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Intestinal ObstructionNecrosisFemur Head NecrosisIschemiaHerniaHernia, InguinalDrugs, Chinese HerbalHernia, DiaphragmaticHernia, AbdominalHernia, VentralIleal DiseasesHernia, HiatalHernia, FemoralBezoarsAirway ObstructionHerniorrhaphyJejunal DiseasesIntussusceptionHernia, UmbilicalIntestinal AtresiaSurgical MeshDuodenal ObstructionLaparotomyMesenteric CystUreteral ObstructionColonic DiseasesMeconiumMeckel DiverticulumHirschsprung DiseaseHernia, ObturatorTumor Necrosis Factor-alphaTissue AdhesionsCecal DiseasesIleal NeoplasmsIntestinal VolvulusIntestinal Pseudo-ObstructionIleusTuberculosis, GastrointestinalLaparoscopyDuodenal DiseasesRadiography, AbdominalIntestine, SmallHernia, Diaphragmatic, TraumaticDigestive System Surgical ProceduresIleocecal ValveLipomaMesocolonIntestinal PerforationIleumAbdomen, AcuteColon, SigmoidPostoperative ComplicationsAbdominal PainFecal ImpactionJejunal NeoplasmsPeritoneal DiseasesPolypropylenesColon, AscendingGastric Outlet ObstructionIntestinal FistulaUrinary Bladder Neck ObstructionTreatment OutcomeUrethral ObstructionIleostomyIntestinal DiseasesNasal ObstructionEntomophthoralesVitelline DuctEnemaForeign BodiesColostomyGangreneColaTomography, X-Ray ComputedBarium SulfateVentricular Outflow ObstructionCecal NeoplasmsPetrolatumJejunumColonic Pseudo-ObstructionDuodenostomyRetrospective StudiesAbdomenAscariasisSurgical SpongesVomitingAbdominal NeoplasmsInfant, NewbornDiverticulumSuperior Mesenteric Artery SyndromeIntestine, LargeAscaris lumbricoidesAnastomosis, SurgicalDiospyrosAppendicitisDigestive System AbnormalitiesAbdominal WallDuodenumCystic FibrosisJejunostomy
Bowel obstructionPathophysiologyStrangulationClosed-loop obstructionsObturatorVolvulusVentralIschemiaComplicationsProximalAbdominal wallAdhesionsPoint of obstructionEtiologySystemicGroinProtrusionComplete obstructionAcuteSymptomsIleusExaminationAbdomenProgressesSwellingPerfusionMimicVasculatureOccurPatientsTissueAnatomicOccursAdhesiveOcclusionStomachRespiratoryInfectionFluidSurgicalIntestineSevereStoolMechanicalCommon causePartialSmallTypicallyMedialDiarrhea
Bowel obstruction11
  • So every patient who shows up with a bowel obstruction should have surgery, to prevent ischemic complications, right? (crashingpatient.com)
  • First off, the traditional terminology used to classify bowel obstruction probably should be discussed. (crashingpatient.com)
  • Partial bowel obstruction describes a patient who has dilated bowel on imaging, has nausea and vomiting, but continues to pass flatus or even stool intermittently. (crashingpatient.com)
  • Let me say a quick word about the pathophysiology of bowel ischemia in the setting of bowel obstruction. (crashingpatient.com)
  • This latter type of bowel ischemia is the reason behind the traditional dictum in surgical training to "Never let the sun rise or set on a complete bowel obstruction. (crashingpatient.com)
  • Dr. Martin Zielinski led a group of providers to create and prospectively validate a model to predict ischemic bowel obstruction. (crashingpatient.com)
  • but currently in the Western world, adhesions have become the most frequent cause of adult small bowel obstruction, accounting for 74% of cases in a series by Miller. (dermatologyadvisor.com)
  • The most frequent etiology of bowel obstruction varies by age. (dermatologyadvisor.com)
  • Scans for hyperemergent conditions such as ruptured aneurysm, aortic dissection, or high-grade bowel obstruction with suspected ischemia should not be delayed for administration of oral contrast. (radiologykey.com)
  • OBJECTIVE: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (ASBO). (bvsalud.org)
  • MATERIAL AND METHODS: A retrospective multiple-center study included 143 (85.6%) patients with ASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. (bvsalud.org)
Pathophysiology2
  • In order to highlight the pathophysiology, presentation, and natural history, however, it is useful to classify obstruction according to the location of the obstructing lesion. (basicmedicalkey.com)
  • There are multiple types of hernias based on the anatomic location and the underlying pathophysiology. (lecturio.com)
Strangulation4
  • One exception to this is a Richter's hernia, in which strangulation may occur without complete obstruction. (dermatologyadvisor.com)
  • Simple obstruction is most often due to adhesion ( A ), groin hernia ( B ), or neoplasm ( C ). The hernia can act as a tourniquet, causing a closed-loop obstruction and strangulation. (basicmedicalkey.com)
