Small bowel obstruction
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- constipation/failure to pass flatus or stool
- risk factors
- intermittent abdominal pain
- vomiting
- abdominal distention
- abdominal tenderness
- abdominal mass
- palpable rectal mass
- peritonitis
Outros fatores diagnósticos
- pyrexia
- nausea (with or without vomiting)
- tachycardia
- groin swelling
Fatores de risco
- previous abdominal surgery
- malrotation
- Crohn's disease
- hernia
- appendicitis
- intestinal malignancy
- intussusception
- volvulus
- intestinal atresia
- foreign-body ingestion
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- computed tomography
- water-soluble contrast study
- arterial blood gases (including lactate)
- full blood count
- electrolytes
- C-reactive protein
- urea/creatinine ratio
- serum lipase or amylase
- glucose
- clotting, group and save, or cross-match
Investigações a serem consideradas
- urine or serum beta–human chorionic gonadotrophin (HCG)
- urinalysis
- ECG
- magnetic resonance imaging
Algoritmo de tratamento
complete or complicated small bowel obstruction: surgery indicated
complete or complicated small bowel obstruction: surgery not indicated
incomplete small bowel obstruction or complete without complications
Colaboradores
Consultores especialistas
John Abercrombie, FRCS
General and Colorectal Surgeon
Queen’s Medical Centre
Nottingham
UK
Biografia
JA is Clinical Lead for General Surgery, Getting It Right First Time.
Declarações
JA is trustee and council member of the Royal College of Surgeons of England.
Neena Randhawa, BSc (Hon), MSc, MBChB, FRCS
Consultant Colorectal Surgeon
Royal Victoria Infirmary
Newcastle-upon-Tyne
UK
Declarações
NR declares she has no competing interests.
Agradecimentos
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
John T. Jenkins MD
Consultant Colorectal Surgeon
Department of Coloproctology
St. Mark's Hospital
London
UK
Disclosures: JTJ declares that he has no competing interests.
Edward T. Pring BSc(Hons), MBChB, MRCS
Surgical Registrar and Clinical Research Fellow
St. Mark's Hospital
London
UK
Disclosures: ETP declares that he has no competing interests.
George Malietzis
MBBS, MSc, MRCS
Honorary Clinical Lecturer
Department of Surgery and Cancer
Imperial College London
UK
Disclosures: GM declares that he has no competing interests.
Revisores
Malcolm McFall, FRCS
Consultant Colorectal Surgeon
Western Sussex Hospitals NHS Foundation Trust
Chichester
West Sussex
UK
Declarações
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Ten Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the World Society Of Emergency Surgery ASBO working group. World J Emerg Surg. 2018 Jun 19;13:24.Texto completo Resumo
Ceresoli M, Coccolini F, Catena F, et al. Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value. Am J Surg. 2016 Jun;211(6):1114-25. Resumo
Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management. Am Fam Physician. 2018 Sep 15;98(6):362-7. Resumo
Eugene N, Oliver CM, Bassett MG, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. Br J Anaesth. 2018 Oct;121(4):739-748.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Ileus
- Infectious gastroenteritis
- Large bowel obstruction
Mais Diagnósticos diferenciaisDiretrizes
- Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update
- Commissioning guide: emergency general surgery (acute abdominal pain)
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