Bowel Obstruction

About 3.2 million cases of bowel obstruction occurred worldwide in 2015 which resulted in 264,000 deaths. Both sexes are equally affected and the condition can occur at any age.

In rural Africa, acute intestinal obstruction accounts for a great proportion of morbidity and mortality. While some studies have been done to assess prevalence and causes of bowel obstruction in developed countries, the condition remains largely understudied in the African context. With only a few studies conducted in some African countries.

Further studies into assessing the parameters of the incidence, prevalence, causes, treatments and mortality associated with bowel obstruction in Africa can become the foundation for a more rigorous approach into better treatment options and preventive interventions for the disease condition and it’s related complications to largely reduce the mortality rate in Africa.

Bowel obstruction, also known as intestinal obstruction refers to a condition whereby the free movement of intestinal contents is blocked mechanically or functionally. This leads to a build up of intestinal content in the intestines. It is a surgical emergency that demands quick response within 24 hours of onset to prevent complications.

 

Classification of Bowel Obstruction

Bowel obstruction is subdivided into two categories to differentiate the cause of the blockage. There are mechanical and non-mechanical factors that can obstruct the bowel.

Mechanical intestinal obstruction refers to bowel obstruction from mechanical factors whiles non-mechanical intestinal obstruction refers to bowel obstruction from non-mechanical or functional factors.

 

Causes of Bowel Obstruction

There are several factors that can cause intestinal obstruction.

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Non-mechanical intestinal obstruction is primarily due to a functional dysfunction of the nerves that supply the intestines called paralytic ileus, which temporarily arrests intestinal peristaltic movement. Possible conditions that can precipitate paralytic ileus include

  • infections of the peritoneum,
  • mesenteric ischemia,
  • intra-abdominal hematoma,
  • metabolic disturbances like hypokalaemia,
  • renal disease and
  • post-surgery.

Mechanical intestinal obstruction may occur in the small intestine (which is more common)  or large intestine. When the obstruction is in the small intestine, it is called small bowel obstruction, and if the obstruction is in the large intestine, it is referred to as large bowel obstruction. Both have different prevalent causes.

Small bowel obstruction is most commonly caused by adhesions after a surgery. In other populations in developing countries in Africa, hernia is the leading cause of small bowel obstruction. Other causes include

  • Merkel’s diverticulitis,
  • inflammatory bowel disease (crohn’s disease),
  • intestinal worms (ascaris),
  • tumors,
  • foreign bodies (gall stones or other swallowed objects),
  • volvolus (twisting of the small intestine),
  • intussusception (which is the most common cause in children).

Large bowel obstructions may be caused by tumors in the large intestine (lipoma or polyps), Sigmoid diverticulitis, volvolus of the large intestine, fecal impaction and post surgical adhesions.

 

Signs and Symptoms of Bowel Obstruction

The cardinal symptoms are

  1. Abdominal cramps
  2. Distention of the abdomen
  3. Vomiting
  4. Constipation

Clinical signs include

  • High pitched bowel sounds.
  • Abdomen may be tender or non-tender.
  • Possible palpable mass like tumours at site of obstruction.

 

Diagnosis and Treatment

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Imaging studies are needed to confirm the diagnosis of suspected bowel obstruction. Abdominal X-rays are usually enough to detect bowel obstructions. Other imaging techniques like CT-Scan and even ultrasound scan can be used for peculiar cases (especially in infants and pregnant women). Barium enema is used to rule out lesions along the colon.

The treatment of bowel obstruction requires the hospitalisation of the patient and the passage of a naso-gastric tube (N-G tube), which resolves simple obstructions.

Intubation for post operative obstruction caused by adhesions in the absence of peritoneal signs can be done.

Cases from electrolyte imbalance like hypokaleamia can be resolved through intravenous fluids and urinary catheter passed.

More complicated bowel obstructions, especially when accompanied with acute pain will require surgery correct the cause like hernia, removal of foreign objects and gall stones, tumours and volvolus.

Manual digital removal of fecal matter from rectum can be done to resolve obstruction due to fecal impaction.

 

Complications

  1. Dehydration which can lead to oliguria and shock.
  2. Ischemia which can advance to necrosis or gangrene of the intestines.
  3. Intestinal perforation.
  4. Peritonitis.
  5. Death.

 

One research study carried out in Ethiopia to ascertain the causes, prevalence and management outcome of intestinal obstruction recommends that health professionals in the hospitals and districts should increase public awareness on intestinal obstruction by providing appropriate health information and physicians should diagnose intestinal obstruction early and appropriate interventions should be taken on time before the intestine develops gangrene.

Wound infection prevention should be improved because it is the most common postoperative complication in the research and this can be decreased by appropriate surgical technique and wound care with sterile techniques.

 

 

 

Reference

https://emedicine.medscape.com/article/774140-overview

https://en.m.wikipedia.org/wiki/Bowel_obstruction

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893295/

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