  • In this five-year study, we aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery to treat incarcerated abdominal wall hernias. (ircmj.com)
  • The presence of intraoperative ischemia and necrosis was defined as "strangulation. (ircmj.com)
Closed-loop obstructions3
  • This almost always occurs in the setting of complete obstruction and is more frequently seen with closed-loop obstructions. (dermatologyadvisor.com)
  • It is also important to distinguish between open-loop and closed-loop obstructions. (basicmedicalkey.com)
  • Examples of closed-loop obstructions are torsion of a loop of small intestine around an adhesive band ( Fig. 49-2 ), incarceration of the bowel in a hernia, volvulus of the cecum or colon, or development of an obstructing carcinoma of the colon with a competent ileocecal valve. (basicmedicalkey.com)
Obturator1
  • Most common are ventral and inguinal hernias, but internal hernias, parastomal, femoral, and obturator hernias may cause obstruction as well. (dermatologyadvisor.com)
Volvulus4
  • In the operative category, I would place the obstructions that are strangulated (by adhesions, hernia, or volvulus) as well as those that will not resolve with nonoperative therapy. (crashingpatient.com)
  • On a very basic level, and obstruction that results in, or is caused by, twisting of the mesenteric vasculature (volvulus, internal hernia, or adhesion-related mesenteric restriction) can, and often does, result in ischemic bowel. (crashingpatient.com)
  • Bowel necrosis may also result from direct compression of the blood supply, as can be seen with volvulus or with a tight hernia ring. (dermatologyadvisor.com)
  • It often results from something like a blood clot or a nearby tumor, a hernia , a volvulus , or intussusception , which blocks blood vessels supplying the small intestine. (osmosis.org)
Ventral2
  • The most common hernias encountered in surgical practice include ventral, inguinal, and femoral hernias. (lecturio.com)
  • One-third of all repaired ventral hernias are incisional hernias and the remaining two-thirds are primary ventral hernias. (lecturio.com)
Ischemia7
  • In the United States alone, there are an estimated 300,000 laparotomies performed annually for SBO, and about one third of these obstructions are complicated by intestinal ischemia, with significantly higher morbidity and mortality resulting. (crashingpatient.com)
  • And if a patient has an obstruction associated with ischemia, why does it matter whether there is anything passing out the rectum? (crashingpatient.com)
  • If effective decompression (either with surgery or with NG tube) does not occur promptly (typically around 6 hours or so), the ischemia may be irreversible, and the chance of intestinal perforation increases dramatically. (crashingpatient.com)
  • In one study, more than 50% of bowel obstructions with ischemia were misdiagnosed. (crashingpatient.com)
  • The pain of a myocardial infarction results from myocardial ischemia caused by anoxia. (rnpedia.com)
  • Small bowel refers to the small intestine and infarction is when ischemia , which is an inadequate blood supply, causes necrosis, or tissue death. (osmosis.org)
  • INTRODUCTION: To identify factors associated with irreversible transmural necrosis (ITN) among critically ill patients experiencing nonocclusive mesenteric ischemia (NOMI) and to compare the predictive value regarding ITN risk stratification with that of the previously described Clichy score. (bvsalud.org)
Complications3
  • Although uncommon, femoral hernias are frequently associated with complications, secondary to the small size of the canal, leading to hernia Hernia Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. (lecturio.com)
  • Dai W, Chen Z, Zuo J, Tan J, Tan M, Yuan Y. Risk factors of postoperative complications after emergency repair of incarcerated groin hernia for adult patients: a retrospective cohort study. (ircmj.com)
  • Complications may include necrosis and ulcers of the rectal tissue. (iiab.me)
Proximal7
  • As an obstruction progresses, the bowel proximal to the point of obstruction becomes progressively more dilated over time as the succus and GI secretions accumulate. (crashingpatient.com)
  • The femoral ring is the proximal or abdominal/pelvic opening of the femoral canal. (lecturio.com)
  • As the stomach and small intestine proximal to the obstruction dilate, patients experience nausea and vomiting and cease oral intake. (dermatologyadvisor.com)
