Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: Small Bowel Obstruction |Colonic (Large bowel) Obstruction |Caecal Volvulus |Small Bowel Ischemia |Hartmann's procedure |Sigmoid Volvulus |Acute Colonic Pseudo-obstruction |
There is an increased incidence of SBO from adhesions, with a higher incidence of laparotomies. Causes include hernias, adhesions, Crohn's disease, and intussusception. SBO is often diagnosed late or misdiagnosed, resulting in significant morbidity and mortality.
Large Bowel Obstruction |
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The valvulae conniventes are well demonstrated. Central distended small bowel with old surgical staples visible. Cause: adhesions.
Type | Small Bowel | Large Bowel |
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Abdominal Pain | Early, colicky, central. | May not be colicky. |
Vomiting | Early bilious, progresses to feculent. | Occurs later. |
Constipation | Occurs late. | Occurs early; may pass diarrhoea in partial obstruction. |
Abdominal Distension | Less if high obstruction; prominent if low. | More severe if lower obstruction. |
Abdominal Percussion | May be resonant. | May be resonant. |
Bowel Sounds | High-pitched, tinkling. | Varied; often absent if severe obstruction. |
AXR | Central small bowel showing valvulae conniventes across width, often distended centrally. Many short fluid levels on erect film. | Peripheral large bowel showing haustra without crossing entire wall, large transverse diameter < 10 cm. |
Causes | Post-surgical adhesions, hernias, volvulus, paralytic ileus, small bowel ischaemia, old irradiation damage, Crohn's disease. | Colorectal cancer, sigmoid volvulus, diverticular disease. |