0071643192.pdf

TREATMENT

■ Initial treatment in the ED includes fluid resuscitation and electrolyte
replacement, NGT placement if obstruction or toxic megacolon are sus-
pected, and broad spectrum antibiotics for patients with peritonitis,
abscess, or fulminant colitis.
■ Patients with severe disease should receive intravenous steroids.
■ Admission is required for severely ill patients.
■ Medical therapy
■ Anti-inflammatories: Sulfasalazine and mesalmine, administered orally
or rectally
■ Antibiotics, eg, metronidazole and ciprofloxacin, with uncertain benefit
■ Corticosteroids: Prednisone, budesonide
■ Immune modifiers: Azathioprine, methotrexate, infliximab
■ Surgery: May be required for obstruction, abscesses; avoid if possible because
of future strictures, adhesions, fistulas

COMPLICATIONS

Obstruction, abscess, toxic megacolon, colorectal cancer, fistulas, strictures

Small-Bowel Obstruction/Ileus

Mechanical obstruction is the most common surgical emergency of the small
intestine. Mechanical small-bowel obstruction results from a physical barrier
that prevents passage of intestinal contents. It may be partial or complete and
occur at one or two points. Simple obstruction blocks the lumen only, while
strangulation impairs the blood supply to the intestine as well. Adynamic or
paralytic ileus implies failure of peristalsis to propel intestinal contents
through the bowel in the absence of a mechanical barrier.

ETIOLOGY

See Tables 11.4 and 11.5.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

Closed-loop obstruction occurs

at two points and often results

in strangulation.

TABLE 11.4. Causes of Mechanical Small-Bowel Obstruction

Adhesions (most common)

Hernias: Inguinal, femoral, internal

Crohn disease

Volvulus

Intusussception

Neoplasms

Strictures

Gallstone ileus

Foreign body