History

Fact Explanation
Commonly occurs in infants Duodenum is the first part of the intestine, and the contents from stomach, the gall bladder, and the pancreas are entered into this. Obstruction is seen mainly near pylorus. When obstruction occurs, passage of food from the stomach doesn't occur. This can occur in adults as well as in infants. In infants under development of the duodenum called duodenal hypoplasia, a narrowed duodenal lumen, which is called duodenal stenosis, and a malformed duodenal lumen, which is called duodenal atresia are common causes and Malrotation or coiling of the duodenum is also a common cause of obstruction as well as volvulus. Malrotation can be caused by Ladd's bands which are congenital bands of fibrous tissue which causes duodenal obstruction. In adults, ingestion of a foreign object, gallstones, Inflammation or infection due to diverticulitis and Crohn's disease are common causes of duodenal obstruction. Benign or malignant tumors, Scarrring due to peptic ulcer disease are also considered as a common causes of obstruction. Rarely Wilkie syndrome or superior mesentric artery syndrome can occur. [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]
Abdominal pain [3] [4] [5] [6] [7] Pain is intermittent and perumbilical. But when it progresses to strangulation, pain becomes severe and constant. [3] [4] [5] [6] [7]
Nausea and Vomiting [1] [3] [4] [5] [7] The vomit will be green in color due to the presence of bile and this is due to reflux of food contents back to the stomach due to distal obstruction which causes nausea and vomiting. [1] [3] [4] [5] [7]
Abdominal Distension [3] [4] [5] Because these food contents which are not digested properly get accumulated, abdomen gets distended [3] [4] [5]
Bowel palpitations [3] [4] [5] Rapd peristaltic contractions, which can make it feel like there are palpitations [3] [4] [5]
Changes in bowel habits [3] [4] [5] Complete obstruction can result in constipation as well as the inability to pass flatus. But partial obstruction may allow liquids to pass and might cause diarrhea [3] [4] [5]
Symptoms in infants [2] [3] [7] Duodenal atresia produces billous vomiting within hours of birth. When there's hypertrophic pyloric stenosis, there's projectile vomiting which is non billious. [2] [3] [7]
References
  1. DAN D, COLLURE DW, HOOVER EL. Bouveret's syndrome: revisiting gallstone obstruction of the duodenum. J Natl Med Assoc [online] 2003 Oct, 95(10):969-973 [viewed 12 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594488
  2. AL SHAHWANI N., MANDHAN P., ELKADHI A., ALI M. J., LATIF A.. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis. Journal of Surgical Case Reports [online] December, 2013(12):rjt108-rjt108 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt108
  3. EKSARKO P., NAZIR S., KESSLER E., LEBLANC P., ZEIDMAN M., ASARIAN A. P., XIAO P., PAPPAS P. J.. Duodenal web associated with malrotation and review of literature. Journal of Surgical Case Reports [online] December, 2013(12):rjt110-rjt110 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt110
  4. CRUZ RUY J, VINCENZI RODRIGO, KETZER BERNARDO M. Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report. Array [online] 2010 December [viewed 14 August 2014] Available from: doi:10.1186/1749-7922-5-23
  5. KARATEKE FARUK, MENEKşE EBRU, DAS KORAY, OZYAZICI SEFA, DEMIRTüRK PELIN. Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management. Case Reports in Surgery [online] 2013 December, 2013:1-3 [viewed 14 August 2014] Available from: doi:10.1155/2013/421961
  6. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  7. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108
  8. GIESE ARND, ZIEREN JüRGEN, WINNEKENDONK GUIDO, HENNING BERNHARD F. Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report. Array [online] 2010 December [viewed 14 August 2014] Available from: doi:10.1186/1752-1947-4-376
  9. BARSOUM M. K, SHEPHERD R. F., WELCH T. J. Patient with both Wilkie syndrome and nutcracker syndrome. Vascular Medicine [online] 2008 August, 13(3):247-250 [viewed 14 August 2014] Available from: doi:10.1177/1358863X08092272
  10. EMANUWA OKIEMUTE F, AYANTUNDE ABRAHAM A, DAVIES TONY W. Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. Array [online] 2011 December [viewed 15 August 2014] Available from: doi:10.1186/1749-7922-6-22

