In Brief

Abstract

<dm:abstracts xmlns:dm="http://www.elsevier.com/xml/dm/dtd"><ce:abstract xmlns:ce="http://www.elsevier.com/xml/common/dtd" id="abs0001" view="all" class="author"><ce:section-title id="cesectitle0001">In brief </ce:section-title><ce:abstract-sec id="abss0001" view="all"><ce:simple-para id="spara0001" view="all">Intestinal obstruction accounts for approximately 15% of all acute abdominal pain. Whereas the mainstay of management has historically been operative intervention, non-operative management, consisting of observation, pharmacologic, and endoscopic therapy, continues to assume a more prominent role, especially depending on the underlying cause of the obstruction. In addition to relying upon the history of present illness to start devising the differential diagnosis and plan of care, there is increasing reliance on radiographic imaging as a means to determine the cause of the obstruction and probability of success with non-operative management.</ce:simple-para><ce:simple-para id="spara0002" view="all">Whereas the diagnostic work-up of patients with suspected bowel obstruction has traditionally started with an abdominal x-ray series, there is an increasing role for initial computerized tomography (CT) in evaluating these patients. This modality allows for identification of both the cause and severity of bowel obstruction in many, if not most, cases. Enteral contrast was thought to be necessary for adequate diagnostic yield, but studies have found that administration of oral contrast delays imaging and does not contribute significantly to diagnostic yield. Specific findings on CT scan are associated with failure of non-operative management, and therefore increased mortality and morbidity, due to a delay to operative intervention. Such findings include: a closed loop obstruction, volvulus (particularly small bowel), ischemic changes, and bowel perforation. Moreover, bowel obstruction due to a hernia, either external or internal, is not likely to resolve without intervention. In this review we will cover the various causes, evaluation and treatment of small and large bowel obstruction.</ce:simple-para></ce:abstract-sec></ce:abstract></dm:abstracts>