From the Guidelines
Bowel obstructions can be classified into two main types: mechanical and functional, with mechanical obstructions being further divided into simple and closed-loop obstructions, and functional obstructions occurring due to a lack of normal peristalsis. The most common causes of mechanical obstruction include adhesions from previous surgeries, hernias, tumors, intussusception, volvulus, and foreign bodies 1. Functional obstructions, on the other hand, can occur due to abdominal surgery, electrolyte imbalances, medications, or neurological disorders.
Classification by Location
Bowel obstructions can also be classified by location as small bowel or large bowel obstructions, each with distinct clinical presentations.
- Small bowel obstructions typically present with cramping periumbilical pain, vomiting, and obstipation, and are most commonly caused by adhesions, hernias, and neoplasms 1.
- Large bowel obstructions often cause lower abdominal pain and distension, and are most commonly caused by cancer, volvulus, and diverticular disease 1.
Treatment
Treatment of bowel obstructions depends on the type and severity, ranging from conservative management with bowel rest, nasogastric decompression, and IV fluids for partial obstructions to emergency surgery for complete obstructions with signs of strangulation or perforation 1. Early recognition is crucial as delayed treatment of complete obstructions can lead to bowel ischemia, perforation, and sepsis. In cases of inflammatory bowel disease, such as Crohn's disease, treatment may involve a trial of medications aimed at reducing inflammation, or interventional approaches such as endoscopic balloon dilation or surgical intervention 1.
Key Considerations
It is essential to note that the management of bowel obstruction requires a multidisciplinary approach, and the choice of treatment should be individualized based on the patient's specific condition and needs. Imaging plays a crucial role in the diagnosis and management of bowel obstruction, and can help guide treatment decisions 1. Additionally, the presence of underlying conditions such as inflammatory bowel disease or cancer can impact treatment options and outcomes 1. In all cases, prompt recognition and treatment of bowel obstruction are critical to preventing complications and improving patient outcomes.
From the Research
Types of Bowel Obstruction
- Mechanical obstruction of the small bowel and colon, which can be total or partial 2
- Pseudo-obstruction, which is usually treated medically 2
- Intestinal obstruction, which can be caused by intra-abdominal adhesions, malignancy, and herniation 3
- Small bowel obstruction and large bowel obstruction, which account for approximately 20% of cases of acute abdominal surgical conditions 4
- Simple or closed loop obstruction, which can be diagnosed using imaging techniques 4
- Strangulation, ischemia, or perforation, which are complications of bowel obstruction that require surgical intervention 3, 4
Causes of Bowel Obstruction
- Intra-abdominal adhesions 3
- Malignancy 3
- Herniation 3
- Other mechanical causes that can interrupt or impair the forward flow of intestinal contents 3
Diagnosis of Bowel Obstruction
- Clinical presentation, including nausea, emesis, colicky abdominal pain, and cessation of passage of flatus and stool 3
- Laboratory evaluation, including complete blood count, metabolic panel, and serum lactate level 3
- Imaging techniques, such as abdominal radiography or computed tomography, to confirm the diagnosis and assist in decision making for therapeutic planning 2, 3, 4