|
|
|
Intra-abdominal causes Intraperitoneal problems Peritonitis or abscess Inflammatory condition Mechanical: operation, foreign body Chemical: gastric juice, bile, blood Autoimmune: serositis, vasculitis Intestinal ischemia: arterial or venous, sickle-cell disease Retroperitoneal problems Pancreatitis Retroperitoneal hematoma Spine fracture Aortic operation Renal colic Pyelonephritis Metastasis Extra-abdominal causes Thoracic problems Myocardial infarction Pneumonia Congestive heart failure Rib fractures Metabolic abnormalities Electrolyte imbalance (e.g., hypokalemia) Sepsis Lead poisoning Porphyria Hypothyroidism Hypoparathyroidism Uremia Medicines Opiates Anticholinergics Alpha agonists Antihistamines Catecholamines Spinal cord injury or operations Head, thoracic, or retroperitoneal trauma Chemotherapy, radiation therapy
Extrinsic causes Adhesions* Hernias (external, internal [paraduodenal], incisional)* Metastatic cancer* Volvulus Intra-abdominal abscess Intra-abdominal hematoma Pancreatic pseudocyst Intra-abdominal drains Tight fascial opening at stoma Intraluminal causes Tumors* Gallstones Foreign body Worms Bezoars Intramural abnormalities Tumors Strictures Hematoma Intussusception Regional enteritis Radiation enteritis
* Approximately 85% of all small bowel obstructions are secondary to adhesions, hernias, or tumors.
Common causes Cancer (primary, anastomotic, metastatic) Volvulus Diverticulitis Pseudo-obstruction Hernia Anastomotic stricture Unusual causes Intussusception Fecal impaction Strictures (from one of the following) Inflammatory bowel disease Endometriosis Radiation therapy Ischemia Foreign body Extrinsic compression by a mass Pancreatic pseudocyst Hematoma Metastasis Primary tumors
Situations necessitating emergent operation Incarcerated, strangulated hernias Peritonitis Pneumatosis cystoides intestinalis Pneumoperitoneum Suspected or proven intestinal strangulation Closed-loop obstruction Nonsigmoid colonic volvulus Sigmoid volvulus associated with toxicity or peritoneal signs Complete bowel obstruction Situations necessitating urgent operation Progressive bowel obstruction at any time after nonoperative measures are started Failure to improve with conservative therapy within 24-48 hr Early postoperative technical complications Situations in which delayed operation is usually safe Immediate postoperative obstruction Sigmoid volvulus successfully decompressed by sigmoidoscopy Acute exacerbation of Crohn disease, diverticulitis, or radiation enteritis Chronic, recurrent partial obstruction Paraduodenal hernia Gastric outlet obstruction Postoperative adhesions Resolved partial colonic obstruction