Gastroenterology
Bowel Obstruction, Ileus, Volvulus, Hernia
Gastroenterology

Bowel Obstruction, Ileus, Volvulus, Hernia

SBO vs ileus vs sigmoid volvulus.

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◆SBO

  • •Most common cause: ADHESIONS from prior surgery
  • •Other: hernias (incarcerated/strangulated), malignancy, IBD strictures, intussusception
  • •Vomiting + distention + obstipation; early hyperactive bowel sounds, late hypoactive
  • •KUB: multiple air-fluid levels + dilated small bowel loops
  • •Initial: NPO + NG decompression + IVF + serial exams
  • •Strangulation/closed-loop: emergent surgery

◆Ileus

  • •Diffuse gas without transition point
  • •Post-op, opioids, electrolyte abnormalities
  • •Treat: NPO, NG, electrolyte correction, ambulation, minimize opioids
  • •Alvimopan may help

◆Sigmoid volvulus

  • •Elderly, institutionalized, chronic constipation
  • •'Coffee bean' sign on X-ray = twisted sigmoid
  • •Without peritonitis: endoscopic detorsion (flexible sigmoidoscopy)
  • •With perforation/ischemia/recurrent: surgical resection

◆Incarcerated/strangulated hernia

  • •Tender nonreducible groin mass + obstruction symptoms
  • •Immediate surgical exploration (don't delay for imaging)

◆Subphrenic abscess

  • •Postoperative day 5–10 + fever + LEFT-sided pleural effusion (after splenic surgery)
  • •CT abdomen → percutaneous drainage + IV abx
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