Case 90: Laparoscopic treatment of Small Bowel Obstruction
A 51 year old man presented with symptoms and signs of a proximal small bowel obstruction. He had a right paramedian scar from an urgent cholecystectomy that was performed 20 years ago.
1. What has caused the obstruction?
A localised small bowel volvulus around an adhesion to the anterior abdominal wall related to the old wound.2. What are the features that would enable you to say that the obstruction was proximal preoperatively?
Clinical indicators:Early vomiting with minimal or only mild abdominal distension.
Investigations:
an abdominal Xray with upper small bowel levels and distension. Also a small bowel contrast study if performed. For instance a gastrograffin follow through.
In this scenario, with little abdominal distension - laparoscopic division of the adhesions is ideal. Laparoscopic adhesiolysis is still difficult due to the distended and often friable chronically obstructed small bowel and great care is needed.
Further Reading
PubMed : Laparoscopic management of acute small bowel obstruction
Case Editor:
Mr Patrick Moore - General and Bariatric Surgeon.
