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Difference between revisions of "Small bowel obstruction"
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'''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]], are dealt with separately. | |||
==General== | |||
*Radiologic/[[clinical diagnosis]]. | |||
The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'': | |||
*Strictures (think [[IBD]]). | |||
*Hernias. | |||
*Adhesions. | |||
*[[Volvulus]]. | |||
*Intussusception. | |||
*Neoplasia. | |||
*Gallstone ileus. | |||
The top three are:<ref>URL: [http://www.emedicine.com/EMERG/topic66.htm http://www.emedicine.com/EMERG/topic66.htm]. Accessed on: 19 April 2011.</ref><ref>{{Ref TN2007 |GS21}}</ref> | |||
* Adhesions > hernias > neoplasms. | |||
In the context of bowel obstructions and IBD, pathologists often see resected [[stoma]]s (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== | |||
<pre> | |||
SMALL BOWEL, RESECTION: | |||
- SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL | |||
NARROWING. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
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. | |||
</pre> | |||
===Ischemic changes=== | |||
<pre> | |||
SMALL BOWEL, RESECTION: | |||
- SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL | |||
MICROABSCESS FORMATION. | |||
- NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | |||
*[[Small intestine]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] | |||