Evaluation and mangement of intestinal obstruction.
Am Fam Physician. 2011 Jan 15;83(2):159-65
Authors: Jackson PG, Raiji MT
Acute intestinal obstruction occurs when there is an interruption in the forward flow of intes- tinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Intestinal obstruc- tion is most commonly caused by intra-abdominal adhesions, malignancy, or intestinal hernia- tion. The clinical presentation generally includes nausea and emesis, colicky abdominal pain, and a failure to pass flatus or bowel movements. The classic physical examination findings of abdominal distension, tympany to percussion, and high-pitched bowel sounds suggest the diagnosis. Radiologic imaging can confirm the diagnosis, and can also serve as useful adjunc- tive investigations when the diagnosis is less certain. Although radiography is often the initial study, non-contrast computed tomography is recommended if the index of suspicion is high or if suspicion persists despite negative radiography. Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompres- sion, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.
PMID: 21243991 [PubMed - in process]