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Review
. 2016 Nov;10(11):PE07-PE12.
doi: 10.7860/JCDR/2016/22170.8923. Epub 2016 Nov 1.

Decision Making in Bowel Obstruction: A Review

Aswini Kumar Pujahari  1
Affiliations
Review

Decision Making in Bowel Obstruction: A Review

Aswini Kumar Pujahari. J Clin Diagn Res. 2016 Nov.

Abstract

Over the last century there have not been significant changes in the anatomical location of obstruction. The age of presentation has increased along with age related co-morbidity. Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management. A selective review of the literature pertaining to common age related aetiologies, diagnosis methods leading to standard decision making and treatment of acute intestinal obstruction was done. The same is obtained from randomized controlled studies, meta-analysis and other related evidence based publications. Predicting the conservative or operative management of Bowel Obstruction (BO) is difficult. BO in young age, in unscarred abdomen and Large Bowel Obstruction (LBO) needs early surgery. Decision on surgery should be taken in paediatric patient by second day and preferably between 3-5 days of admission in adults. Higher American Society of Anaesthesiologists (ASA) grade correlates well with the mortalities. In this article, the timing of surgery, methods to avoid bowel resection and type of surgery in various causes are stressfully analysed and discussed.

Keywords: Adhesive obstruction; Intestinal obstruction; Non adhesive obstruction; Timing of surgery; Virgin abdomen.

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Figures

[Table/Fig-1]:
[Table/Fig-1]:
Plain X-ray abdomen- localized dilated bowel (Ischemic).
[Table/Fig-2]:
[Table/Fig-2]:
Subtotal colectomy specimen in left sided cancer colon with obstruction.
[Table/Fig-3]:
[Table/Fig-3]:
Neglected megacolon.
[Table/Fig-4]:
[Table/Fig-4]:
Meckel’s Diverticulum causing obstruction.
[Table/Fig-5]:
[Table/Fig-5]:
Meckel’s related BO needing resection.
[Table/Fig-7]:
[Table/Fig-7]:
Barium enema study showing all small bowel to right (right paraduodenal hernia).
[Table/Fig-8]:
[Table/Fig-8]:
Bowel coming out of internal hernia.
[Table/Fig-9]:
[Table/Fig-9]:
Localized leak as a cause of ileus.
[Table/Fig-11]:
[Table/Fig-11]:
Management protocol.
[Table/Fig-12]:
[Table/Fig-12]:
Plicated bowel.
[Table/Fig-13]:
[Table/Fig-13]:
Stenting the bowel.
[Table/Fig-14]:
[Table/Fig-14]:
Undilated bowel in advanced ovarian cancer.
See this image and copyright information in PMC

References

    1. Drozdd W, Budzynski P. Change in mechanical bowel obstruction demographic and aetiological patterns during the past century: observations from one health care institution. Arch Surg. 2012;147:175–80. - PubMed
    1. Cirocchi R, Abraha I, Farinella E, Montedori A, Sciannameo F. Laparoscopic versus open surgery in small bowel obstruction. Cochrane Database Syst Rev. 2010;17(2):CD007511. - PMC - PubMed
    1. Miller G, Boman J, Shrier I, Gordon PH. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240–47. PMID: 10971435. - PubMed
    1. Lo OS, Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Early outcomes of surgery for small bowel obstruction: analysis of risk factors. Langenbecks Arch Surg. 2007;392:173–78. - PubMed
    1. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, Sarr MG. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg. 2010;34:910–19. - PMC - PubMed

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