Difference between revisions of "Small bowel obstruction"
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==General== | ==General== | ||
*Radiologic/[[clinical diagnosis]]. | *Radiologic/[[clinical diagnosis]]. | ||
*The conventional thinking is ''the sun should never set on a SBO in a virgin abdomen'', i.e. a laparotomy is required to exclude serious pathology in an unoperated abdomen. | |||
**Approximately 10% of virgin (or previously unoperated) abdomens (in a series from 2014) had an unknown malignancy as the underlying cause.<ref name=pmid24565365>{{Cite journal | last1 = Beardsley | first1 = C. | last2 = Furtado | first2 = R. | last3 = Mosse | first3 = C. | last4 = Gananadha | first4 = S. | last5 = Fergusson | first5 = J. | last6 = Jeans | first6 = P. | last7 = Beenen | first7 = E. | title = Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. | journal = Am J Surg | volume = 208 | issue = 2 | pages = 243-8 | month = Aug | year = 2014 | doi = 10.1016/j.amjsurg.2013.09.034 | PMID = 24565365 }}</ref> | |||
The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'': | The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'': | ||
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==Sign out== | ==Sign out== | ||
<pre> | |||
Small Bowel, Resection: | |||
- Small bowel wall with focal ischemia and fibrous adhesions, surgical | |||
margins appear viable. | |||
- NEGATIVE for significiant vascular disease in vessels examined. | |||
- NEGATIVE for malignancy. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
SMALL BOWEL, RESECTION: | SMALL BOWEL, RESECTION: | ||
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==See also== | ==See also== | ||
*[[Small intestine]]. | *[[Small intestine]]. | ||
*[[Ischemic enteritis]]. | |||
==References== | ==References== | ||
Latest revision as of 17:42, 8 September 2016
Small bowel obstruction, abbreviated SBO, is a common pathology managed by general surgeons.
This article gives an overview of SBOs. Its primary focus is benign causes of SBO that have nonspecific pathologic findings.
Specific causes definitively identified by pathology, e.g. adenocarcinoma, or by clinical history/pathology, e.g. Crohn's disease, are dealt with separately.
General
- Radiologic/clinical diagnosis.
- The conventional thinking is the sun should never set on a SBO in a virgin abdomen, i.e. a laparotomy is required to exclude serious pathology in an unoperated abdomen.
- Approximately 10% of virgin (or previously unoperated) abdomens (in a series from 2014) had an unknown malignancy as the underlying cause.[1]
The usual causes of bowel obstruction (large & small) are (mnemonic) SHAVING:
- Adhesions > hernias > neoplasms.
In the context of bowel obstructions and IBD, pathologists often see resected stomas (that were put in place emergently). These specimens are usually fairly straight forward.
Radiology
- Air-fluid levels.
Gross
- +/-Adhesions.
- +/-Bowel contorted.
- +/-Luminal narrowing +/-proximal dilation.
- +/-Serosal exudate.
- Suggestive of perforation.
Microscopic
Features:
- +/-Adhesions (serosal).
- Dense fibrous tissue replaces the adipose tissue.
- +/-Increased vascularity.
- +/-Submucosal fibrosis.
- +/-Serositis - seen in small bowel perforation.
- +/-Foreign body-type granuloma - due to previous surgical intervention.
DDx:
- Small bowel adenocarcinoma - most important differential diagnosis.
- Metastatic adenocarcinoma - classically on the serosal aspect.
- Signet ring cell carcinoma.
Sign out
Small Bowel, Resection:
- Small bowel wall with focal ischemia and fibrous adhesions, surgical
margins appear viable.
- NEGATIVE for significiant vascular disease in vessels examined.
- NEGATIVE for malignancy.
Block letters
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL NARROWING. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE), FOCAL LUMINAL NARROWING AND A FOREIGN BODY-TYPE GRANULOMA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Ischemic changes
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL MICROABSCESS FORMATION. - NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT. - NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Beardsley, C.; Furtado, R.; Mosse, C.; Gananadha, S.; Fergusson, J.; Jeans, P.; Beenen, E. (Aug 2014). "Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored.". Am J Surg 208 (2): 243-8. doi:10.1016/j.amjsurg.2013.09.034. PMID 24565365.
- ↑ URL: http://www.emedicine.com/EMERG/topic66.htm. Accessed on: 19 April 2011.
- ↑ Greenwald, J.; Heng, M. (2007). Toronto Notes for Medical Students 2007 (2007 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. GS21. ISBN 978-0968592878.