Question

What is the best course of action to take when a patient presents with signs consistent with SBO and is now beginning to show indications of hemorrhagic shock?

Answer 1

The first approach in the management of intestinal obstruction includes the correction of physiologic impairment caused by obstruction. Some measures can be required: the use of a bladder catheter to monitoring urine output, adequate intravenous access, arterial canalization, and CVP monitoring.

The purpose of the therapeutic approach is the correction of hypovolemia and electrolytes depletion with volume resuscitation. The development of fluid-electrolyte replacement and the adequacy of resuscitation should be guided by the degree of systemic impairment and the reaction of the patient to therapy. Therefore, aggressive replacement of fluid and electrolytes can be employed after restoration of renal function. The use of nasogastric tube for the control of severe intestinal distension can be helpful.

Antibiotics should be started at the confirmation of diagnosis of intestinal obstruction, mostly if fever, and leucocytosis is present.

The aim of the use of antibiotics is based on the control and treatment of intestinal overgrowth of bacteria and their translocation across the bowel wall .Antibiotics, based on the particular type of bacterial overgrowth in the obstruction, could have more coverage against anaerobes and Gram-negative bacteria. The main objective of the therapeutic program of bowel obstruction is to remove the obstacle. Surgery is the leading option.