Bowel obstruction

I was watching an episode of Grey’s Anatomy over dinner, and this one caught my attention and i decided to take some snapshots and write a little about it.

The episode is entitled “Enough is enough“. Link on to find out about the story. Anyway the part of the episode i wish to highlight is when Miranda deals with an unusual surgery of a man who has blocked bowels. He doesn’t say what caused the blockage. The surgical team highly suspect packs of drugs, which apparently is common with drug trafficking and all. But then highly observant Karev says, “Are you sure they are drugs?” And everyone takes a closer look at the films…

Can you make up whats in shown by the abdominal XR?

Let’s have a further look.

Get a shrink, this guy’s got a problem.

Causes of small bowel obstructions (SBOs): The leading cause of SBO in developed countries is postoperative adhesions (60%) followed by malignancy, Crohn disease, and hernias, although some studies have reported Crohn disease as a greater etiologic factor than neoplasia.

Several surgeries are closely associated with SBO. They are appendectomy, colorectal surgery, and gynecologic and upper gastrointestinal (GI) procedures.

Classification of SBOs: (1)partial or (2) complete, simple (ie, nonstrangulated) or (3) strangulated. Strangulated obstructions are surgical emergencies. If not diagnosed and properly treated, vascular compromise leads to bowel ischemia and further morbidity and mortality. Because as many as 40% of patients have strangulated obstructions, differentiating the characteristics and etiologies of obstruction is critical to proper patient treatment.

History: Abdo pain (often described as crampy and intermittent), nausea, vomiting, diarrhea (early finding), constipation (late finding), fever and tachycardia (suspect strangulation), previous abdo or pelvic surgery, history of malignancy

Examination: Abdo distension, hyperactive bowel sounds (early obstruction as GI contents are attempting to overcome obstruction), hypoactive bowel sounds (late), routine abdo exam to exclude hernia, DRE (gross or occult blood suggests late strangulation or possible malignancy), symptoms of GIT ischaemia (fever, tachycardia, peritoneal signs)

Best management option would be a laparotomy.

There it is in the small bowel.

Out it comes.

I think this is probably rare. Crazy guy swallows heads of Judy dolls. What for? I don’t know.

What is the weirdest thing you ever removed from someone’s bowels?

References:

• Emedicine – Small bowel obstruction
  
• Histopatho India – causes of SBO (picture credit)