Small bowel obstruction
小结
定义
病史和体格检查
关键诊断因素
- abdominal pain
- constipation/failure to pass flatus or stool
- vomiting
- abdominal distention
- abdominal tenderness
- peritonitis
- presence of risk factors
- palpable abdominal mass
其他诊断因素
- nausea
- fever
- tachycardia
- tachypnea
- severe lethargy
- hypotension
- diarrhea
- groin swelling
危险因素
- previous abdominal surgery
- intestinal malignancy
- malrotation
- Crohn disease
- hernia
- intussusception
- volvulus
- intestinal atresia
- appendicitis
- foreign body ingestion
诊断性检查
首要检查
- abdominal CT scan
- CBC
- BUN
- electrolyte panel
需考虑的检查
- abdominal x-rays
- water-soluble contrast study
- laparotomy/laparoscopy
- abdominal ultrasound
- abdominal MRI
治疗流程
complicated or strangulated SBO: surgical candidate
complicated or strangulated SBO: surgery not indicated
simple SBO
撰稿人
专家顾问
Adrian Maung, MD, MBA, FACS, FCCM
Associate Professor of Surgery
Division of General Surgery, Trauma and Surgical Critical Care
Department of Surgery
Yale School of Medicine
New Haven
CT
利益声明
AM declares that he has no competing interests.
鸣谢
Dr Adrian Maung would like to gratefully acknowledge Dr John T. Jenkins, Dr Edward T. Pring, Dr George Malietzis, Dr Frances J. McNicol, and Dr David J. Hackam, previous contributors to this topic.
利益声明
JTJ , ETP, GM, FJM, and DJH declare that they have no competing interests.
同行评议者
Steven D. Wexner, MD, FACS, FRCS, FRCS (Ed)
Chief Academic Officer
Emeritus Chief of Staff (1997-2007)
Chairman Department of Colorectal Surgery
Professor of Surgery Ohio State University
Affiliate Professor Department of Surgery
Division of General Surgery
University of South Florida College of Medicine
Cleveland Clinic Florida
FL
利益声明
SDW declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Maung AA, Johnson DC, Piper GL, et al; Eastern Association for the Surgery of Trauma. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 suppl 4):S362-9.全文 摘要
Jackson P, Vigiola Cruz M. Intestinal obstruction: evaluation and management. Am Fam Physician. 2018 Sep 15;98(6):362-7. 摘要
American College of Radiology. ACR appropriateness criteria: suspected small-bowel obstruction. 2019 [internet publication].全文
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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