Emergency Cases Northwest Group
059 An Ill wind
Situation
Patient said she could pass wind but still had small bowel
obstruction.
Background
91 Year old lady presented with abdominal pain, vomiting and distension
onset that morning. Said she opened her bowels that day too and could
still pass wind. Initially declined by surgeons as: AXR didn’t show
obstruction, she could still pass wind and open bowels. CT showed high
grade SBO in left iliac fossa, loop obstruction with ischaemia.
Assessment
AXR didn’t show obstruction because the small bowel was filled with
liquid not air.
Being able to pass wind didn’t fit with diagnosis: perhaps the
obstruction was incomplete or she was mistaken.
Recommendation
If the clinical picture is of SBO don’t let passing wind or diarrhoea
dissuade you; it may be a partial obstruction.
Note the AXR wasn’t diagnostic.
Be aware that SBO can be a closed loop: high risk of ischaemia.
PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR
GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED
IMAGES
Emergency Cases Northwest Group