Bowel Obstruction Causes And Symptoms. What Is A Bowel Obstruction? Bowel Obstruction Small Bowel Obstruction. This website uses cookies to help provide visitors to our site with the best user experience possible. Click the 'I Accept' button to acknowledge you understand our cookie policy and are happy for our site to place cookies on your computer. If the obstruction is caused by a twisting of the sigmoid area of the large intestine, a doctor may try to straighten out the twisting segment with lighted instruments such as a proctoscope or sigmoidoscope or a barium enema.
But surgery is sometimes needed to fix twisting of the intestine. Surgery is recommended for twisting of the cecum of the large intestine. Doctors may try several treatments. The blocked section can be removed and the ends reattached.
In another type of surgery, the cecum can be attached to the abdominal belly wall so that it won't twist cecopexy. Mesenteric rotation torsion causes vascular insufficiency, and resultant ischemia and tissue hypoxia. Depending on the etiology, intestinal volvulus may present as a closed-loop obstruction in which a segment of bowel is occluded at two points along its length, resulting in fluid sequestration and gas production due to bacterial overgrowth.
Substantial increases in intraluminal pressure and dilation of the bowel segment further compromise vascular supply to the intestinal wall, ultimately leading to hemorrhagic infarction and perforation [ 10 ]. In our case, the fibrous band acted as a point of strangulation resulting in the necrosis of the small bowel.
If an extensive segment of bowel is involved, large volumes of blood and plasma are extravasated into the intestinal wall and lumen [ 12 ]. Gut bacteria are introduced into the lymphatics and capillaries as mucosal integrity is lost, potentially leading to septic shock, multiorgan failure, and death.
Patients with SBV may present with colicky abdominal pain, nausea, vomiting, abdominal distention, and obstipation [ 13 ]. However, as seen with this case, some of these symptoms may be blatantly present and others may be more subtle or absent entirely.
In addition, certain physical exam findings such as tachycardia and rebound tenderness as well as abdominal radiography yield nonspecific results that do not differentiate this disease process from other causes of small bowel obstruction [ 1 , 6 ].
The clinician must utilize multislice CT with contrast to achieve visualization of the underlying pathology [ 1 ]. Also, three-dimensional reconstruction of abdominal angiography can delineate the features of the mesenteric vessels [ 7 ].
It is uncertain why neither emergency department chose to use this imaging modality, which may have produced a better outcome. Typically, when a patient requires opioid management, further workup is initiated to identify the underlying etiology.
The sensitivity and specificity of the whirl sign in the diagnosis of SBV are variable; while not pathognomonic, it remains a useful finding [ 4 , 8 , 14 ]. In addition, Sandhu et al. Emergent surgical intervention is necessary to avoid ischemic necrosis or perforation of the bowel [ 1 , 5 ].
Exploratory laparotomy can be performed to confirm the diagnosis and guide further decision-making [ 16 ]. According to Grasso et al. Most authors agree that resection is required for necrotic bowel [ 1 — 5 , 9 ]. In the absence of necrosis, if the bowel appears to be edematous or congested, simple derotation, with or without fixation of the involved small bowel, may be considered. However, this procedure is associated with recurrence of SBV [ 9 ].
Patient-specific factors such as age, comorbidities, and general health play a role in the decision of which treatment option to pursue [ 3 ]. Immediate surgical intervention is highly encouraged to prevent adverse outcomes including peritonitis, sepsis, and death [ 2 ]. In summary, clinical clues to the diagnosis of SBV are often nonspecific, which is why the clinician must always consider the differential diagnosis of SBV in cases of acute abdominal pain.
Often, abdominal pain will precede alterations in laboratory blood work results by hours. In this case, causes for concern included the history of unremitting abdominal pain for at least 15 hours, vomiting, the abdominal exam findings, and an absolute neutrophilia on presentation to the first emergency department. When evaluating acute abdominal pain, a CT scan may be more useful than ultrasound in providing evidence of etiology or anatomic localization. Surgical exploration is indispensable to confirm the diagnosis of SBV and prevent excess morbidity or mortality as was the result with our patient.
In our case, the fibrous band causing volvulus was located at the mesenteric root of the ischemic segment of jejunum. While a congenital band is rare in adults, we favor this interpretation of the etiology of volvulus in our patient for two reasons. In conclusion, it was the lack of proper imaging that prevented the diagnosis of SBV in our patient, which resulted in her death.
If a CT scan had been performed, she may have undergone surgery for small bowel detorsion or resection, which could have saved her life. The authors declare that there is no conflict of interests regarding the publication of this paper.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Some children with intestinal malrotation are born with other associated conditions, including:. An intestinal blockage can prevent the proper passage of food.
So one of the earliest signs of malrotation and volvulus is abdominal pain and cramping, which happen when the bowel can't push food past the blockage. Vomiting is another symptom of malrotation, and it can help the doctor determine where the obstruction is.
Vomiting that happens soon after the baby starts to cry often means the blockage is in the small intestine; delayed vomiting usually means it's in the large intestine. The vomit may contain bile which is yellow or green or may resemble feces. If volvulus or another intestinal blockage is suspected, the doctor will examine your child and then may order X-rays , a computed tomography CT scan , or an abdominal ultrasound. The doctor may use barium or another liquid contrast agent to see the X-ray or scan more clearly.
The contrast can show if the bowel has a malformation and can usually find where the blockage is. Adults and older kids usually drink barium in a liquid form. Infants may need to be given barium through a tube inserted from the nose into the stomach, or sometimes are given a barium enema, in which the liquid barium is inserted through the rectum.
Treating significant malrotation almost always requires surgery. The timing and urgency will depend on the child's condition. If there is already a volvulus, surgery must be done right away to prevent damage to the bowel. Any child with bowel obstruction will need to be hospitalized.
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