Small bowel obstruction

Obstructing disorders Pyloric obstruction Small bowel obstruction Colonic obstruction Achalasia... 

Studies have shown that MDCT-enterography may demonstrate characteristic findings of celiac disease, including small bowel dilatation, fold separation, non-obstructing small bowel intussusception, and extraintestinal diseases such as adenopathy and celiac-associated T-cell lymphoma (Strobl and Warshauer 1995). Reversal of the jejunoileal fold... 

Small bowel resection, severe diarrhea, intractable vomiting, bowel obstruction, and fistulas ° Critically ill patients with nonfunctioning GI tract... 

Gastrointestinal involvement may present initially as small bowel obstruction shortly after birth (known as meconium ileus) due to abnormally thick meconium that cannot be passed. Older CF patients may develop distal intestinal obstruction syndrome (DIOS), formerly called meconium ileus equivalent, which occurs due to fecal impaction in the terminal ileum and cecum. 

In ovarian cancer patients, small bowel obstruction is a common complication of progressive disease. In general, laxatives should not be used in patients with small bowel obstructions. 

Debulking surgery is intended to relieve symptoms associated with complications such as small bowel obstructions and to help improve the patient s quality of life but does not have a curative intent. 

AA is 45-year-old woman admitted to the hospital with chief complaints of fever, abdominal pain, nausea, and vomiting for 2 days. She also reports decreased appetite and decreased oral intake for the past 3 to 4 days. The patient was discharged 2 weeks ago after having a small bowel resection for recurrent bowel obstruction. 

Severe hemorrhagic pancreatitis Severe necrotizing pancreatitis Necrotizing enterocolitis Diffuse peritonitis Small bowel obstruction Paralytic ileus... 

PTT Partial thromboplastin time SBO Small bowel obstruction... 

Complications of Crohn s disease may involve the intestinal tract or organs unrelated to it. Small-bowel stricture and subsequent obstruction is a complication that may require surgery. Fistula formation is common and occurs much more frequently than with ulcerative colitis. 

Small bowel obstruction Renal disease (uremia)... 

Any cause of small bowel obstruction (adhesions, hernia) Vascular causes... 

Coverage against obligate anaerobic bacilli should be provided for distal small-bowel and colon-derived infections and for more-proximal gastrointestinal perforations when obstruction is present. 

Acute adverse effects associated with RT include hematologic depression, dysuria, diarrhea, abdominal cramping, and proctitis. Chronic symptoms may persist for months after RT and may involve diarrhea, proctitis, enteritis, small-bowel obstruction, perineal tenderness, and impaired wound healing. 

Gl lesions Potassium chloride tablets have caused stenotic or ulcerative lesions of the small bowel and death. These lesions are caused by a concentration of potassium ion in the region of a rapidly dissolving tablet, which injures the bowel wall and produces obstruction, hemorrhage, or perforation. The reported frequency of small bowel lesions is much less with wax matrix tablets and microencapsulated tablets than with enteric coated tablets. Immediately discontinue either type of tablet and consider the possibility of bowel obstruction or perforation if severe vomiting. 

Gl obstruction (Concerts only) Because the Concerts tablet is nondeformable and does not appreciably change shape in the Gl tract, do not administer to patients with pre-existing severe Gl narrowing (eg, small bowel inflammatory disease, short gut syndrome because of adhesions or decreased transit time, history of peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, Meckel s diverticulum). 

Approximately 1 to 1.5 L of fluid is ingested per day, and coupled with secretions from the stomach, pancreas, and proximal duodenum, approximately 8 L of chyme enters the jejunum per day. Reabsorption of 6 to 7 L occurs within the small bowel, leaving a residual of 1.5 L fluid, 90% of which is reabsorbed in the colon. This pattern of liquid reabsorption permits the elimination of fecal waste containing an average of 0.1 to 0.2 L fluid per day. Diarrhea occurs if there is an altered rate of intestinal motility, if mucosal function or permeability is altered, or if the fluid load entering the colon overwhelms colonic reabsorption. Constipation may occur if intestinal movement is inhibited or if there is a fixed obstruction. 

Octreotide inhibits intestinal secretion and has dose-related effects on bowel motility. In low doses (50 meg subcutaneously), it stimulates motility, whereas at higher doses (eg, 100-250 meg subcutaneously), it inhibits motility. Octreotide is effective in higher doses for the treatment of diarrhea due to vagotomy or dumping syndrome as well as for diarrhea caused by short bowel syndrome or AIDS. Octreotide has been used in low doses (50 meg subcutaneously) to stimulate small bowel motility in patients with small bowel bacterial overgrowth or intestinal pseudo-obstruction secondary to scleroderma. 

Lewis JH. Esophageal and small bowel obstruction from guar gum-containing diet pills analysis of 26 cases reported to the Food and Drug Administration. Am J Gastroenterol 1992 87(10) 1424-8. 

Migration of intrauterine contraceptive devices is relatively rare, although they have been found in the omentum, rectosigmoid, peritoneum, bladder, appendix, small bowel, adnexa, and iliac vein. Most authors have recommended removal of copper-containing devices, because of the potential for inflammatory reactions, which can cause bowel obstruction and perforation (15). Two cases of migration of intrauterine contraceptive devices to the bowel have been reported. 

Antibiotics can be used as either (1) adjunctive treatment along with other medications for active IBD (2) treatment for a specific complication of Crohn s disease or (3) prophylaxis for recurrence in postoperative Crohn s disease. Metronidazole, ciprofloxacin, and clarithromycin are the antibiotics used most frequently. They are more beneficial in Crohn s disease involving the colon than in disease restricted to the Ueum. Specific Crohn s disease-related complications that may benefit from antibiotic therapy include intra-abdominal abscess and inflammatory masses, perianal disease (including fistulas and perirectal abscesses), small bowel bacterial overgrowth secondary to partial small bowel obstruction, secondary infections with organisms such as Clostridium difficile, and postoperative complications. Metronidazole may be particularly effective for the treatment of perianal disease. Postoperatively, a 3-month course of metronidazole (20 mg/kg/day) can prolong the time to both endoscopic and clinical recurrence. 

Pitiakoudis, M., Tsaroucha, A., Constantinidis, T.C., Miraidis, K. Mid Efttathiou, E., Stathopoulos, G. A. and Simopoulos, C. (2003). Occupational exposure to wood dust. Oesophageal and small bowel obstruction by occupational bezoar report of a case. 5 International Symposium ofISSA Research Section, Abstracts, pp. 377-78. 

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