Small Bowel Obstruction (SBO – Emergency Medicine)

00:01 Hi. We’re gonna be talking about bowel obstruction.

00:04 Let’s take a quick moment to just review the anatomy when we’re thinking about bowel obstruction.

00:10 We’re gonna be talking separately about obstruction of the small intestine and then obstruction of the large intestine.

00:16 So obstruction of the small intestine is called small bowel obstruction and then the large intestine is large bowel obstruction.

00:23 We’ll be going through the differences and the ideologies of these two conditions as well as differences in diagnosis and treatment for them.

00:31 So we’re gonna start out by talking about small bowel obstruction.

00:36 Small bowel obstruction is a mechanical obstruction for the most part.

00:39 There can be a simple obstruction which is obstruction just at a singular point or possibly a closed loop obstruction which is what’s pictured over here where basically, there’s a circle of bowel that’s obstructed.

00:52 There’s also neurogenic obstruction.

00:56 Neurogenic obstruction is when you have an adynamic ileus.

01:00 The most common time that this is seen is in the post-operative period.

01:04 So patients after they’ve had an operation, sometimes on the abdominal cavity, sometimes the intestines are a little bit upset afterwards and they decide they just don’t wanna move, they don’t wanna do anything.

01:15 It can also be related to different medications, related to infection, or metabolic processes.

01:22 So, neurogenic obstruction or an ileus is a little bit different than a mechanical obstruction.

01:27 For the most part with an adynamic ileus, we generally just wait it out.

01:31 It oftentimes gets better on its own.

01:33 The mechanical obstructions are the ones that can pose more issues.

01:37 So thinking about what causes small bowel obstruction relative to the intestine wall, we think about things that are external to the intestinal wall and then things that are intrinsic to the intestinal wall.

01:51 So thinking about things that are external to the intestinal wall.

01:55 So basically, something that is outside of the bowel wall.

01:58 We’re thinking about postoperative adhesions.

02:00 This is by far the most common cause here for small bowel obstruction.

02:05 We’re thinking about hernias, volvulus which is when the bowel twists upon itself, any masses that could potentially compress the bowel wall, or the bowel, the intestines such as tumors, abscesses, or hematomas.

02:22 So a big blood clot that’s hanging out in the abdomen.

02:25 And then, things that are intrinsic to the intestinal wall.

02:28 So what can obstruct the intestine that’s within the intestinal wall itself? Within there, there’s primary neoplasms, so a primary cancer of the small bowel, inflammation, intestinal tuberculosis which is a very rare condition but is a possibility, intussusception, trauma, so is there a wall hematoma? So this is different than a hematoma that’s outside of the bowel.

02:53 This is a hematoma of the bowel wall itself.

02:56 Anything intraluminal, a bezoar, a bezoar is like a big hunk of hair or some kind of foreign body that the patient has ingested.

03:07 Sometimes, it’s related to medications.

03:09 So if someone takes a big overdose of medications, those can sometimes stick together and form what we call a bezoar.

03:16 A foreign body, so someone has swallowed something that can potentially block their intestines.

03:22 This is something we see more commonly in kids, right? Kids are putting everything in their mouths at a certain age.

03:27 So more common in kids that they would do this but sometimes it does happen, we think about it potentially in adults as a suicide attempt that someone ate something that they weren’t supposed to necessarily ingest.

03:39 Gallstones interestingly enough if they get big enough, and then, ascariasis infestation.

03:44 Again, rare, but potentially depending on where you’re practicing emergency medicine, this might be something you see more commonly.