Examination

Fact Explanation
Signs in infants [2] [3] [7] Scaphoid abdomen, with signs of dehydration and weight loss are seen. The classic "olive" is palpated in hypertrophic pyloric stenosis. [2] [3] [7]
Signs of dehydartion such as loss of skin turgor, thirst, Sunken eyes, lack of tears, Dry mucous membranes [1] [3] [4] [5] [6] Due to prolonged vomiting, adults and infants may appear dehydrated. [1] [3] [4] [5] [6]
Distended abdomen [1] [3] [4] [5] [6] Because these food contents which are not digested properly get accumulated, abdomen gets distended [1] [3] [4] [5] [6]
Visible peristaltic wave [1] [2] [3] [4] [5] [6] Intestinal obstruction results in increases peristalsis and in thin individuals this is particularly visible. [1] [3] [4] [5] [6]
Abdominal tenderness [1] [3] [4] [5] [6] This usually indicates strangulation as prolonged obstruction causes loss of blood supply to the bowel and bowel ischemia. [1] [3] [4] [5] [6]
Tympanitic mass on percussion, in the epigastric area and/or left upper quadrant of the abdomen [1] [3] [4] [5] [6] Due to dilated stomach [1] [3] [4] [5] [6]
Exaggeration of bowel sounds [1] [3] [4] [5] [6] Intestinal obstruction results in increases peristalsis and exaggeration of bowel sounds. [1] [3] [4] [5] [6]
References
  1. DAN D, COLLURE DW, HOOVER EL. Bouveret's syndrome: revisiting gallstone obstruction of the duodenum. J Natl Med Assoc [online] 2003 Oct, 95(10):969-973 [viewed 12 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594488
  2. AL SHAHWANI N., MANDHAN P., ELKADHI A., ALI M. J., LATIF A.. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis. Journal of Surgical Case Reports [online] December, 2013(12):rjt108-rjt108 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt108
  3. EKSARKO P., NAZIR S., KESSLER E., LEBLANC P., ZEIDMAN M., ASARIAN A. P., XIAO P., PAPPAS P. J.. Duodenal web associated with malrotation and review of literature. Journal of Surgical Case Reports [online] December, 2013(12):rjt110-rjt110 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt110
  4. CRUZ RUY J, VINCENZI RODRIGO, KETZER BERNARDO M. Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report. Array [online] 2010 December [viewed 14 August 2014] Available from: doi:10.1186/1749-7922-5-23
  5. KARATEKE FARUK, MENEKşE EBRU, DAS KORAY, OZYAZICI SEFA, DEMIRTüRK PELIN. Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management. Case Reports in Surgery [online] 2013 December, 2013:1-3 [viewed 14 August 2014] Available from: doi:10.1155/2013/421961
  6. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  7. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108

