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HOW URGENT A PROBLEM is bowel obstruction? Most patients with this condition are admitted to the hospital
through the emergency department, and 10% to 20% of them are acute surgical cases. Because a bowel obstruction
can be deadly if not treated promptly, it requires precise identification for proper treatment. In this article, I'll review
what a bowel obstruction is, what causes it, the signs and symptoms to look for, and how to care for a patient who
presents with this diagnosis.
What's a bowel obstruction?
A bowel obstruction, or intestinal obstruction, is anything that stops, delays, or changes the advancing of solid and
liquid material through the small and/or large bowel. Treatment for bowel obstructions ranges from medical
management to surgical intervention.
Bowel obstructions are classified as mechanical or nonmechanical (also called a functional
obstruction ), partial or complete , and acute or insidious . Their signs and symptoms differ, according to their
category, position, and severity. Initial indicators of a bowel obstruction can include a feeling of fullness, a swollen or
stretched abdomen, nausea, mild or severe vomiting, stomach cramps, an absence of bowel sounds or high-pitched
and resonant sounds, and diarrhea or constipation.
First, let's review the two types of bowel obstructionsmechanical and nonmechanical.
It takes two
A mechanical bowel obstruction is something that decreases the diameter of the bowel's opening from either the
inside or outside. It physically blocks the movement of material through the intestines. Possible mechanical
obstructions could be due to:
* scar tissue (adhesions) from previous surgery
* hernias
* malignant tumors
* foreign bodies such as gallstones
* twisting of the bowel (volvulus)
* telescoping of the bowel (intussusception)
* fecal impaction
* Crohn's disease.
In a simple mechanical obstruction, ingested liquids and food, digestive secretions, and gas accumulate above the
obstruction. The proximal bowel enlarges and the distal bowel collapses. Normal bowel function decreases, and the
bowel wall becomes edematous and congested. Blood flow to the intestines is also impaired, which can cause the
tissue to die. This can lead to bacterial infection, sepsis, dehydration, and electrolyte abnormalities.
Bowel obstructions can also be classified as being partial or complete . A partial bowel obstruction indicates that
some, but not all, of the food and air in the intestines can move. A complete bowel obstruction indicates complete
blockage, and no food or air can move through the intestines.
Two more classifications for bowel obstructions are acute and insidious . Acute bowel obstructions cause a rapid
onset of cramps, abdominal distension, vomiting, and severe constipation. Insidious obstructions develop over a
period of weeks and are more often associated with large bowel obstructions.
The location of a bowel obstruction is important in making a proper assessment. Let's look at where they can occur.
Location, location, location
Most mechanical obstructions (80%) occur in the small bowel. Small-bowel mechanical obstructions are usually
caused by:
* surgical or nonsurgical adhesions
Testing, testing