| ICD-9-CM: |
| 560 - | Intestinal Obstruction without Mention of Hernia |
| 560.0 - | Intestinal Obstruction (No Hernia), Intussusception |
| 560.1 - | Intestinal Obstruction (No Hernia), Paralytic Ileus |
| 560.2 - | Intestinal Obstruction, Volvulus; Knotting, Strangulation, Torsion or Twist of Intestine, Bowel or Colon |
| 560.3 - | Intestinal Obstruction, Intestinal Impaction |
| 560.30 - | Intestinal Obstruction, Intestinal Impaction, Unspecified Impaction of Colon |
| 560.31 - | Intestinal Obstruction; Intestinal Impaction, Gallstone Obstruction of Intestine |
| 560.39 - | Intestinal Obstruction; Intestinal Impaction, Concretion of Intestine, Enterolith or Fecal Impaction |
| 560.8 - | Intestinal Obstruction, Other Specified |
| 560.81 - | Intestinal Obstruction; Intestinal or Peritoneal Adhesions with Obstruction |
| 560.9 - | Intestinal Obstruction, Unspecified; Enterostenosis, Obstruction, Occlusion, Stenosis or Stricture of Intestine or Colon |
| An intestinal obstruction is a partial or complete blockage of the small or large intestine that results in failure of the intestinal contents to pass through the bowel. Obstruction can occur anywhere in the small or large intestine and can be mechanical or nonmechanical. A mechanical cause will physically block the movement of materials through the intestines, such as a tumor, scar tissue (adhesions), or a swallowed foreign object. Nonmechanical causes stem from certain intestinal conditions, such as a disruption of the normal propelling motion (peristalsis) of muscles of the intestinal wall (dysmotility syndrome or pseudo-obstruction), or paralysis of the bowel wall (paralytic ileus). Paralytic ileus may result from infection within the abdominal cavity, decreased blood supply to support structures in the abdomen, reduced blood flow to the intestines from compression of blood vessels (intussusception), disorders of the upper gastrointestinal (GI) tract such as the esophagus or stomach, or metabolic disturbances (such as decreased potassium levels).
Causes of small-bowel obstruction include adhesions from prior surgery, weakness in the abdominal wall that may trap a portion of small intestine (abdominal hernia), or tumors (cancer). Large-bowel obstruction may be caused by tumors (colorectal cancer), abnormal twisting of a portion of bowel around itself (volvulus), or small, balloon-shaped pouches on the intestinal wall (diverticula). In older individuals or in the bedridden, feces can become hard and obstruct the bowel (fecal impaction). In individuals who have experienced rapid, significant weight loss, an abdominal artery (superior mesenteric artery) can compress part of the intestines, causing a rare type of obstruction called superior mesenteric artery (SMA) syndrome.Risk: Abdominal surgery, hernia, and digestive disturbances can put individuals at higher risk for intestinal obstruction. Adhesions account for 50% to 70% of all small-bowel obstructions admitted to US hospitals ("Bowel Obstruction"). Incidence and Prevalence: In the US and overseas, intestinal obstruction is found in 20% of individuals admitted to hospital with acute abdominal pain; of this number, 80% of the obstructions involve the small intestine (Khan). |
Source: Medical Disability Advisor
| History: Symptoms of obstruction in the small intestine include abdominal pain, nausea, and vomiting. The vomitus is usually greenish because of the presence of bile. With obstruction in the large intestine, vomiting is less likely, but abdominal pain is still present. Bowel movements are infrequent or absent in both, as is the passing of gas. Abdominal bloating may be present. Physical exam: The exam with a complete obstruction will show abdominal distention and tenderness. Listening to the abdomen may reveal characteristic bowel sounds of obstruction, such as high pitched "tinkling" or loud rushes of sound. Temperature is normal or slightly elevated. Tests: Blood tests include a complete blood count (CBC), electrolytes, and prothrombin time. Serum chemistries, blood urea nitrogen (BUN), creatinine, lactate, urinalysis, and arterial blood gases (ABGs) may also be done. Abdominal x-rays may appear normal in early, complete, or strangulation obstruction. X-rays can be enhanced by contrast material (opaque media), when given either by mouth or as an enema (barium enema), to help confirm the obstruction. Abdominal ultrasound alone can visualize 80% of obstructions occurring in the colon (Helton). Sometimes CT scanning or magnetic resonance imaging (MRI) are used, especially if a tumor is suspected. A sigmoidoscopy may be done in conjunction with a barium enema to visualize the bowel (sigmoid colon) with a lighted, flexible fiberoptic instrument (sigmoidoscope) that is inserted rectally. |
Source: Medical Disability Advisor
| Complete obstruction is typically treated with immediate surgery while partial obstruction seldom requires surgery. A partial obstruction is treated in the hospital by stopping oral intake of liquids and food, giving intravenous fluids, using a stomach tube to keep the stomach empty of gas and fluids, or resting the bowel with a long intestinal tube. These methods are employed prior to possible surgery.
