Causes of loud hyperactive bowel sounds8/16/2023 Evidence of vascular compromise or perforation, or failure to resolve with adequate nonoperative management is an indication for surgical intervention.Ī closed-loop obstruction should be treated as a surgical emergency.Ī closed-loop obstruction may quickly lead to compromised arterial flow, ischemia, necrosis, and ultimately perforation.Ībdominal radiography is an appropriate initial examination in patients with suspected intestinal obstruction.Īlthough CT has greater sensitivity and specificity, plain radiography may be considered as an initial diagnostic option, particularly in patients who are hemodynamically unstable or unable to undergo cross-sectional imaging, or who have equivocal clinical findings.ĬT with intravenous or enteric contrast media is recommended in patients with suspected intestinal obstruction.ĬT can reliably determine the cause of obstruction and associated complications.Īdmission to or consultation with a surgical service should occur upon diagnosis of intestinal obstruction. Patients with fever and leukocytosis should receive antibiotic coverage against gram-negative organisms and anaerobes. Management of uncomplicated obstructions includes intravenous fluid resuscitation with correction of metabolic derangements, nasogastric decompression, and bowel rest. Imaging with abdominal radiography or computed tomography can confirm the diagnosis and assist in decision making for therapeutic planning. Laboratory evaluation should include a complete blood count, metabolic panel, and serum lactate level. Abdominal distension, tympany to percussion, and high-pitched bowel sounds are classic findings. The clinical presentation generally includes nausea, emesis, colicky abdominal pain, and cessation of passage of flatus and stool, although the severity of these clinical symptoms varies based on the acuity and anatomic level of obstruction. It is most commonly induced by intra-abdominal adhesions, malignancy, and herniation. Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause.
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