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Grand Round Case Presentation Sub Acute Obstruction

Grand Round Case Presentation Sub Acute Obstruction. Causes of SBO. Adhesions (70%) – usually from previous surgery but TB infection can cause them Hernia (20%) Pressure from extrinsic structures (eg. tumour) Gallstones Inflammatory bowel disease

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Grand Round Case Presentation Sub Acute Obstruction

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  1. Grand Round Case PresentationSub Acute Obstruction

  2. Causes of SBO • Adhesions (70%) – usually from previous surgery but TB infection can cause them • Hernia (20%) • Pressure from extrinsic structures (eg. tumour) • Gallstones • Inflammatory bowel disease • Intussusception (especially in young children – it can kill quickly so beware!) • Volvulus • Gynaecological causes in women • 20% of all Surgical admissions

  3. Small Bowel Obstruction Adhesions – what do they look like?

  4. Initial Management of ?SBO • Full history including details of past surgery • Full abdominal exam including PR • Don’t forget hernial orifices (or end up in court)! • Imaging (CXR, AXR, CT, barium) & all bloods • Conservative management unless: • Perforation (imaging) and/or overt peritonism • Irreducible hernia • Palpable mass

  5. Conservative Management • NBM, NG tube and close observations • Patient must have adequate resuscitation before surgery: IV fluids & monitor urine output • Imaging studies: CXR, AXR, CT & barium studies • Closely monitor patient bowel habits!! A SBO can rapidly change from incomplete to complete • Be ready for any deterioration: pain, distension, peritonism, dehydration, sepsis or absolute constipation

  6. Small bowel obstruction: AXR • Dilated loops of small bowel • Central position • Valvulae conniventes • Distal collapse • Barium studies show location of obstruction • ?Absolute indication for surgery

  7. Take home points: SBO • Common surgical emergency • Good history, good examination, appropriate investigations • Conservative management? • Close monitoring for deterioration • Repeat imaging • Peritonism or sepsis = surgery!

  8. TB: Profs Prophecy • Suspect TB in any foreign national with: • Mediastinal/hilar lymphadenopathy • Persistent cervical lymphadenopathy • Pleural effusion • Monoarthritis • Chronic discharging sinus • Small bowel obstruction (7% of all Indian SBO’s!) • 50% of TB presentations are extra-pulmonary! • TB is a notifiable disease: need to trace all contacts for assessment and prophylactic therapy

  9. References • Wysocki A. Pozniczek M. Kulawik J. Krzywon J. Peritoneal adhesions as cause of small bowel obstruction. Przeglad Lekarski. 60 Suppl 7:32-5, 2003. • Vijay K. Anindya C. Bhanu P. Mohan M. Rao PL. Adhesive small bowel obstruction (ASBO) in children--role of conservative management. Medical Journal of Malaysia. 60(1):81-4, 2005 Mar. • Fevang BT. Fevang J. Lie SA. Soreide O. Svanes K. Viste A. Long-term prognosis after operation for adhesive small bowel obstruction. Annals of Surgery. 240(2):193-201, 2004 Aug. • Ellis H. Adhesions: the early history. Historical Article. Hospital Medicine (London). 65(6):328-9, 2004 Jun • Corfitsen MT. Hantho AF. Nilsson T. Conservative treatment of ileus caused by adhesions, with a Miller-Abbott tube. Ugeskrift for Laeger. 146(18):1360-2, 1984 Apr 30. • Totikov VZ. Kalitsova MV. Amrillaeva VM. Diagnostic and treatment program in acute adhesive obturative obstruction of the small bowel.Khirurgiia. (2):38-43, 2006.

  10. Thanks for listening! Any Questions?

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