Differential Diagnoses

Fact Explanation
Birth defects in infants [1] [2] In duodenal hypoplasia, duodenal stenosis, duodenal atresia result in duodenal obstruction. [1] [2]
Malrotation and volvulus in infants [3] Malrotation is also a common cause of obstruction. Occasionally it is accompanied by volvulus, which is when the duodenum twists around it's own axis compromising the blood supply. [3]
Hypertrophic pyloric stenosis in infants [10] Infants with hypertrophic pyloric stenosis also present with projectile vomiting, which is non billious. But in duodenal obstruction, vomitus is billious which helps in differentiation. [10]
Foreign body ingestion [11] Injested foreign body can get lodged and should be considered in both adults as well as in children. [11]
Gall stone ileus [4] [5] Gall stone can get lodged in the duodenum which again causes obstruction. It is sometimes called Bouveret's syndrome which is a revisiting gallstone obstruction of the duodenum. [4] [5]
Diverticulits [12] Inflammation of the duodenum due to Diverticular disease can cause duodenal obstruction as well. [12]
Crohn's disease [6] Duodenal Crohn’s disease mainly occurring at the duodenal bulb often presents with obstruction [6]
Benign and malignant tumours [7] Both benign tumours as well as malignant intestinal tumours can cause obstruction particularly malignant duodenal obstruction is seen is adults. [7]
Superior mesentric artery syndrome [9] Wilkie syndrome causes compression of the third portion of the duodenum by the superior mesenteric artery when it passes over the duodenum. This is a rare cause. [9]
Worm infections [8] Some worm infections of the intestines can also cause duodenal obstruction, particularly Strongyloides stercoralis enteritis. [8]
References
  1. AL SHAHWANI N., MANDHAN P., ELKADHI A., ALI M. J., LATIF A.. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis. Journal of Surgical Case Reports [online] December, 2013(12):rjt108-rjt108 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt108
  2. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108
  3. EKSARKO P., NAZIR S., KESSLER E., LEBLANC P., ZEIDMAN M., ASARIAN A. P., XIAO P., PAPPAS P. J.. Duodenal web associated with malrotation and review of literature. Journal of Surgical Case Reports [online] December, 2013(12):rjt110-rjt110 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt110
  4. DAN D, COLLURE DW, HOOVER EL. Bouveret's syndrome: revisiting gallstone obstruction of the duodenum. J Natl Med Assoc [online] 2003 Oct, 95(10):969-973 [viewed 12 August 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594488
  5. GIESE ARND, ZIEREN JüRGEN, WINNEKENDONK GUIDO, HENNING BERNHARD F. Development of a duodenal gallstone ileus with gastric outlet obstruction (Bouveret syndrome) four months after successful treatment of symptomatic gallstone disease with cholecystitis and cholangitis: a case report. Array [online] 2010 December [viewed 14 August 2014] Available from: doi:10.1186/1752-1947-4-376
  6. KARATEKE FARUK, MENEKşE EBRU, DAS KORAY, OZYAZICI SEFA, DEMIRTüRK PELIN. Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management. Case Reports in Surgery [online] 2013 December, 2013:1-3 [viewed 14 August 2014] Available from: doi:10.1155/2013/421961
  7. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  8. CRUZ RUY J, VINCENZI RODRIGO, KETZER BERNARDO M. Duodenal obstruction - an unusual presentation of Strongyloides stercoralis enteritis: a case report. Array [online] 2010 December [viewed 14 August 2014] Available from: doi:10.1186/1749-7922-5-23
  9. BARSOUM M. K, SHEPHERD R. F., WELCH T. J. Patient with both Wilkie syndrome and nutcracker syndrome. Vascular Medicine [online] 2008 August, 13(3):247-250 [viewed 14 August 2014] Available from: doi:10.1177/1358863X08092272
  10. FENG ZHIQIANG, NIE YUQIANG, ZHANG YOUXIANG, LI QINGNING, XIA HUIMING, GONG SITANG, HUANG HAI, HUANG LI-MIN. The Clinical Features of Infantile Hypertrophic Pyloric Stenosis in Chinese Han Population: Analysis from 1998 to 2010. PLoS ONE [online] 2014 February [viewed 14 August 2014] Available from: doi:10.1371/journal.pone.0088925
  11. SYMEONIDIS DIMITRIOS, KOUKOULIS GEORGIOS, BALOYIANNIS IOANNIS, RIZOS APOSTOLOS, MAMALOUDIS IOANNIS, TEPETES KONSTANTINOS. Ingested Fish Bone: An Unusual Mechanism of Duodenal Perforation and Pancreatic Trauma. Case Reports in Gastrointestinal Medicine [online] 2012 December, 2012:1-3 [viewed 14 August 2014] Available from: doi:10.1155/2012/308510
  12. KUMAR S., ADEVA M., KING B. F., KAMATH P. S., TORRES V. E.. Duodenal diverticulosis in autosomal dominant polycystic kidney disease. Nephrology Dialysis Transplantation [online] 2006 September, 21(12):3576-3578 [viewed 14 August 2014] Available from: doi:10.1093/ndt/gfl405