A complete small-bowel obstruction may be treated by open surgical exploration of the abdomen (laparotomy). The obstruction is relieved and any diseased or nonfunctioning intestine is removed. Laparotomy may also be used to remove gallstones that have entered the small intestine. Insertion of a fiber-optic instrument (laparoscope) through a "keyhole" abdominal incision is sometimes an option to open surgery to minimize risk and complications. Laparoscopic-assisted lysis of adhesions (laparoscopic adhesiolysis) reduces complications and has a shorter recovery time with fewer new adhesions. Large-bowel obstruction usually requires surgery to remove the diseased or nonfunctioning segment of intestine. In some cases, the lower colon and anus may be bypassed with placement of a shunt (colostomy) for the removal of feces. Fecal impactions sometimes can be removed manually. |
Source: Medical Disability Advisor
| With proper diagnosis and early treatment of the obstruction, the outcome is generally good. Complete obstructions managed successfully with nonoperative treatment have higher incidence of recurrence than those treated surgically. Laparoscopic lysis of adhesions has shown lower morbidity and a faster return to normal diet and bowel function. If the obstruction is secondary to cancer, the outcome is dependent on the cancer prognosis. There is a 2% mortality rate with uncomplicated small-bowel obstruction, mostly in the elderly; the fatality rate is much higher if some of the small intestine has died (ischemia). Overall mortality with large-bowel obstruction is 20%.
Individuals who have a colostomy are able to return to normal activities (colostomy bags need to be emptied and changed routinely by the individual). Those with a temporary colostomy usually have a second surgery a few months later to reattach the bowel and remove the colostomy. In these cases, bowel function often returns to normal. |
Source: Medical Disability Advisor
| If treatment is delayed, dehydration and related electrolyte imbalance can complicate treatment once it is begun. Delayed treatment can also significantly increase morbidity and mortality. The intestine can become perforated, sometimes through a pre-existing weak spot (diverticulum). Abdominal abscesses, wound rupturing (dehiscence), and post-operative infection can occur. The intestine can become strangulated under some conditions and its blood supply seriously reduced. This may cause gangrene and subsequent death (ischemia) of bowel tissue, a very serious complication with a high fatality rate. |
Source: Medical Disability Advisor
| If abdominal surgery is required to relieve the obstruction, limitations on lifting may be necessary. When major surgery has been performed to remove segments of the intestinal tract or to insert bypasses, reassignment to other work may be needed. Dietary restrictions may be needed and arrangements for these special needs should be made in the work place. If the individual had a partial obstruction that was treated with conservative management (i.e., stopping oral intake, nasogastric tube), then the individual may be on a soft diet for a few days to weeks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual complain of abdominal pain, nausea, and vomiting? Is the vomitus greenish in color (suggesting small-intestine obstruction)?
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Does individual complain of abdominal pain without vomiting, suggesting a large-intestine obstruction?
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Are bowel movements and passing gas infrequent or absent?
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Were a complete blood count (CBC), blood chemistries, prothrombin time, and arterial blood gases (ABGs) done?
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Were x-rays of the abdomen done? Did they reveal an obstruction, or may they have been taken before the obstruction could be seen?
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Was computed tomography (CT scan) done, especially if a tumor is suspected?
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Has the diagnosis of intestinal obstruction been confirmed?
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Has the cause of the obstruction been determined?
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Is the obstruction partial or complete?
Regarding treatment:
- For partial obstruction, was individual hospitalized to stop oral intake of liquids and food, to give intravenous fluids, to keep the stomach empty through a stomach tube, or to rest the bowel with an intestinal tube? Was this treatment successful, or was surgery required?
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For complete small intestine obstruction, was surgical exploration of the abdomen (laparotomy) done and the obstruction relieved? Was any diseased intestine removed also?
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For large intestine obstruction, was surgical creation of an opening (stoma) onto the abdomen made for stool to pass, thereby bypassing the lower colon and anus (colostomy)?
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Is the colostomy expected to be temporary or permanent?
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Were medical and/or surgical interventions successful in relieving the obstruction?
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Were there any complications after surgery?
Regarding prognosis:
- Is this the first intestinal obstruction individual has had, or is this a recurrence?
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If the obstruction is secondary to cancer, was the obstruction able to be relieved?
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Has the cancer spread (metastasized) to other parts of the body?
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Did any surgical complications occur?
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Did individual experience dehydration or electrolyte imbalance complications?
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Did the intestine become perforated?
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Did the intestine become strangulated causing decreased blood flow and development of gangrene? If so, is individual expected to live?
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If individual has a colostomy, would psychological counseling be of benefit to cope with the impact of the changes in body image?
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Source: Medical Disability Advisor
| "Bowel Obstruction." InteliHealth. 7 Oct. 2004 <http://www.intelihealth.com/IH/ihtIH?t=25862&p=~br,IHW|~st,24479|~r,WSIHW000|~b,*|#info>.Helton, W. S., and P. M. Fisichella. "Intestinal Obstruction." WebMD.com. WebMD Inc. 7 Oct. 2004 <http//www.medscape.com/viewarticle/47067>. Khan, Ali Nawaz, and John Howat. "Small-Bowel Obstruction." eMedicine. Eds. Eric P. Weinberg, et al. 10 May. 2004. Medscape. 7 Sep. 2006 <http://emedicine.com/radio/topic781.htm>. |
Source: Medical Disability Advisor
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