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A D V E R T I S E M E N T
A D V E R T I S E M E N T
Adhesions may be a simple cord-like band that creates and internal hernia when bowel loops slip beneath it, or may be widespread and cause kinking and recurrent obstruction. The former situation may be relieved when the loop of bowel extricates itself by by its contractions. Kinked bowel may become obstructed by undigested fibrous vegetable matter (see the other Chinese restaurant syndrome), and the resulting obsruction may be relieved when the blockage breaks up. Gastrografin, by stimulating peristalsis, may assist in this process. Thus many obstructions may resolve with non-operative management.
A D V E R T I S E M E N T
It requires surgical judgment and a time limit to operate when resolution is no longer likely and before a loop of bowel becomes compromised and an acute abdomen results. With a complete obstruction, a bowel loop may become compromised as early as 6 hours from onset (see intestinal obstruction with bowel resection.)
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A D V E R T I S E M E N T
Focal conditions such as appendicitis (see appendectomy, atypical appendicitis, urinary symptoms, atypical appendicitis, diarrhea, perforated appendicitis, perforated appendicitis, and ugly appendix) and Meckel's diverticulitis (see intestinal obstruction from Meckel's band) can present with an urgent need for surgical correction before perforation occurs. Appendicitis occurs most commonly in children and young adults. Young children, elderly, and immunocompromised are most at risk for developing rupture and generalized peritonitis in a shorter time than the 48-hour course of adults. Unrecognized rupture of a walled-off appendicitis can lead to abscess (see pelvic abscess following appendectomy.) CT or US-guided drainage is now the initial treatment followed by interval appendectomy at 6 weeks.
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This page was last modified on 4/28/2006.
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