small bowel obstruction

小腸閉塞、小腸閉塞症

関

small intestinal obstruction

WordNet

1. something curved in shape (同)arc
2. play on a string instrument with a bow
3. a knot with two loops and loose ends; used to tie shoelaces (同)bowknot
4. front part of a vessel or aircraft; "he pointed the bow of the boat toward the finish line" (同)fore, prow, stem
5. a decorative interlacing of ribbons
6. a slightly curved piece of resilient wood with taut horsehair strands; used in playing certain stringed instruments
7. a stroke with a curved piece of wood with taut horsehair strands that is used in playing stringed instruments
8. a weapon for shooting arrows, composed of a curved piece of resilient wood with a taut cord to propel the arrow
9. bending the head or body or knee as a sign of reverence or submission or shame or greeting (同)bowing, obeisance
10. an appearance by actors or performers at the end of the concert or play in order to acknowledge the applause of the audience (同)curtain_call
11. bend ones knee or body, or lower ones head; "He bowed before the King"; "She bowed her head in shame" (同)bow down
12. bend the head or the upper part of the body in a gesture of respect or greeting; "He bowed before the King"
13. slight or limited; especially in degree or intensity or scope; "a series of death struggles with small time in between"
14. a garment size for a small person
15. the slender part of the back
16. limited or below average in number or quantity or magnitude or extent; "a little dining room"; "a little house"; "a small car"; "a little (or small) group" (同)little
17. have fine or very small constituent particles; "a small misty rain"
18. on a small scale; "think small"
19. the physical condition of blocking or filling a passage with an obstruction (同)blockage
20. any structure that makes progress difficult (同)obstructor, obstructer, impediment, impedimenta
21. getting in someones way
22. the act of obstructing; "obstruction of justice"
23. the center of the Earth

PrepTutorEJDIC

1. 『弓』 / (楽器の)弓 / 弓形,弓形のもの(にじなど) / (リボンなどの)ちょう結び;ちょうネクタイ(bowtie) / (めがねの)つる / 〈バイオリンなど〉'を'弓でひく
2. (…に)『身をかがめる』,頭をさげる,おじぎをする《+『down』『to』+『名』》 / (…に)屈服する,従う《+『to』+『名』》 / 〈ひざ・腰〉'を'かがめる,(頭など)'を'さげる / …'を'曲げる / 〈感謝など〉'を'おじぎをして示す / …'を'身をかがめて案内する / おじぎ,えしゃく
3. 《時に複数形で;単数扱い》(ボート・船・飛行機の)『先端部』;へさき,機取 / ベートの最前部のオール;そのこぎ手
4. (大きさが)『小さい』,小形の;(量が)『少ない』,わずかな / 『取るに足りない』,ささいな(trivial) / 《名詞の前にのみ用いて》(仕事・活動などが)『小規模の』,ささやかな / 心が狭い,利己的な / (音・声が)弱い,小さい / (文字が)小型の,小文字の / 《the~》小さいもの;(…の)細い部分《+『of』+『名』》 / 《複数形で》《英》(衣類・ハンカチなどの)小物,小間物 / 小さく,細かく / (声などが)低く,弱く / 小規模に,こぢんまりと
5. 〈U〉(…への)妨害,障害《+『to』+『名』》 / 〈C〉(…への)妨害物,障害物《+『to』+『名』》
6. 〈C〉『腸』;《通例複数形で》腹わた,内臓 / 《複数形で》内部,中心部

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/28 21:19:03」(JST)

wiki en

[Wiki en表示]

For the condition in newborns, see Neonatal bowel obstruction.

Bowel obstruction
Classification and external resources
Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.
ICD-10	K56
ICD-9	560
DiseasesDB	15838
MedlinePlus	000260
MeSH	D007415

Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion. It can occur at any level distal to the duodenum of the small intestine and is a medical emergency. The condition is often treated conservatively over a period of 2–5 days with the patient's progress regularly monitored by an assigned physician. Surgical procedures are performed on occasion however, in life-threatening cases, such as when the root cause is a fully lodged foreign object or malignant tumor.

Signs and symptoms

Depending on the level of obstruction, bowel obstruction can present with abdominal pain, swollen abdomen, abdominal distension, vomiting, fecal vomiting, and constipation.

Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischaemia or perforation from prolonged distension or pressure from a foreign body.

In small bowel obstruction the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.

In large bowel obstruction, the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.

Causes

Small bowel obstruction

Upright abdominal X-ray demonstrating a small bowel obstruction. Note multiple air fluid levels.

Causes of small bowel obstruction include:

• Adhesions from previous abdominal surgery (most common cause)
• Pseudoobstruction
• Hernias containing bowel
• Crohn's disease causing adhesions or inflammatory strictures
• Neoplasms, benign or malignant
• Intussusception in children
• Volvulus
• Superior mesenteric artery syndrome, a compression of the duodenum by the superior mesenteric artery and the abdominal aorta

• Ischemic strictures
• Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects)
• Intestinal atresia

Large bowel obstruction

Upright abdominal X-ray of a patient with a large bowel obstruction showing multiple air fluid levels and dilated loops of bowel.

Causes of large bowel obstruction include:

• Neoplasms
• Diverticulitis / Diverticulosis
• Hernias
• Inflammatory bowel disease
• Colonic volvulus (sigmoid, caecal, transverse colon)
• Adhesions
• Constipation
• Fecal impaction
• Fecaloma
• Colon atresia
• Intestinal pseudoobstruction
• Endometriosis
• Narcotic induced (especially with the large doses given to cancer or palliative care patients)

Outlet obstruction

Outlet obstruction is a sub-type of large bowel obstruction and refers to conditions affecting the anorectal region that obstruct defecation, specifically conditions of the pelvic floor and anal sphincters. Outlet obstruction can be classified into 4 groups.

• Functional outlet obstruction
  • Inefficient inhibition of the internal anal sphincter
    • Short-segment Hirschsprung's disease
    • Chagas disease
    • Hereditary internal sphincter myopathy
  • Inefficient relaxation of the striated pelvic floor muscles
    • Anismus (pelvic floor dyssynergia)
    • Multiple sclerosis
    • Spinal cord lesions
• Mechanical outlet obstruction
  • Internal intussusception
  • Enterocele
• Dissipation of force vector
  • rectocele
  • Descending perineum
  • Rectal prolapse
• Impaired rectal sensitivity
  • Megarectum
  • Rectal hyposensitivity

Differential diagnosis

Differential diagnoses of bowel obstruction include:

• Ileus
• Pseudo-obstruction or Ogilvie's syndrome
• Intra-abdominal sepsis
• Pneumonia or other systemic illness.

Diagnosis

A small bowel obstruction as seen on CT

The main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning, and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass.

Radiological signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs.

Contrast enema or small bowel series or CT scan can be used to define the level of obstruction, whether the obstruction is partial or complete, and to help define the cause of the obstruction.

According to a meta-analysis of prospective studies by the Cochrane Collaboration, the appearance of water-soluble contrast in the cecum on an abdominal radiograph within 24 hours of oral administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 96% and specificity of 96%.

Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy are other diagnostic options.

Treatment

Some causes of bowel obstruction may resolve spontaneously; many require operative treatment. In adults, frequently the surgical intervention and the treatment of the causative lesion are required. In malignant large bowel obstruction, endoscopically placed self-expanding metal stents may be used to temporarily relieve the obstruction as a bridge to surgery, or as palliation. Diagnoses of the type of bowel obstruction is normally conducted through initial plain radiograph of the abdomen, luminal contrast studies, computed tomography scan, or ultrasonography prior to determining the best type of treatment.

Small bowel obstruction

In the management of small bowel obstructions it was once said, "[n]ever let the sun rise or set on small-bowel obstruction" because about 5.5% of small bowel obstructions are ultimately fatal if treatment is delayed. However improvements in radiological imaging of small bowel obstructions allow for confident distinction between simple obstructions, that can be treated conservatively, and obstructions that are surgical emergencies (volvulus, closed-loop obstructions, ischemic bowel, incarcerated hernias, etc.).

A small flexible tube (nasogastric tube) may be inserted from the nose into the stomach to help decompress the dilated bowel. This tube is uncomfortable but does relieve the abdominal cramps, distension and vomiting. Intravenous therapy is utilized and the urine output is monitored with a catheter in the bladder.

