2010, bcr0820092177. DOI: 10.1136/bcr.08.2009.2177.
