Difference between revisions of "Small bowel obstruction"
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'''Small bowel obstruction''', abbreviated '''SBO''', is a common [[pathology]] managed by general surgeons. | |||
This article gives an overview of SBOs. Its primary focus is benign causes of SBO that have nonspecific pathologic findings. Specific causes definitively identified by pathology, e.g. [[adenocarcinoma]], are dealt with separately. | |||
==General== | |||
*Radiologic/[[clinical diagnosis]]. | |||
The usual causes of bowel obstruction (large & small) are (mnemonic) ''SHAVING'': | |||
*Strictures (think [[IBD]]). | |||
*Hernias. | |||
*Adhesions. | |||
*[[Volvulus]]. | |||
*Intussusception. | |||
*Neoplasia. | |||
*Gallstone ileus. | |||
The top three are:<ref>URL: [http://www.emedicine.com/EMERG/topic66.htm http://www.emedicine.com/EMERG/topic66.htm]. Accessed on: 19 April 2011.</ref><ref>{{Ref TN2007 |GS21}}</ref> | |||
* Adhesions > hernias > neoplasms. | |||
In the context of bowel obstructions and IBD, pathologists often see resected [[stoma]]s (that were put in place emergently). These specimens are usually fairly straight forward. | |||
==Radiology== | |||
*Air-fluid levels. | |||
==Gross== | |||
*+/-Adhesions. | |||
*+/-Bowel contorted. | |||
*+/-Luminal narrowing +/-proximal dilation. | |||
*+/-Serosal exudate. | |||
**Suggestive of perforation. | |||
==Microscopic== | |||
Features: | |||
*+/-Adhesions (serosal). | |||
**Dense fibrous tissue replaces the adipose tissue. | |||
**+/-Increased vascularity. | |||
*+/-Submucosal fibrosis. | |||
*+/-[[Serositis]] - seen in small bowel perforation. | |||
*+/-Foreign body-type granuloma - due to previous surgical intervention. | |||
DDx: | |||
*Small bowel [[adenocarcinoma]] - most important differential diagnosis. | |||
*Metastatic adenocarcinoma - classically on the serosal aspect. | |||
*[[Signet ring cell carcinoma]]. | |||
==Sign out== | |||
<pre> | |||
SMALL BOWEL, RESECTION: | |||
- SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL | |||
NARROWING. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
SMALL BOWEL, RESECTION: | |||
- SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE), FOCAL LUMINAL NARROWING AND A | |||
FOREIGN BODY-TYPE GRANULOMA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
===Ischemic changes=== | |||
<pre> | |||
SMALL BOWEL, RESECTION: | |||
- SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL | |||
MICROABSCESS FORMATION. | |||
- NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==See also== | |||
*[[Small intestine]]. | |||
==References== | |||
{{Reflist|1}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Gastrointestinal pathology]] | |||
Revision as of 06:11, 2 January 2016
Small bowel obstruction, abbreviated SBO, is a common pathology managed by general surgeons.
This article gives an overview of SBOs. Its primary focus is benign causes of SBO that have nonspecific pathologic findings. Specific causes definitively identified by pathology, e.g. adenocarcinoma, are dealt with separately.
General
- Radiologic/clinical diagnosis.
The usual causes of bowel obstruction (large & small) are (mnemonic) SHAVING:
- Adhesions > hernias > neoplasms.
In the context of bowel obstructions and IBD, pathologists often see resected stomas (that were put in place emergently). These specimens are usually fairly straight forward.
Radiology
- Air-fluid levels.
Gross
- +/-Adhesions.
- +/-Bowel contorted.
- +/-Luminal narrowing +/-proximal dilation.
- +/-Serosal exudate.
- Suggestive of perforation.
Microscopic
Features:
- +/-Adhesions (serosal).
- Dense fibrous tissue replaces the adipose tissue.
- +/-Increased vascularity.
- +/-Submucosal fibrosis.
- +/-Serositis - seen in small bowel perforation.
- +/-Foreign body-type granuloma - due to previous surgical intervention.
DDx:
- Small bowel adenocarcinoma - most important differential diagnosis.
- Metastatic adenocarcinoma - classically on the serosal aspect.
- Signet ring cell carcinoma.
Sign out
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE) ASSOCIATED WITH FOCAL LUMINAL NARROWING. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH FIBROUS ADHESIONS (EXTENSIVE), FOCAL LUMINAL NARROWING AND A FOREIGN BODY-TYPE GRANULOMA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
Ischemic changes
SMALL BOWEL, RESECTION: - SMALL BOWEL WITH ISCHEMIC CHANGES, FIBROUS ADHESIONS, FOCAL SEROSITIS AND MURAL MICROABSCESS FORMATION. - NO SIGNIFICANT VASCULAR PATHOLOGY APPARENT. - NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ URL: http://www.emedicine.com/EMERG/topic66.htm. Accessed on: 19 April 2011.
- ↑ Greenwald, J.; Heng, M. (2007). Toronto Notes for Medical Students 2007 (2007 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. GS21. ISBN 978-0968592878.