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Mechanical obstruction
Aetiology
Small bowel obstruction accounts for 5% of acute surgical admissions
In UK the commonest causes are:
o Adhesions (60%)
o Strangulated hernia (20%)
o Malignancy (5%)
o Volvulus (5%)
Pathophysiology
Investigation
Management
Adequate resuscitation prior to surgery is vital
May require more than 5 litres of intravenous crystalloid
Adequacy of resuscitation should be judged by urine output or central venous
pressure
Surgery in under resuscitated patient is associated with increased mortality
If obstruction presumed to be due to adhesions and there are no features of
peritonism
o Conservative management for up to 48 hours is often safe
Paralytic ileus
Clinical features
Investigation
Management
Bibliography
Coleman M G, Moran B J. Small bowel obstruction. In: Johnson C D, Taylor I eds.
Recent advances in surgery 22. Churchill Livingstone, Edinburgh ,1999; 87-98.
Burke M. Acute intestinal obstruction: diagnosis and management. Hosp Med
2002; 63: 104-107.
Luckey A, Livingstone E, Tache Y. Mechanisms and treatment of postoperative
ileus. Arch Surg 2003; 138: 206-214.