Investigations - for Diagnosis

Fact Explanation
Full blood count [1] [4] [5] [6] [7] Increases hematocrit value may point towards dehydration. Leukocytosis is also possible in intestinal obstruction. [1] [4] [5] [6] [7]
Serum electrolytes [1] [4] [5] [6] [7] Prolonged vomiting causes loss of hydrochloric (HCl) acid and resultant loss of hydrogen irons are attempted to conserve by the kidney by increased secretion of Potassium ions, resulting in hypokalemia [1] [4] [5] [6] [7]
Blood urea nitrogen/ Serum creatinine [1] [4] [5] [6] [7] High levels are late findings due to dehydration [1] [4] [5] [6] [7]
Arterial blood gas analysis [1] [4] [5] [6] [7] Prolonged vomiting causes loss of hydrochloric (HCl) acid the result is a metabolic alkalosis. [1] [4] [5] [6] [7]
Plain abdominal radiograph [1] [2] [7] It may show double bubble appearance in infants with duodenal atresia. And gastric dilatation may be observed and other differential diagnosis can be excluded [1] [2] [7]
contrast upper GI studies (Gastrografin or barium) [1] [2] [4] [5] [6] [7] These studies are helpful because they demonstrate the site of obstruction. Use of contrast studies in suspected obstruction is controversial sometimes. [1] [4] [5] [6] [7]
CT with oral contrast [1] [2] [4] [5] [6] [7] This helps to determine the site of obstruction and may show masses such as tumors [1] [2] [4] [5] [6] [7]
Abdominal ultrasound scan [1] [2] [4] [5] [6] [7] A midline abdominal mass maybe observed when there's a volvulus. [1] [2] [4] [5] [6] [7]
Nuclear gastric emptying studies [1] [2] [4] [5] [6] [7] Orally administered radionuclide is measured over time to detect any functional abnormalities [1] [2] [4] [5] [6] [7]
Upper gastrointestinal endoscopy and biopsy [1] [2] [4] [5] [6] [7] This allows the direct visualization of some anomalies in the duodenum such as duodenal stenosis, atresia, and also particularly helpful to take biopsy from suspected intraluminal tumors. . [1] [2] [4] [5] [6] [7]
Gastrointestinal manometry [3] This is important in excluding intestinal dysmotility syndromes [3]
Tests for H- Pylori [8] Urease breath test uses the fact that H. pylori contains the enzyme urease, which breaks down urea in the stomach to ammonia and carbon dioxide and if H. pylori is present in the stomach it will break down the labelled urea into ammonia and carbon dioxide. Since the carbon dioxide is labelled it can be detected in the breath. Also specific antibody tests for H-Pylori can be done in blood. These tests are done as peptic ulcer disease is a common cause for duodenal obstruction. [8]
References
  1. TESSIER DERON J, BROPHY COLLEEN M. Causes, diagnosis, and management of duodenal obstruction after aortic surgery. Journal of Vascular Surgery [online] 2003 July, 38(1):186-189 [viewed 14 August 2014] Available from: doi:10.1016/S0741-5214(03)00145-9
  2. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  3. LOFTUS EDWARD V., FARRUGIA GIANRICO, DONOHUE JOHN H., CAMILLERI MICHAEL. Duodenal Obstruction: Diagnosis by Gastroduodenal Manometry. Mayo Clinic Proceedings [online] 1997 February, 72(2):130-132 [viewed 14 August 2014] Available from: doi:10.4065/72.2.130
  4. EMANUWA OKIEMUTE F, AYANTUNDE ABRAHAM A, DAVIES TONY W. Midgut malrotation first presenting as acute bowel obstruction in adulthood: a case report and literature review. Array [online] 2011 December [viewed 14 August 2014] Available from: doi:10.1186/1749-7922-6-22
  5. HENEYKE S, SMITH V V, SPITZ L, MILLA P J. Chronic intestinal pseudo-obstruction: treatment and long term follow up of 44 patients. Archives of Disease in Childhood [online] 1999 July, 81(1):21-27 [viewed 14 August 2014] Available from: doi:10.1136/adc.81.1.21
  6. AL SHAHWANI N., MANDHAN P., ELKADHI A., ALI M. J., LATIF A.. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis. Journal of Surgical Case Reports [online] December, 2013(12):rjt108-rjt108 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt108
  7. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108
  8. CALVET XAVIER, et al. Accuracy of Diagnostic Tests for A Reappraisal . CLIN INFECT DIS [online] 2009 May, 48(10):1385-1391 [viewed 14 August 2014] Available from: doi:10.1086/598198

