Case Study: General Diagnosis and Management of Bowel Obstruction

This case study presents the diagnosis and management of a 73-year-old woman admitted with abdominal pain and vomiting, later diagnosed with bowel obstruction. The initial management focuses on rehydration via intravenous fluids and pain management. Differential diagnosis involves considering various causes of abdominal pain, with bowel obstruction confirmed via abdominal X-ray. Further diagnostic measures such as ultrasonography and CT scans are discussed to determine the severity and location of the obstruction. The decision-making process for surgical intervention is explored, emphasizing conservative therapy as the first-line approach and monitoring the patient's response over 48 hours. Surgical intervention is considered if conservative measures fail. The study concludes that proper diagnosis and management, with a preference for non-operative treatment, are crucial for successful outcomes in bowel obstruction cases. Desklib provides access to similar case studies and solved assignments for students.

Running head: GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
General Diagnosis and Management of Bowel Obstruction
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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
Introduction
Background of the case study
The patient, a 73-year old woman, has been reported with abdominal pain and vomiting
at the emergency clinic. Abdominal X-ray confirmed that multiple loops of bowel have been
found in her intestines. Further detailing of the medical investigation showed that the woman had
undergone appendectomy and hysterectomy a long time back. Abdominal X-ray shows that
intestinal obstruction may be present for which the patient is suffering severely. These symptoms
have been common among the population. This clinical condition is treatable with efficient
management, provided early diagnosis and medical care is given. Abdominal pain accompanied
by vomiting is the most common among emergency admissions of patients. Abdominal pain and
vomiting are associated with a variety of pathologies; therefore a more comprehensive and
elaborate approach is to be taken to accurately determine the cause and related pathology [1].
Multiple diagnoses involving laboratory tests need to be performed.
Initial Management
The old woman has been admitted at the emergency hour, symptoms being severe.
Vomiting has resulted in an excessive fluid loss from her body. Conservative therapy or non-
operative therapy should be the first choice of approach. Care should be taken so that the patient
does not suffer from dehydration; in response to excessive vomiting, immediate intravenous fluid
therapy needs to be given to replenish for fluid loss, thereby promoting rehydration. Medication
should be allowed to reduce the severe abdominal pain. Dilated loops of the bowel as confirmed
by abdominal X-ray suggests intestinal bowel obstruction as a probable pathology. To address
this, intestinal volume and electrolyte balance need to be restored through intubation methods

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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
[3]. Blood samples should be taken for biochemical and microbiological, cross-matching testing
before intravenous fluid therapy. Saline should be provided immediately to recover from the
effects of excessive vomiting. Nasogastric tubes need to be inserted to allow food intake. Various
water-soluble contrast agents like gastrograffin need to be administered, to determine the need
for surgery. Gastrograffin administration promotes water movement through the bowel, thereby
enhancing the peristaltic motility [4].
Differential Diagnosis
Diagnosis of small bowel syndrome is done based on the clinical presentation of the
patient. There is no morbidity related to the appendix as she had already undergone an
appendectomy. Initial diagnosis involves a plain radiograph of the abdomen. Plain abdominal
radiography is performed in the supine position. It shows the presence of multiple jejunal loops
of bowel which are lacking air passages. The distended diameters of the loops are determined in
this diagnostic method. Radiographic data can be negative or inconclusive if the obstruction is
acute. In that case, Ultrasonography or Computed Tomographic scan is performed to confirm the
diagnosis. Accurate clinical decision-making is based on initial diagnostic measures [2]. Blood
tests are performed which show changes in electrolytic balance and increase in white blood cells.
Ultra Sonography is another cross-sectional imaging technique, commonly employed for
diagnosis of intestinal obstruction if radiographic diagnosis indicates the severity of obstruction.
The location and pattern of obstruction of distended loops are clearly determined through
Sonography. Low grade and high grade bowel obstruction are confirmed through sonography
and CT scan. Multidetector Computed Tomography (CT) scan is a fast evaluation measure for
diagnosis of bowel obstruction. The level of obstruction of the jejunal loops in the intestine and
their associated complications, if any, are determined effectively through CT scan [3]. CT scan is

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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
more effective and confirmatory diagnosis of bowel obstruction; the causes of bowel obstruction
and a distinguishing feature between acute and complicated bowel obstruction are determined
through CT [6]. In response to vomiting, an X-ray should be performed to confirm the bacterial
infection of intestines.
Decision- making for a surgical requirement
In severity of bowel obstructions, doctors promptly recommend a surgical operative
procedure to improve the bowel obstruction. A milder form of bowel obstruction can be treated
at home and through intake of less fluids in diet. Diagnostic tests should be performed to confirm
the necessity of operative procedures for intestinal bowel obstruction. In many cases, surgical
operations are not even required even when the patients are admitted to the hospitals at the
emergency hours [4]. Rehydration therapy and electrolyte therapy often improves the severity in
an emergency. In the given pathologic condition, how the old woman responds to the intravenous
fluid therapy and electrolyte therapy should be monitored initially. Conservative therapy is
effective often in reducing the severity of outcomes in bowel obstruction. In the given case,
response to conservative therapy needs to be monitored for the next 48 hours to take any decision
on the operative procedure. If the conservative therapies do not respond positively during 48
hours post-treatment, a decision is taken to surgically operate and treat the condition,
confirmation of surgery needs to be achieved through medical tests. Gastric fluoroscopy is often
performed to confirm the need for surgery as the only means to improve the bowel obstruction
[7].
Conclusion

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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
Intestinal obstruction or peristaltic obstruction is increasing among the population, the
condition can be well treated with proper diagnosis and management. Non-operative or
conservative treatment is most commonly preferred by doctors. The surgical operation is
recommended only when the patient does not show any positive result after 48 hours of
conservative therapy. Most cases of intestinal obstruction are cured through rehydration therapy
and restoring the electrolyte balance.

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GENERAL DIAGNOSIS AND MANAGEMENT OF BOWEL OBSTRUCTION
References
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medicine research. 2017 Dec;9(12):987.
2. Saber YA, Hakim BI, Ayoub MZ, Zenaidi AZ. A case report of small bowel obstruction
secondary to congenital peritoneal band in adult.
3. Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and
treatment of small bowel obstruction. Current gastroenterology reports. 2017 Jun
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4. Ceresoli M, Coccolini F, Catena F, Montori G, Di Saverio S, Sartelli M, Ansaloni L.
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6. Suri RR, Vora P, Kirby JM, Ruo L. Computed tomography features associated with
operative management for nonstrangulating small bowel obstruction. Canadian Journal of
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7. Levine MS. Gastric Functional Tests: Upper Gatrointestinal Barium Studies.
InGastrointestinal Motility Disorders 2018 (pp. 317-329). Springer, Cham.

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