Case 134: Small bowel obstruction - No prior surgery and no hernias
This 80 yr old man presented with a distal small bowel obstruction. You rang your boss and told him that there were no scars, no hernias and the patient had some abdominal tenderness. He had a microcytic anaemia. Your boss said to book the patient for theatre without further investigation.
1. What reasons do you think he had to, over the phone, book the patient directly for theatre?
Tenderness.This usually implies a compromised loop of gut that either requires release, or if left too long, resection.
The fact that the patient had a 'virgin' abdomen and no other cause for obstruction in the setting of an anaemia increases the likelihood of the cause being a carcinoma obstructing the ileocaecal valve.
2. What was the diagnosis?
A right colon carcinoma obstructing the ileocaecal valve3. What are the options for treatment?
Formal right hemicolectomy, with proximal tie of the ileocolic vessels and resulting lymphovascular clearance. A primary anastomosis is usually possible - especially if operated early before the bowel and the patient deteriorate.Further information and images at Gastrolab