Investigations - Fitness for Management

Fact Explanation
Prothrombin time and international normalization ratio [1] [2] To exclude any coagulopathy and correction is done [1] [2]
Renal function tests including estimated glomerular filteration rate, serum creatinine, blood urea nitrogen [2] To assess fitness for anesthesia and to exclude any renal dysfunction [2]
Full blood count [2] To exclude anaemia. [2]
References
  1. LIMDI J K. Evaluation of abnormal liver function tests. Postgraduate Medical Journal [online] 2003 June, 79(932):307-312 [viewed 14 August 2014] Available from: doi:10.1136/pmj.79.932.307
  2. KUMAR A, SRIVASTAVA U. Role of routine laboratory investigations in preoperative evaluation J Anaesthesiol Clin Pharmacol [online] 2011, 27(2):174-179 [viewed 14 August 2014] Available from: doi:10.4103/0970-9185.81824

Investigations - Followup

Fact Explanation
Plain abdominal radiographs [1] [2] [3] [4] [5] [6] Diameter of loops of small bowel is important as it predicts the perforation in serial x-rays and air-fluid levels may be seen. [1] [2] [3] [4] [5]
Serum electrolytes [1] [2] [5] Prolonged vomiting results in loss of hydrochloric (HCl) acid and produces a hypokalemia and to monitor potassium levels this is helpful. [1] [2]
Full blood count [1] [2] [5] This also helps in evaluation of hematocrit as an indicator of dehydration and white cell count as a indicator of strangulation [1] [2]
Blood urea nitrogen/ Serum creatinine [1] [2] [5] Elevation of these levels indicate dehydration. [1] [2]
References
  1. AL SHAHWANI N., MANDHAN P., ELKADHI A., ALI M. J., LATIF A.. Congenital duodenal obstruction associated with Down's syndrome presenting with hematemesis. Journal of Surgical Case Reports [online] December, 2013(12):rjt108-rjt108 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt108
  2. HENEYKE S, SMITH V V, SPITZ L, MILLA P J. Chronic intestinal pseudo-obstruction: treatment and long term follow up of 44 patients. Archives of Disease in Childhood [online] 1999 July, 81(1):21-27 [viewed 14 August 2014] Available from: doi:10.1136/adc.81.1.21
  3. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  4. EKSARKO P., NAZIR S., KESSLER E., LEBLANC P., ZEIDMAN M., ASARIAN A. P., XIAO P., PAPPAS P. J.. Duodenal web associated with malrotation and review of literature. Journal of Surgical Case Reports [online] December, 2013(12):rjt110-rjt110 [viewed 14 August 2014] Available from: doi:10.1093/jscr/rjt110
  5. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108
  6. GONG JUN. Malrotation causing duodenal chronic obstruction in an adult. WJG [online] 2009 December [viewed 14 August 2014] Available from: doi:10.3748/wjg.15.1144