Most people with SBO are initially managed conservatively because in many cases, the bowel will open up. Some adhesions loosen up and the obstruction resolves. However, when conservative management is undertaken, the patient is examined several times a day, and X-ray images are obtained to ensure that the individual is not getting clinically worse.

Conservative treatment involves insertion of a nasogastric tube, correction of dehydration and electrolyte abnormalities. Opioid pain relievers may be used for patients with severe pain. Antiemetics may be administered if the patient is vomiting. Adhesive obstructions often settle without surgery. If obstruction is complete a surgery is usually required.

Most patients do improve with conservative care in 2–5 days. However, in some occasions, the cause of obstruction may be a cancer and in such cases, surgery is the only treatment. These individuals undergo surgery where the cause of SBO is removed. Individuals who have bowel resection or lysis of adhesions usually stay in the hospital a few more days until they are able to eat and walk.

Small bowel obstruction caused by Crohn's disease, peritoneal carcinomatosis, sclerosing peritonitis, radiation enteritis, and postpartum bowel obstruction are typically treated conservatively, i.e. without surgery.

In children

Main article: Neonatal bowel obstruction

Fetal and neonatal bowel obstructions are often caused by an intestinal atresia, where there is a narrowing or absence of a part of the intestine. These atresias are often discovered before birth via a sonogram, and treated with using laparotomy after birth. If the area affected is small, then the surgeon may be able to remove the damaged portion and join the intestine back together. In instances where the narrowing is longer, or the area is damaged and cannot be used for a period of time, a temporary stoma may be placed.

Prognosis

The prognosis for non-ischemic cases of SBO is good with mortality rates of 3-5%, while prognosis for SBO with ischemia is fair with mortality rates as high as 30%.

Cases of SBO related to cancer are more complicated and require additional intervention to address the malignancy, recurrence, and metastasis, and thus are associated with poorer prognosis.

All cases of abdominal surgical intervention are associated with increased risk of future small-bowel obstructions. Statistics from U.S. healthcare report 18.1% re-admittance rate within 30 days for patients who undergo SBO surgery. More than 90% of patients also form adhesions after major abdominal surgery. Common consequences of these adhesions include small-bowel obstruction, chronic abdominal pain, pelvic pain, and infertility.

See also

• Bowel management
• Enema
• Constipation
• Ileus
• Colorectal cancer

References

External links

• Obstruction, Small Bowel at eMedicine
• Obstruction, Large Bowel at eMedicine
• UCSF Fetal Treatment Center: Bowel Obstructions
• A Lecture on Bowel Obstruction

UpToDate Contents

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• 1. 成人における機械的小腸閉塞のマネージメントの概要 overview of management of mechanical small bowel obstruction in adults
• 2. 成人における機械的小腸閉塞の疫学、臨床的特徴、および診断 epidemiology clinical features and diagnosis of mechanical small bowel obstruction in adults
• 3. Overview of gastrointestinal tract perforation
• 4. 成人における重症または難治性クローン病の内科的マネージメントの概要 overview of the medical management of severe or refractory crohn disease in adults
• 5. 腸回転異常 intestinal malrotation

English Journal

• A case-control study of risk factors for ileus and bowel obstruction following benign gynecologic surgery.

• Antosh DD, Grimes CL, Smith AL, Friedman S, McFadden BL, Crisp CC, Allen AM, Gutman RE, Rogers RG; Fellows’ Pelvic Research Network.SourceDepartment of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center, Washington, USA. Electronic address: ddantosh@tmhs.org.
• International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.Int J Gynaecol Obstet.2013 Aug;122(2):108-11. doi: 10.1016/j.ijgo.2013.03.014. Epub 2013 May 22.
• OBJECTIVE: To identify risk factors leading to the development of postoperative ileus and small-bowel obstruction (SBO) after benign gynecologic surgery.METHODS: In a multicenter case-control study across the United States, data were examined from women with International Classification of Diseases
• PMID 23706188

• Adrenal crisis in a patient with acute myeloid leukaemia.

