Procedures

Intestinal obstruction

Intestinal obstruction (blocking of intestinal flow) can occur anywhere in the intestinal pathway between the stomach and rectum.  A CT scan of the abdomen and pelvis can identify the location.  Incarcerated hernias can cause the intestine to become stuck in the hernia and requires an urgent operation to relieve the obstruction prior to the intestines becoming strangulated and repairing the hernia.  The small intestine can become entrapped in adhesions from previous surgery and the treatment generally consists of nasogastric tube placement to drain the stomach, IV hydration, and frequently responds to conservative management as long as there is no indication of intestinal strangulation as evidenced by severe pain, localized tenderness and acidosis, for which emergency surgery is required. 

 

For patients with small bowel obstruction that have never had surgery before, considered a virgin abdomen, surgery is indicated since there will be an underlying cause(adhesions, small bowel tumor, foreign body) found which will require fixing to relieve the obstruction and prevent its recurrence.Crohn's disease may cause partial to complete small bowel obstruction and may improve with medical management.  I approach small bowel obstructions laparoscopically since I am generally successful in resolving the condition without a laparotomy(open surgery) incision.  Large bowel obstruction is generally caused by carcinoma, a volvulus (twist) or a stricture of long-standing diverticulitis.  If a bowel prep can be performed prior to emergency surgery and the risk of infection and leak is diminished(volvulus is a complete obstruction and needs emergency management ).  Surgery for diverticulitis and colon cancer is generally laparoscopic,only using a hand-assisted port for very complex problems.

 

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