Bowel obstruction surgery
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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.
- Open abdominal surgery is commonly performed in small bowel obstruction.
- Laparoscopic adhesiolysis is another viable option that has the advantages of:
Indications based upon complicated clinical presentation
- Continuous or worsening abdominal pain
- Metabolic acidosis
- Systemic inflammatory response syndrome (SIRS)
Indications based upon image findings
- Free air on x-ray or CT
- Indicates a perforation
- Signs of ischemia
- 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 aims to relieve symptoms in those that have an inoperable malignancy.
- Palliative surgeries include bowel resection, or a bypass surgery which includes:
Alternatives to surgery
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