Intestinal Obstruction



Intestinal Obstruction


Joseph Tjan





A 73-year-old woman with an acute abdomen was scheduled to undergo an emergency exploratory laparotomy. She complained of severe abdominal pain with periodic bouts of bilious vomiting. Her past surgical history included a right hemicolectomy for colon cancer. She had a blood pressure of 85/60 mm Hg, pulse of 115 beats per minute, and hematocrit of 45%.


A. Medical Disease and Differential Diagnosis



  • What is the differential diagnosis of the acute abdomen?


  • What are the causes of intestinal obstruction of the small bowel and of the large bowel?


  • Differentiate between simple and strangulated bowel obstruction.


  • Is it important to differentiate whether the bowel obstruction is located in the small bowel or large bowel? Why?


  • What are the signs and symptoms of intestinal obstruction?


  • What are the causes and effects of bowel distention?


  • Describe the fluid shifts during small bowel intestinal obstruction.


  • Discuss the systemic derangements that occur with intestinal obstruction.


  • Can there be actual losses of red cell mass?


  • What is an ileus? Discuss its causes and treatment.


  • What are the systemic effects from the absorption of bacteria and bacterial products?


B. Preoperative Evaluation and Preparation



  • Is it important to decompress the abdomen before surgical intervention? Why?


  • Describe the respiratory implications.


  • What are the implications of the tense abdominal wall?


  • Outline the methods of abdominal decompression.


  • Discuss the goals of fluid management.


  • What would you use as a guide to fluid volume replacement?


C. Intraoperative Management



  • What dangers are present during induction? How are they planned for?


  • Does the administration of antacids and/or histamine-2 (H2) blockers before the induction of anesthesia have a significant value in patients with small bowel obstruction?



  • In what position would you intubate this patient?


  • Is succinylcholine the best muscle relaxant to use for the rapid sequence induction?


  • Would you remove or leave the nasogastric tube (NGT) in place before inducing anesthesia?


  • Would you use nitrous oxide in this patient?


  • Are there any benefits to using a high concentration of inspired oxygen?


D. Postoperative Management

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Mar 18, 2021 | Posted by in ANESTHESIA | Comments Off on Intestinal Obstruction

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