Travel Reference
In-Depth Information
Intestinal Obstruction
Obstruction of the intestinal tract produces cramping abdominal pain and ultimately
causesnauseaandvomiting.Iftheobstructionisintheupperpartofthesmallintestinenear
the stomach, vomiting usually begins soon after obstruction occurs. An obstruction lower
in the bowel first produces an accumulation of gas and fluid in the obstructed segment of
intestine. The onset of vomiting occurs later, and the abdomen is noticeably distended by
dilated loopsofintestine. Theonset ofacute small bowel obstruction isusually suddenand
unexpected and is characterized by waves of severe, sharp colicky pain that seem to in-
volve the entire abdomen. Each rush of gas and fluid propelled against the obstruction by
peristalsis is accompanied by a spasm of acute pain felt throughout the entire abdomen.
When the flow of intestinal contents is blocked, diarrhea is absent. Not even gas is passed.
Regardlessofthecauseoftheobstruction,theurgencyofevacuationisbasedonwheth-
er the obstruction is complete or incomplete. If the obstruction is complete—does not per-
mit intestinal contents to pass beyond the site of obstruction—immediate evacuation is
needed to avoid perforation of the intestine and catastrophic peritonitis.
The most common cause of small bowel obstruction is postoperative adhesions, fol-
lowedbyanirreducible(incarcerated)hernia,whichisusuallyinguinal.Thecauseofadhe-
sions is tissue reaction that occurs with any surgery in the abdominal cavity. After certain
surgeries, particularly those associated with infection in the lower abdomen, fibrous adhe-
sions or scar tissue bind loops of intestine together. Kinking or narrowing of the intestine
by adhesions can obstruct the flow of intestinal contents and is the most common cause
of small bowel obstruction. Some individuals are much more prone to developing adhe-
sions than others. A surgical scar on the abdominal wall strongly suggests adhesions as the
cause of an intestinal obstruction. Although such obstructions manifest most frequently in
the weeks following surgery, they may not occur for months or even longer.
Almost nothing can be done in a wilderness setting to relieve obstruction due to adhe-
sions. The only decision to be made is whether obstruction is complete and the individual
should be evacuated immediately, or whether the obstruction is incomplete and evacuation
may be delayed. Only a few hours are available for this decision. If the obstruction is un-
relieved, perforation results andcan belife threatening. Avenerated surgical maxim states,
“The sun must not rise or set on a patient with an obstructed small intestine” (without
surgery). In a wilderness environment, this translates into deciding within about six hours
whether the obstruction is incomplete—whether the individual is passing gas, has had a
bowel movement, is experiencing less pain, or the distention of the abdomen is diminish-
ing. Antibiotics should be administered once the decision for evacuation has been made.
Incarcerated Hernia
Most hernias (ruptures) are protrusions of the intestines through an abnormal weakness
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