INTESTINAL OBSTRUCTION

Clinical Features

In infants, suspect bowel obstruction if:

1. No meconium is evacuated within the first 24 hours of birth.
2. There is a green or bilious vomiting.
3. There is abdominal distension.

In older children and adults, suspect bowel obstruction if:

1. There is constipation
2. There is abdominal distension
3. There is fever(if advanced obstruction is present).
4. There are features of dehydration.
5. There are altered bowel sounds.
6. There is abdominal pain with vomiting.

If there is a gross abdominal distension with no pain, suspect sigmoid volvulus.

Investigations

1. Haemoglobin, white blood count, packed cell volume
2. Urinalysis
3. Urea and electrolytes
4. Radiograph of abdomen(erect AP and dorsal decubitus)

• Multiple air-fluid levels, gaseous distension of gut, double bubble sign in children, etc.
• Volvulus

Management

1. Initiate resuscitation with nasogastric suction, intravenous fluids and nil orally.
2. Monitor vital signs.
3. Take radiographs(if available). If not able refer to a facility with ability to manage the condition.
4. Perform definitive management be it surgery or conservative management
5. Correct fluid and electrolyte imbalance.
6. Group and cross match blood.
7. Deflate the distended stomach with nasogastric suction. This is more effective for small bowel than in large bowel obstruction.
8. Give prophylactic antibiotics at induction: metronidazole 500mg IV stat and cefuroxime 1.5g STAT.
9. Note that high enema may be effective for faecal impaction only.
10. Remove the cause of the obstruction by surgery or conservative treatment.
11. NB:Obstruction due to adhesions from previous surgery may open under conservative treatment.
12. Emergency large bowel surgical resection usually involves creation of a defunctioning colostomy rather than performing primary resection and anastomosis if strangulation has taken place(Hartmann’s procedure).