  • The proximal small bowel is normally relatively sterile, but with a high grade or complete obstruction, bacterial overgrowth with anaerobes such as Bacteroides may result in feculent vomiting. (dermatologyadvisor.com)
  • Proximal or "high" obstructions involve the pylorus, duodenum, and proximal jejunum. (basicmedicalkey.com)
  • Distal levels of obstruction arise in the distal ileum, ileocecal valve, and proximal colon whereas the most distant or "low" obstructions would arise in regions beyond the transverse colon. (basicmedicalkey.com)
  • An open-loop obstruction occurs when intestinal flow is blocked but proximal decompression is possible through vomiting. (basicmedicalkey.com)
Abdominal wall9
Adhesions2
  • Because the most common cause of SBO is post-operative adhesions, and each subsequent exploration carries a higher risk of unintentional damage to the intestine, surgical exploration therefore should be reserved for patients who absolutely need it. (crashingpatient.com)
  • Adhesions are the most common cause of intestinal obstruction, accounting for more than half of all cases. (basicmedicalkey.com)
Point of obstruction2
  • In a simple obstruction there is a single point of obstruction, whereas a closed-loop obstruction is caused by two distinct points of obstruction. (dermatologyadvisor.com)
  • A complete obstruction is present if there is no passage of intestinal contents beyond the point of obstruction, whereas a partial obstruction allows for the passage of some contents distal to the obstruction. (dermatologyadvisor.com)
Etiology1
Systemic2
Groin2
Protrusion3
  • A femoral hernia Hernia Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. (lecturio.com)
  • Hernias are most commonly diagnosed on physical exam (abnormal bulge or protrusion), but imaging studies can sometimes be helpful for a definitive diagnosis. (lecturio.com)
  • A hernia is an abnormal protrusion of the abdominal contents through a weakness or defect along the wall of the abdomen. (lecturio.com)
Complete obstruction1
  • A complete obstruction has all the same signs and symptoms except for passage of flatus or stool. (crashingpatient.com)
Acute2
Symptoms5
  • As shown in Table 49-2 , clinical symptoms and signs of obstruction (pain, vomiting, abdominal distention, and gas pattern on abdominal radiographs) vary with the level of obstruction. (basicmedicalkey.com)
  • The primary symptoms of a closed-loop obstruction of the small intestine are sudden, severe midabdominal pain and vomiting whereas symptoms of the large intestine are pain and sudden abdominal distention. (basicmedicalkey.com)
  • Pernicious anemia results from the failure to absorb vitamin B12 in the GI tract and causes primarily GI and neurologic signs and symptoms. (rnpedia.com)
  • Severe jaundice suggests another cause of symptoms such as choledocholithiasis . (wikizero.com)
  • [2] The pseudodiverticulae themselves rarely cause symptoms, and treatment is not directed toward them. (mdwiki.org)
Ileus1
Examination2
  • Hernias may be detected on routine physical examination, or patients with hernias may present because of a complication associated with the hernia. (medscape.com)
  • History and physical examination remain the best means of diagnosing hernias. (medscape.com)
Abdomen1
  • [13] Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes severe pain ( Murphy's sign ). (wikizero.com)
Progresses1
Swelling1
  • More common in adults than in children, femoral hernias usually present with swelling Swelling Inflammation that protrudes into the femoral triangle (inferiorly to the inguinal ligament and medial to the femoral vein). (lecturio.com)
Perfusion2
  • If the bowel is not healthy (history of IBD, prior surgery, radiation, etc.), or if the dilation happens quickly, the luminal pressures exceed the perfusion pressure of the intestinal capillary network, and blood flow stops. (crashingpatient.com)
  • Stasis of luminal content favors bacterial overgrowth, alters intestinal fluid transport properties and motility, and causes variations in intestinal perfusion and lymph flow. (basicmedicalkey.com)
Mimic1
  • Knowledge of these hernias (usual and unusual) and of protrusions that mimic them is an essential component of the armamentarium of the general and pediatric surgeon. (medscape.com)
Vasculature1
  • Any obstruction of the venous vasculature of the liver is referred to as Budd-Chiari syndrome, from the venules to the right atrium . (wikipedia.org)
