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Bowel obstruction is a blockage that prevents the normal flow of intestinal contents through the small or large intestine. It can be mechanical (physical blockage) or functional (paralytic ileus), presenting with abdominal pain, vomiting, distension, and inability to pass gas or stool. This condition requires prompt recognition and treatment to prevent serious complications including bowel ischemia, perforation, and sepsis.
Mechanical obstruction occurs when physical barriers such as adhesions, hernias, tumors, or intussusception block the intestinal lumen, causing proximal bowel distension and increased peristalsis. Functional obstruction results from impaired intestinal motility due to neurogenic or myogenic factors, leading to accumulation of gas and fluid. Both types cause increased intraluminal pressure, compromised blood flow, bacterial overgrowth, and potential translocation of bacteria and toxins across the bowel wall.
Diagnosis relies on the classic tetrad of crampy abdominal pain, vomiting, abdominal distension, and obstipation, though not all symptoms may be present initially. CT imaging is the gold standard for diagnosis, revealing dilated bowel loops, transition points, and potential complications like perforation or ischemia. Management depends on the location, severity, and underlying cause, ranging from conservative treatment with nasogastric decompression and IV fluids to urgent surgical intervention for complete obstruction or signs of strangulation.