• Li W, Okwuwa I, Toledo-Frazzini K, Alhomosh A.SourceDepartment of Family and Community Medicine, Texas Tech University Health Sciences Center, Odessa, Texas, USA.
• BMJ case reports.BMJ Case Rep.2013 Jul 9;2013(jul08_2). pii: bcr2013010426. doi: 10.1136/bcr-2013-010426.
• Adrenal crisis is a group of clinical manifestation predominantly with hypotensive shock, electrolyte imbalance in a patient with adrenal insufficiency or in a patient who was abruptly withdrawn from glucocorticoid treatment acute myeloid leukaemia (AML) is one of the most common acute leukaemia in
• PMID 23843412

Japanese Journal

• 結節形成によるイレウス (特集 必読 イレウスの診断から治療まで) -- (機械的イレウス)

• 毛利 靖彦,内田 恵一,楠 正人
• 外科 74(3), 265-267, 2012-03
• NAID 40019207441

• Transmesenteric hernia due to double-loop formation in the small intestine: a fatal case involving a toddler.

• Kakimoto Yu,Abiru Hitoshi,Kotani Hirokazu,Ozeki Munetaka,Tsuruyama Tatsuaki,Tamaki Keiji
• Forensic science international 214(1-3), e39-e42, 2012-01-10
• … No significant findings suggesting bowel obstruction (e.g. air-fluid levels or dilation of the bowel) were obtained on examinations and bloody feces were not observed in this particular episode. … A subsequent autopsy revealed that the small bowel had herniated through a defect in the mesentery resulting in two consecutive and inversely forming loops, in which each loop protruded on either side of the mesentery. …
• NAID 120003779169

• 回腸末端部の石灰化が進行し，腹膜透析離脱5年後に被嚢性腹膜硬化症を発症した1症例

• 山初 あや,濱田 千江子,野中 香苗,佐々木 洋平,渡邊 智成,石井 杏理紗,牧田 侑子,仲本 宙高,鈴木 仁,高原 久嗣,井尾 浩章,金子 佳代,堀越 哲,室谷 典義,富野 康日己
• 日本透析医学会雑誌 45(4), 367-373, 2012
• 56歳，男性．IgA腎症による慢性腎不全のため，1992年に腹膜透析（PD）を導入した．PDを11年間施行し，2003年難治性腹膜炎の発症を契機に血液透析（HD）に移行した．PD中止後2009年までに軽症のイレウスのため6回の入院歴があるが，数日の絶食で症状が消失する経過や検査所見から被嚢性腹膜硬化症（EPS）の診断には至らず，経過観察を行っていた．PD中止2年目ごろより骨盤内の腹膜石灰化像を認め …
• NAID 130002145623

Related Links

• Small-Bowel Obstruction

A small-bowel obstruction (SBO) is caused by a variety of pathologic processes. The leading cause of SBO in industrialized countries is postoperative adhesions (60%), followed by malignancy, Crohn disease, and hernias. Essential update: CT scans alone may miss bowel complications following ...

• Small Bowel Obstruction - wikiRadiography

Introduction Small bowel obstruction (SBO) is a common abdominal pathology. This page examines radiographic techniques and pathological appearances of plain... ... Adhesions Neoplasms Hernias-external, internal Crohns Other ...

Related Pictures

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★リンクテーブル★

リンク元	「小腸閉塞」「小腸閉塞症」「small intestinal obstruction」
関連記事	「obstruction」「small」「bow」「bowel obstruction」

「小腸閉塞」

　　[★]

英

small bowel obstruction、small intestinal obstruction

関

小腸閉塞症

「小腸閉塞症」

　　[★]

英

small bowel obstruction

関

小腸閉塞

「small intestinal obstruction」

　　[★]

小腸閉塞

関

small bowel obstruction

「obstruction」

　　[★]

• n.

• 妨害、障害、支障、差し障り。妨害物、
• 閉塞、閉塞症。

関

blockage、deterrent、obliteration、occlude、occlusion、stasis

　 　 　 　 　

「small」

　　[★]

• adj.

• 小さい

関

little、petit、tiny

　 　 　 　 　 　 　

「bow」

　　[★] 　 　 　 　 　 　 　 　 　 　 　 　 　 　 　

「bowel obstruction」

　　[★]

関

Intestinal obstruction