Occur1
Patients3
  • Malignant tumors are the second-most common cause of SBO, with as many as 42% of women with ovarian carcinoma developing SBO and 28% of patients with advanced colorectal carcinoma. (dermatologyadvisor.com)
  • The cause of Budd-Chiari syndrome can be found in more than 80% of patients. (wikipedia.org)
  • But too few patients seek 2nd opinions, and it's causing issues for both employees and employers. (surgerysecondopinion.com)
Tissue1
Anatomic2
  • Anatomic locations for various hernias. (medscape.com)
  • [4] In the 15th century, anatomic dissection was repeatedly used by the Italian physician Antonio Benivieni (1443-1502) to determine cause of death. (bionity.com)
Occurs3
  • Pain is usually colicky and poorly localized due to visceral distention of the intestine that occurs as it contracts against an obstruction. (dermatologyadvisor.com)
  • A closed-loop obstruction occurs when inflow to the loop of bowel and outflow from the loop are both blocked. (basicmedicalkey.com)
  • A positive Kernig's sign, seen in meningitis, occurs when an attempt to flex the hip of a recumbent patient causes painful spasms of the hamstring muscle and resistance to further extension of the leg at the knee. (rnpedia.com)
Adhesive1
  • The laparoscopic approach results in a lower incidence of adhesive obstruction in many procedures but not in appendectomy and not clearly in colorectal surgery. (dermatologyadvisor.com)
Occlusion1
  • [1] [2] The condition is caused by occlusion of the hepatic veins (usually due to a blood clot ) that drain the liver . (wikipedia.org)
Stomach2
  • Travelers' diarrhea ( TD ) is a stomach and intestinal infection. (wikipedia.org)
  • Many people experience a burning sensation in their chest occasionally, caused by stomach acids refluxing into the esophagus , normally called heartburn. (cloudfront.net)
Respiratory1
  • In burn victims, the leading cause of death is respiratory compromise. (rnpedia.com)
Infection1
Fluid1
  • When a loop of bowel becomes obstructed, intestinal gas and fluid accumulate. (basicmedicalkey.com)
Surgical1
  • This ecology can be disturbed by antibiotic therapy or by surgical reconstructions that result in stasis within intestinal segments. (basicmedicalkey.com)
Intestine2
  • Intermediate levels of obstruction involve the intestine from the midjejunum to the midileum. (basicmedicalkey.com)
  • So, a small bowel infarction happens when there's a reduced blood supply to the small intestine causing parts of the intestinal wall to necrose or die which can be life threatening. (osmosis.org)
Severe1
  • Osmotic laxatives can cause cramping and even severe pain as the patient's attempts to evacuate the contents of the rectum are blocked by the fecal mass. (iiab.me)
Stool2
  • The team showed that three signs are associated with an ischemic obstruction: obstipation (no flatus or stool for 24 hours), mesenteric edema on CT scan, and absence of small bowel feces sign on CT. (crashingpatient.com)
  • There can be fecal incontinence and paradoxical or overflow diarrhea ( encopresis ) as liquid stool passes around the obstruction. (iiab.me)
Mechanical2
Common cause3
  • The most common cause is due to acquired hypercoagulability associated with myeloproliferative disorders (accounting for 40-50% of cases). (wikipedia.org)
  • Spinal cord injury is a common cause. (iiab.me)
  • The most common cause of esophageal varices is from aging changes in the vessels. (en-academic.com)
Partial1
  • But how reliably can a surgeon categorize bowel obstructions as complete or partial? (crashingpatient.com)
Small1
  • SBO can also be caused by small intestinal tumors such as carcinoid, lymphoma, and small bowel adenocarcinoma. (dermatologyadvisor.com)
Typically1
  • Treatment typically involves addressing the underlying cause and restoring blood flow to the affected area, using medications or surgery. (osmosis.org)
Medial2
  • The femoral canal is a cylindrical space, making up the medial compartment enclosed within the femoral sheath. (lecturio.com)
  • The femoral triangle is located on the medial aspect of the anterior thigh Thigh The thigh is the region of the lower limb found between the hip and the knee joint. (lecturio.com)
Diarrhea1
  • Blood or mucus in the diarrhea, significant abdominal pain, or high fever suggests a more serious cause, such as cholera , characterized by a rapid onset of weakness and torrents of watery diarrhea with flecks of mucus (described as "rice water" stools). (wikipedia.org)