Editing Small bowel obstruction (section)

== '''Aetiology of duodenal obstructions''' ==

* '''Benign'''
** '''PUD'''
*** Combination of local inflammation, oedema, pylorospasm and fibrosis
*** Endoscopic balloon dilatation gives good results but patients often require surgery eventually
*** Give PPI and test for H. pylori
** '''Crohn's disease'''
*** Endoscopic balloon dilatation is worthwhile but often need surgery eventually
** '''SMA syndrome''' - reduced angle between SMA and aorta causes entrapment of duodenum
*** See separate topic
*** Develops in severe weight loss and post-surgically
*** Food intolerance with nausea and vomiting and epigastric pain in c/o weight loss
*** Can sometimes be managed conservatively (TPN + NGT) but generally needs surgery
*** Strong's procedure (cutting ligament of Treitz to allow duodenum to fall away) or deuodenojejunostomy
** '''Annular pancreas'''
*** Encircling ring of normal pancreatic tissue
*** Normally diagnosed <1yo by double bubble sign on AXR
* '''Malignant''' 50-80% of duodenal obstructions nowadays
** Most commonly pancreatic cancer with extension to duodenum
** Small bowel adenocarcinoma
** Gastric carcinoma
** Distal cholangiocarcinoma
** GI lymphoma
** Often end up requiring pancreaticoduodenectomy