Chapter 78 Intestinal Obstruction

Intestinal obstruction may be classified into two types: dynamic and adynamic. Irrespective of aetiology or acuteness of onset, in dynamic obstruction the bowel proximal to the obstruction dilates and the bowel below the obstruction exhibits normal peristalsis and absorption until it becomes empty and collapses. It is important to appreciate that the consequences of intestinal obstruction are not immediately life-threatening unless there is superimposed strangulation. When strangulation occurs, the blood supply is compromised and the bowel becomes ischaemic. Internal herniation occurs when a portion of the small intestine becomes entrapped in one of the retroperitoneal fossae or in a congenital mesenteric defect. Bolus obstruction in the small bowel may be caused by gallstones, food, trichobezoar, phytobezoar, stercoliths and worms. In western countries adhesions and bands are the most common cause of intestinal obstruction. Acute intussusception occurs when one portion of the gut invaginates into an immediately adjacent segment.

Multiple Choice Questions
Weblinks

Journal articles

https://www.sciencedirect.com/science/article/abs/pii/S1072751505011361?via%3Dihub/ (paid)

Influence of time on risk of bowel resection in complete small bowel obstruction.

https://www.sciencedirect.com/science/article/abs/pii/S0002961015004249?via%3Dihub/ (paid)

Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1356393/ (free)

Long-term prognosis after operation for adhesive small bowel obstruction.

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1463-1318.2007.01371.x/ (paid)

The management of malignant large bowel obstruction: Association of Coloproctology of Great Britain and Ireland (ACPGBI) position statement.

https://www.sciencedirect.com/science/article/abs/pii/S0002961016302203?via%3Dihub/ (paid)

Adhesive small bowel obstruction after laparoscopic and open colorectal surgery: a systematic review and meta-analysis.

https://www.sciencedirect.com/science/article/abs/pii/S0140673613616876?via%3Dihub/ (paid)

Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis.

https://journals.lww.com/dcrjournal/Abstract/2005/48060/Small_Bowel_Obstruction__Conservativevs_Surgical.4.aspx/ (paid)

Small bowel obstruction: conservative versus surgical management.

https://onlinelibrary.wiley.com/doi/full/10.1111/codi.13210/ (paid)

Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis.

Guidelines

https://journals.lww.com/dcrjournal/Fulltext/2021/09000/The_American_Society_of_Colon_and_Rectal_Surgeons.5.aspx/ (free)

Clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction.

https://onlinelibrary.wiley.com/doi/10.1111/codi.15503/ (free)

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery.

https://www.thieme-connect.com/products/ejournals/html/10.1055/a-1140-3017/ (free)

Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) guideline – update 2020.

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