When we take food, water, soda, and every other edible into our body, we expect that we will be able to expel waste from the body. In cases where there are difficulties in removing these wastes, it might be a result of several clinical conditions which include; Hirschsprung's disease, Colorectal cancer, Irritable bowel syndrome (IBS), Rectal prolapse, Fecal incontinence, Rectocele, Anal stenosis, Bowel obstruction, and so on. In today's post, I will be looking at one of these conditions and that is Bowel obstruction.
Just as its name implies, a bowel obstruction is a blockage in the intestine, preventing the passage of food, fluid, and gas through it. The obstruction can occur in both small and large bowel but it common is small bowel than in large bowels. It is as a result of gas and fecal matter buildup in the intestine. This obstruction can lead to the dilation of the intestinal region proximal to the obstruction, and cause back pressure which coul cause vomiting. This clinical condition is regarded as a medical emergency. About 85% of the bowel obstruction in small intestines that aren't complete do not require operative treatment, while 85% of a complete obstruction of the small intestine us always resolved with surgical procedures. Bowel obstruction account to the death of about 30,000 patients. 15% of admission into the hospital in the United States is as a reult of acute abdominal cases and about 20% of these cases require sugical procedures. Most cases of small bowel obstruction is as a result of adhesions, neoplasm, and hernias. About 75% of small bowel obstruction is as a result of adhesions, while bowel tumors and hernias account for about 20% of all small bowel obdtruction. Tumors basically affects the large bowels but they can affect the small intestine as well. Other causes are volvulus which affects the large bowel, divertivular disease, intussusceptions and strictures.
The stomach sends food and fluids which are being mixed and digested to the small intestine where further digestion of food and the absorption of nutrients occur. The unabsorbed contents are sent to the large intestine continues to aid in digestion and is responsible for vitamin synthesis, bilirubin breakdown, and water absorption. When there is an obstruction, these substances will not be reabsorbed, and the obstruction will lead to the dilation of the bowel which could cause fluid loss in the intravascular space causing hypovolaemia, and could also lead to sepsis/septic shock as a result of fluid loss.
Adhesions are scar tissues that form between tissues and organs in the body, in this case, in the abdomen that holds abdominal contents together. It occurs as a result of previous abdominal surgery, pelvic inflammatory disease, peritonitis, endometriosis, and injury. Adhesion usually leads to obstruction in the small bowel compared to th large bowel. Bowel Obstruction exist as close-loop obstruction which occurs when a section of the colon is is being blocked at two point, isolating the section causing the inability to move fluid and substnce through it. This could occur as a result of adhesion, hernias, and volvulus can also cause close-loop obstruction. This condition is usually treated with surgery which is done as a matter of emergency.
Patients with bowel obstruction can present with vomiting, which could be dark green bile (bilious vomiting), abdominal distention, Diffused abdominal pain, Constipation with a lack of flatulence (obstipation), and loud sounds from your belly. People who are at risk of developing bowel obstruction are people with Cancer, people who have exiting Inflammatory bowel disease, people who swallowed foreign objects, people with chronic constipation, previous abdominal surgery, and patients with Diverticulosis.
Identifying bowel obstruction can be done via physical evaluation, as it is the most essential diagnostic tool to identify the severity of the bowel obstruction, for further evaluation. Imaging with an abdominal CT with oral contrast, allows for the visuallization of the transition point, and how severe the obstruction is. It will help to identify distended loops of bowel. Laboratory evaluation can also be done to identify and evaluate leukocytosis, lactic acid levels in the case of sepsis or perforation. Blood culture can be done to identify other signs of sepsis.
Initial Management of bowel obstruction would depend on the immediate clinical presentation of the patient. Assessment of patients airways, circulation can be done. In cases where the patient is haemodynamically unstable as a result of hypovolaemic shock, bowel ischaemia, sepsis, and bowel perforation, it is important to look out for electrolyte imbalances, metabolic alkalosis, and raised lactate can be shecked through blood test.
At an early stage, the use of nasogastric (NG) tube to suctions fluid from the stomach, while passing fluid intravenously to hydrate the patient. In serious cases, surgical operation known as lysis of adhesions will be used to cut out the bad intestine and the healthy one ends will be sewn back together.