In infants, suspect bowel obstruction if:
- No meconium is evacuated within the first 24 hours of birth.
- There is a green or bilious vomiting.
- There is abdominal distension.
In older children and adults, suspect bowel obstruction if:
- There is constipation
- There is abdominal distension
- There is fever(if advanced obstruction is present).
- There are features of dehydration.
- There are altered bowel sounds.
- There is abdominal pain with vomiting.
If there is a gross abdominal distension with no pain, suspect sigmoid volvulus.
- Haemoglobin, white blood count, packed cell volume
- Urea and electrolytes
- Radiograph of abdomen(erect AP and dorsal decubitus)
- Multiple air-fluid levels, gaseous distension of gut, double bubble sign in children, etc.
- Initiate resuscitation with nasogastric suction, intravenous fluids and nil orally.
- Monitor vital signs.
- Take radiographs(if available). If not able refer to a facility with ability to manage the condition.
- Perform definitive management be it surgery or conservative management
- Correct fluid and electrolyte imbalance.
- Group and cross match blood.
- Deflate the distended stomach with nasogastric suction. This is more effective for small bowel than in large bowel obstruction.
- Give prophylactic antibiotics at induction: metronidazole 500mg IV stat and cefuroxime 1.5g STAT.
- Note that high enema may be effective for faecal impaction only.
- Remove the cause of the obstruction by surgery or conservative treatment.
- NB:Obstruction due to adhesions from previous surgery may open under conservative treatment.
- 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).