Bowel obstruction surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
The mainstay of treatment for bowel obstruction is surgical. Surgery is specifically indicated for complicated bowel obstruction. Complications include: Complete obstruction, closed-loop obstruction, bowel ischemia, necrosis, and perforation.
Surgery
- Open abdominal surgery is commonly performed in small bowel obstruction.[1][2][3][4][5][6][7][8][9]
- Laparoscopic adhesiolysis is another viable option that has the advantages of:
Indications
Indications based upon complicated clinical presentation
- Fever
- Leukocytosis
- Tachycardia
- Continuous or worsening abdominal pain
- Metabolic acidosis
- Peritonitis
- Systemic inflammatory response syndrome (SIRS)
Indications based upon image findings
- Free air on x-ray or CT
- Indicates a perforation
- Signs of ischemia
- Such as pneumatosis intestinalis and portal venous gas
- Complete or closed loop obstruction
- Such as U-shaped or triangular loop, distended and fluid-filled loops, and a pair of collapsed loops near the obstruction site
- Abnormal route of a mesenteric vessel
- Fluid in the peritoneum
- Presence of a transition point
Indications based on a point system
- A score of more than or equal to 3 indicates surgery, each criterion is allotted one point:
Bowel obstruction in Children
- Fetal and neonatal bowel obstructions are often caused by an intestinal atresia where there is a narrowing or absence of a part of the intestine.
- These atresias are often discovered before birth via a sonogram and treated with using laparotomy after birth.
- If the area affected is small then the surgeon may be able to remove the damaged portion and join the intestine back together.
- In instances where the narrowing is longer, or the area is damaged and cannot be used for a period of time, a temporary stoma may be placed.
Bowel obstruction in cancer patients
- Patients with malignancy experience bowel obstruction due to:
- On average, one third of patients have been found to experience bowel obstruction because of benign adhesions, otherwise the obstructions are often inoperable.
- If a cancer patient is in remission then the likelihood of a benign adhesion increases.
- If a cancer patient is not in remission then the likelihood of recurrent cancer increases, meaning that the obstruction is inoperable.
- A cancer patient may undergo a trial of non-operative management if they do not meet the indications for surgery.
Palliative surgery
- Palliative surgery aims to relieve symptoms in those that have an inoperable malignancy.
- Palliative surgeries include bowel resection, or a bypass surgery which includes:
- Enteroenterostomy
- Enterocolostomy
- Colocolostomy
Alternatives to surgery
- Stent:
- A duodenal stent may be placed proximal to a small bowel tumor to relieve an obstruction in those that are not fit for surgery.
References
- ↑ Chen JH, Huang TC, Chang PY, Dai MS, Ho CL, Chen YC, Chao TY, Kao WY (2014). "Malignant bowel obstruction: A retrospective clinical analysis". Mol Clin Oncol. 2 (1): 13–18. doi:10.3892/mco.2013.216. PMC 3915666. PMID 24649301.
- ↑ Butler JA, Cameron BL, Morrow M, Kahng K, Tom J (1991). "Small bowel obstruction in patients with a prior history of cancer". Am. J. Surg. 162 (6): 624–8. PMID 1727026.
- ↑ Tang E, Davis J, Silberman H (1995). "Bowel obstruction in cancer patients". Arch Surg. 130 (8): 832–6, discussion 836–7. PMID 7632142.
- ↑ Dalal KM, Gollub MJ, Miner TJ, Wong WD, Gerdes H, Schattner MA, Jaques DP, Temple LK (2011). "Management of patients with malignant bowel obstruction and stage IV colorectal cancer". J Palliat Med. 14 (7): 822–8. doi:10.1089/jpm.2010.0506. PMID 21595546.
- ↑ Oyasiji T, Angelo S, Kyriakides TC, Helton SW (2010). "Small bowel obstruction: outcome and cost implications of admitting service". Am Surg. 76 (7): 687–91. PMID 20698371.
- ↑ Diaz JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen MM, Mayberry JC, Jerome R (2008). "Guidelines for management of small bowel obstruction". J Trauma. 64 (6): 1651–64. doi:10.1097/TA.0b013e31816f709e. PMID 18545135.
- ↑ Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML (2014). "Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review". JAMA Surg. 149 (4): 383–92. doi:10.1001/jamasurg.2013.4059. PMC 4030748. PMID 24477929.
- ↑ Richards WO, Williams LF (1988). "Obstruction of the large and small intestine". Surg. Clin. North Am. 68 (2): 355–76. PMID 3279551.
- ↑ Ripamonti C, De Conno F, Ventafridda V, Rossi B, Baines MJ (1993). "Management of bowel obstruction in advanced and terminal cancer patients". Ann. Oncol. 4 (1): 15–21. PMID 8435356.