accurate but involves radiation exposure. The ultrasound will sometimes be complicated by intestinal gases. The mortality rate is more than 50 percent if there is no treatment. If treated surgically, the mortality rate is less than one percent. The treatment is largely surgical but IV fluids and antibiotics play a role. Patients who have inflammatory bowel disease of the cecum should not have surgical excision. Third generation cephalosporins are most commonly used prior to surgery.
BOWEL OBSTRUCTION A bowel obstruction or intestinal obstruction is a mechanical blockage of the intestines with limited passage of intra-intestinal contents through the intestinal lumen. Patients will have a lack of flatus, obstipation, crampy pain, and vomiting. It can involve the large or small intestine. Most partial obstructions do not require surgery, while 85 percent of complete obstructions require surgery. The most common causes of obstruction include adhesions, tumors, and hernias. In the postoperative patient, adhesions are the most common cause of this problem. Other less common causes include intussusception, diverticulitis, volvulus, foreign bodies, and fecal impaction. If the obstruction is purely mechanical, it is rare to have vascular compromise. Fluid, secretions, and food will accumulate above the level of obstruction with distention of proximal bowel. There will be congestion and edema of the bowel, which progresses the problem. If the blood flow strangulates the bowel, this can lead to perforation secondary to gangrene. Perforation can be segmental in an ischemic segment; perforation can also be secondary to marked dilation of the intestine above the obstruction. Small bowel obstruction happens quickly, with periumbilical or epigastric pain, obstipation, and vomiting. Partial obstruction often leads to diarrhea. Steady pain suggests strangulation. Listen for hyperactive and high-pitched bowel sounds. Dilated loops of bowel may be palpable. If there is infarction, the bowel will be silent; late findings are oliguria and shock.
16
