الفهرس 
ANATOMY OF THE SMALL AND LARGE INTESTINEOnly 14 pages are availabe for public view
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Abstract
T
he most common causes of SBO are adhesions and incarcerated hernias, with a relative increase in the incidence of adhesions during the last few decades. Complications include bowel ischemia and perforation, the incidence of which is higher in closed-loop obstruction. SBO is diagnosed by clinical examination and radiographic studies. Patients appear acutely ill, complaining of colicky abdominal pain, emesis, abdominal distention, and progressive obstipation. The plain abdominal roentgenogram usually provides useful, but limited, information. Although SBFT is still widely used, its diagnostic role is being superceded by abdominal CT. The initial treatment is supportive, with intravenous fluid resuscitation, correction of electrolyte disorders, bowel rest, and nasogastric decompression. If an SBO is complete or if intestinal ischemia or peritonitis is evident, the patient should be administered antibiotics and undergo emergency surgery. If an SBO is partial, conservative management is maintained for 24 to 48 hours. If the patient does not improve with conservative management or develops signs of peritonitis, laparotomy is indicated. The mortality from SBO has recently decreased to 5%. The recurrence rate of SBO from adhesions is high, ranging from 15% to 50% at 10 years.
The most common cause of LBO is colorectal carcinoma, followed by colonic volvulus and diverticular disease. The clinical presentation is variable, but patients commonly present with abdominal distention, abdominal pain, progressive obstipation, and nausea and emesis. Pyrexia and marked leucocytosis suggest possible bowel ischemia or perforation.LBOis usually diagnosed by clinical presentation, plain abdominal roentgenogram, and specialized radiographic tests. LBO is an abdominal emergency associated with high morbidity and significant mortality. Initial therapy includes aggressive fluid replacement, correction of electrolyte abnormalities, and broad-spectrum antibiotics. Right-sided colon cancer is usually treated by a single-stage resection with primary anastomosis. The management of left-sided colon cancer is controversial, with commonly used alternatives of single-stage resection versus initial decompression with staged resection. Hartmann procedure is preferred in the presence of bowel ischemia or perforation. A primary anastomosis is avoided on an unprepped colon. Poor surgical candidates may undergo colonoscopic palliation by laser ablation, stenting, or balloon dilatation of the stricture. Sigmoid volvulus is initially treated with sigmoidoscopic decompression, followed by consideration of definitive elective surgery. Cecal volvulus is usually treated by segmental resection if nonviable colon is present, or by detorsion with cecopexy or cecostomy when the colon is viable.