- intestinal colic
- absolute constipation
(neither faeces nor flatus)
- abd. distension
- usu. nontender (tenderness implies strangulation)
- frequent, high-pitched, "tinkling" bowel sounds (later silent)
- visible peristalsis (hallmark of incomplete obstruction)
- AXR: distended loops of bowel proximal
to the obstruction.
(Small bowel: plicae circulares/valvulae conniventes.
Large bowel: haustrae.)
Proximal small bowel: vomiting closely follows onset of pain (hours).
Distal small bowel: vomiting occurs one or two days after onset of pain.
Large bowel: vomiting may be absent. Distension predominates.
Appearance of vomitus is also helpful:
Semidigested food: gastric outlet obstruction.
Bile stained: proximal small bowel.
Faeculent: distal small bowel.
Fluid resuscitation, then
- Conservative: Pass an NG tube (control vomiting, prevent aspiration, ?decompress bowel).
- Surgical: Laparotomy.
Perforation (esp. closed loop syndrome)
- Small bowel
- Strictures (usu. Crohn's)
- Bolus (gallstone ileus, phytobezoar, worms)
- intussusception (usu. paediatric)
- midgut volvulus (paediatric only)
- paralytic ileus (adynamic small bowel obstruction)
- Large bowel
- Stricture (malignant or IBD)
- Volvulus (sigmoid or caecum)
- large bowel pseudo-obstruction (adynamic large bowel obstruction)