Severe Colicky type Central abdominal pain

Saturday, December 26, 2009
This is the erect abdominal X-ray of a man who was complaining of Severe colicky type central abdominal pain.Comment on this X-Ray?


ANSWER -Small Intestinal Obstruction

Intestinal obstruction may be described variously as:
  • simple - lumen obstructed, blood supply intact
  • strangulated - blood supply occluded
  • closed loop - both limbs of loop are obstructed
  • partial or complete
Small bowel obstruction is mainly due to
  • incarcerated hernia
  • adhesions 
 
CLINICAL FEATURES
Cardinal symptoms
  • Vomiting
  • Colicky abdominal Pain
  • Abdominal Distention- visible peristalsis may be present
  • Absolute constipation
INVESTIGATIONS
Routine bloods for any disturbances caused by the obstruction
Abdominal radiographs:
supine - may show which piece of gut is obstructed
erect - may show fluid levels



TREATMENT
  • The patient is kept nil by mouth
  • given intravenous fluids
  • A nasogastric tube is placed - minimize the risk of aspiration of gastric content
  • Pain relief is given
  • Antibiotic prophylaxis against sepsis
  • If peritonism is absent,  conservative Mx for two or three days

Indications for immediate surgery in small intestine obstruction:
  • crescendo pain
  • localised peritonism, implying perforation or ischaemia
  • "closed loop" seen radiologically
  • obstruction occurring as a result of hernial incarceration

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4 comments

  1. Anonymous Says:
  2. Complete Large Intestinal Obstruction

     
  3. Anonymous Says:
  4. I think small intestine the first anses are big

     
  5. shameel Says:
  6. Intestinal Obstruction

     
  7. Anonymous Says:
  8. small intestinal obstruction..

     

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