Episode 1 - Small Bowel Obstructions - SBO

In this episode we take you on a journey through the world of small bowel obstructions. Join us in discovering the 4 D's of Radiology of SBOs...

(For the full show notes and more information please visit learninginthedark.com)

Detect:

Symptoms - Colicky abdominal pain, distension, nausea and vomiting, constipation, inability to pass gas. 

Signs - High pitched, tinkling or absent bowel sounds

Often non specific

Describe:

Hallmark- Obstruction leading to dilation upstream and decompression downstream

Warning Signs-

Complete: nothing getting past Incomplete or Partial: some air and fluid post  Closed Loop: Obstructed bowel at 2 points along the GI tract Strangulated obstruction 

 Differential:
Differential goes back to our common causes so break it down into intrinsic, extrinsic or intraluminal

Decision:
Conservative: NG decompression, bowel rest

Surgical: Resection indicated in high grade obstruction, bowel ischemia, failure to improve with conservative management 

Both clinical and radiological presentations can predict the need for surgical intervention 

Clinical Predictors: Clinical signs of intestinal ischemia: abdominal pain worse despite conservative management, SIRS, Peritonitis, Metabolic Acidosis Failure of conservative management

CT Indications for surgical management Predictors of poor CT outcomes: 1.) Intraperitoneal free fluid 2.) Free intra-abdominal gas 3.) Duodenal distension 4.) High grade obstruction 5.) Signs of intestinal ischemia 6.) Closed Loop Obstruction Surgical Correctable causes of SBO: 1.) Volvulus 2.) Incarcerated Hernia 3.) Closed Loop Obstruction 4.) Small Bowel Tumour 5.) gallstone ileus 6.) Foreign body ingestionSigns of small bowel obstruction with equivocal outcomes in regard to conservative vs. surgical intervention: Mesenteric congestion, presence of a transition point, small bowel feces sign

Produced By Mike Spouge