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Seminar in Surgery
Rwanda, September 2010
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Hobart
Differentiating large bowel obstruction
from small bowel obstruction
Objectives
• Physiology & anatomy of small/large bowel
• Causes of bowel obstruction
• Symptoms & signs
• Investigations (plain xray)
• Complications
• Management – conservative & operative
Functions of intestine
• Small intestine – absorption of fluid, food,
vitamins
Bile 140 5 80 40
Small Bowel 90 10 90 30
Fluid replacement - GI loss
• Type Volume
(litres)
Gastric 2.0
Bile 1.0
Pancreas 1.0
Small bowel 3.5
Total 7.5
Causes of small bowel obstruction
• adhesions (previous operation)
• external hernia
• small bowel volvulus (primary)
• neoplasms
• miscellaneous
Causes of large bowel obstruction
• carcinoma of colon
• volvulus (sigmoid)
• diverticular disease
• miscellaneous
Symptoms of bowel obstruction
• abdominal pain
• vomiting
• distension
• constipation (no flatus)
High small bowel obstruction
• frequent, profuse vomiting
• central abdo pain
• minimal distension
Lower small bowel obstruction
• colic pain
• moderate vomiting ( may be faeculent)
• moderate distension
Large bowel obstruction
• abdominal distension
• constipation
• lower abdo pain ( may be minimal)
• minimal vomiting
Physical Examination
• abdo scars
• external hernia
• signs strangulation (tenderness, fever, mass)
Investigations
• Plain Xray – supine
- erect
- chest
• Hb, WCC, Urea & Electrolytes
Further investigations
• CT abdomen
• contrast study (via NG )
Plain x ray SBO
• dilated loops with gas
• centrally placed
• transverse lines (circular folds)
Plain x ray LBO
• dilated bowel with gas (caecum)
• peripheral
• haustra (not lines across bowel)
• may have cut-off point
SBO
Supine
LBO
Prone