NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Figure 8-5: Three causes of intestinal obstruction. A: Intussusception: invagination or shortening of the colon caused by the movement of one segment of bowel into another. B: Volvulus of the sigmoid colon: The twist is counterclockwise in most cases. Note the edematous bowel. C: Hernia (inguinal): The sac of the hernia is a continuation of the peritoneum of the abdomen. The hernial contents are intestine, omentum, or other abdominal contents that pass through the hernial opening into the hernial sac. (From Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing , 14th ed. Wolters Kluwer Health; 2017, Fig. 47-5.)

Case Variation 8.1.8. Ovarian cancer that had been previously excised ◆ ◆ Ovarian cancer can recur locally or as peritoneal studding , resulting in obstruction. Treatment is similar to melanoma (see Case Variation 8.1.7). Debulking incurable ovarian tumors may improve survival and warrants consideration. Case Variation 8.1.9. Metastatic breast cancer treated with chemotherapy 1 year ago ◆ ◆ Metastatic breast cancer can also manifest as bowel obstruction. Treatment is similar to that used in Case Variation 8.1.7. Case Variation 8.1.10. Localized abdominal tenderness with rebound ◆ ◆ Localized tenderness with other signs and symptoms of bowel obstruction should alert the clinician that a potential serious complication such as a closed loop obstruction, perfora- tion, ischemia, or an abscess is present. Localized tenderness is an indication that surgical exploration rather than observation is necessary. SAMPLE