Early post-operative intestinal obstruction after gynaecological surgery.

Abstract

Summary: Always consider the possibility of mechanical obstruction in the early postoperative period, even though the symptomatology is atypical. Do not be misled into thinking it is a case of paralytic ileus just because pain is absent or insignificant. Paralytic ileus does not recur. If there is recurrent vomiting or distension think of a mechanical cause. Check the serum electrolyte levels and give intravenous potassium if indicated. Re‐examine the patient frequently and take particular note of the pulse. Take repeated x‐rays of the abdomen, as they will often show whether the obstruction is progressing or not. Remember that oral Gastrografin will often reach the caecum in six hours if the bowel is not mechanically obstructed. Strangulating obstruction is not uncommon, occurs particularly in the first week and carries a high mortality. Use continuous suction in preference to intermittent suction because the former removes air as well as liquid. Do not imagine that suction decompression will be effective in all cases. Remember the indications to re‐open the abdomen: the slightest suspicion of strangulation; signs that the obstruction is not relenting. Decompression of the small bowel at operation is safe and effective.