Management - General Measures

Fact Explanation
Correction of dehydration [2] [3] [4] [5] [6] Normal saline is used for fluid resuscitation to replace the hypovolemia and followed by potassium replacement [2] [3] [4] [5] [6]
Stomach decompression [1] [2] [3] [4] [5] [6] Nasogastric tube with a large bore is placed to decompress the stomach. [1] [2] [3] [4]
Close observation [2] [3] [4] Patient should be monitored with regard to heart rate, respiratory rate, blood pressure, urine output, temperature and the clinical condition until a definitive management is undertaken. [2] [3] [4]
Analgesic therapy [3] administration of analgesia is important as patient is in pain. [3]
antiemetic therapy [3] Antiemetics are given as there's severe vomiting. [3]
Antibiotic therapy [3] administration of antibiotics are to cover against gram-negative and anaerobic organisms. [3]
References
  1. TESSIER DERON J, BROPHY COLLEEN M. Causes, diagnosis, and management of duodenal obstruction after aortic surgery. Journal of Vascular Surgery [online] 2003 July, 38(1):186-189 [viewed 14 August 2014] Available from: doi:10.1016/S0741-5214(03)00145-9
  2. VALLICELLI CARLO, COCCOLINI FEDERICO, CATENA FAUSTO, ANSALONI LUCA, MONTORI GIULIA, DI SAVERIO SALOMONE, PINNA ANTONIO D. Small bowel emergency surgery: literature's review. Array [online] 2011 December [viewed 14 August 2014] Available from: doi:10.1186/1749-7922-6-1
  3. CHEN S.-C.. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. Canadian Medical Association Journal [online] 2005 November, 173(10):1165-1169 [viewed 14 August 2014] Available from: doi:10.1503/cmaj.1041315
  4. TAYLOR MARK R., LALANI NADIM, CARPENTER CHRISTOPHER R.. Adult Small Bowel Obstruction. Acad Emerg Med [online] December, 20(6):527-544 [viewed 14 August 2014] Available from: doi:10.1111/acem.12150
  5. CARLSON DOROTHY S., PFADT ELLEN. Postoperative intestinal obstruction. Nursing [online] 2010 August [viewed 14 August 2014] Available from: doi:10.1097/01.NURSE.0000386598.46169.e0
  6. CHEN HUA-DONG, JIANG HONG, KAN ANNA, HUANG LI-E, ZHONG ZHI-HAI, ZHANG ZHI-CHONG, LIU JUN-CHENG. Intestinal obstruction due to dual gastrointestinal atresia in infants: diagnosis and management of 3 cases. Array [online] 2014 December [viewed 14 August 2014] Available from: doi:10.1186/1471-230X-14-108

Management - Specific Treatments

Fact Explanation
Surgical management with resection of the obstructed part and anastomosis. [1] [2] [3] [5] [6] This is the definitive therapy where the obstructed part is resected and the two ends are anastomosed. Repair of hernia, Removal of gall stones, foreign bodies are also done [1] [2] [3] [5] [6]
palliative gastrojejunostomy [1] [2] [3] [5] [6] When the lesion removal is not possible, this is done. This is also done as a treatment for annular pancreas. [1] [2] [3] [5] [6]
Insertion of stents [4] [7] Stents help to relieve obstruction for a short period of time. [4] [7]
H-Pylori eradication therapy [8] This regime is carried out if the patient is having peptic ulcer disease and H-Pylori infection is suspected. [8]
References
  1. TAYLOR MARK R., LALANI NADIM, CARPENTER CHRISTOPHER R.. Adult Small Bowel Obstruction. Acad Emerg Med [online] December, 20(6):527-544 [viewed 14 August 2014] Available from: doi:10.1111/acem.12150
  2. SORIANO A., DAVIS M. P.. Malignant bowel obstruction: Individualized treatment near the end of life. Cleveland Clinic Journal of Medicine [online] December, 78(3):197-206 [viewed 14 August 2014] Available from: doi:10.3949/ccjm.78a.10052
  3. NARH-MARTEY P., BELLO A., ORR D., GALDYN I.. Laparoscopic management of small bowel obstruction with associated intestinal ischemia. Journal of Surgical Case Reports [online] 2012 August, 2012(8):4-4 [viewed 14 August 2014] Available from: doi:10.1093/jscr/2012.8.4
  4. CHEN S.-C.. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. Canadian Medical Association Journal [online] 2005 November, 173(10):1165-1169 [viewed 14 August 2014] Available from: doi:10.1503/cmaj.1041315
  5. CARLSON DOROTHY S., PFADT ELLEN. Postoperative intestinal obstruction. Nursing [online] 2010 August [viewed 14 August 2014] Available from: doi:10.1097/01.NURSE.0000386598.46169.e0
  6. TESSIER DERON J, BROPHY COLLEEN M. Causes, diagnosis, and management of duodenal obstruction after aortic surgery. Journal of Vascular Surgery [online] 2003 July, 38(1):186-189 [viewed 14 August 2014] Available from: doi:10.1016/S0741-5214(03)00145-9
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