Mid or Distal Obstruction
• Cramping abdominal pain
• Mild abdominal tenderness
• Audible rushes and high-pitched tinkles
• High fever
• Abdominal pain: Severe and continuous
• Vomitus may contain blood
• Abdominal tenderness and rigidity
• Abdominal x-ray
• The colon is often devoid of gas
• Intraperitoneal air indicates perforation
• Contrast upper GI series: Assesses completeness of obstruction
• CT scan
-Intraperitoneal free fluid
-Dilated bowel proximal and decompressed distal to the obstruction
-Point of obstruction may be visualized
• Gas within the bowel wall or portal vein may be seen in strangulation
• Intraperitoneal free air or air-fluid levels indicate perforation
• Classification of small bowel obstruction
• Functional (failure of peristalsis to propel intestinal contents) or mechanical (a physical barrier impedes aboral progress of intestinal contents)
• Complete or partial
• Simple (occludes the lumen only) or strangulated (impaired the blood supply leading to necrosis of the intestine)
• Open loop (the lumen is occluded in 1 place) or closed loop (the lumen is occluded in at least 2 places)
• 33% of strangulation obstructions are unsuspected before operation
• Acute appendicitis
• Obstruction of the large intestine
• Acute gastroenteritis
• Acute pancreatitis
• Mesenteric vascular occlusion
• Pseudo-obstruction associated with scleroderma, systemic lupus erythematosus, amyloidosis, drug abuse, or radiation
• Intrinsic dysmotility
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