Bowel Obstruction In The Elderly

Super Memory Formula

Memory Loss Holistic Treatments

Get Instant Access

Causes of bowel obstruction usually specific to the elderly include sigmoid volvulus, Ogilvie's Syndrome, colon carcinoma, and gallstone ileus. These conditions in the elderly patient can lead to gangrene with resulting perforation.

4.1. Sigmoid Volvulus

Sigmoid volvulus is 20 times more likely in the patient age 60 yr and greater (19). This age association may be due to acquired redundancy of the sigmoid colon. High-residue diets are believed to be the causative factor in developing a redundant sigmoid (20). Other factors associated with volvulus are Parkinson's disease, dementia including Alzheimer's disease, bedridden state, and prior abdominal operations, all of which increase in frequency in the elderly patient. Sigmoid volvulus usually presents as acute onset of colicky abdominal pain, distention, and obstipation. When strangulation has occurred, the patient can present with generalized abdominal pain, tenderness to palpation, fevers, leukocytosis, and hypotension. Plain abdominal radiographs characteristically show a dilated sigmoid loop with a "bird's beak" pointing to the site of obstruction. If the plain abdominal radiographs are equivocal, a barium enema may be used. However, this test is contraindicated if strangulation is suspected. Decompression with endoscopy and rectal tube placement should be performed in the absence of peritoneal signs. This is successful in 70-80% of patients. The risk of recurrence of sigmoid volvulus is high (approximately 55-90%), therefore the patient should be evaluated for elective sigmoid resection. If the sigmoid volvulus has progressed to gangrene, mortality approaches 50-70%. When peritoneal signs are present emergent laparotomy is indicated.

4.2. Ogilvie's Syndrome

Ogilvie's syndrome, also called colonic pseudo-obstruction, usually occurs in the elderly bedridden patient. When cecal distension approaches 12 cm, the risk of gangrene, infarction, and perforation increases. When perforation and gangrene occur, mortality is 50%. As in sigmoid volvulus, colonoscopic decompression is the treatment of choice. However, if endoscopy fails or the patient is unstable, cecostomy or laporatomy with resection may be indicated.

4.3. Gallstone Ileus

An interesting, yet rare, cause for small bowel obstruction in the elderly is gallstone ileus. This is caused by the passage of a large biliary calculus from the gallbladder to the distal iliem through a cholecystenteric fistula. This disorder carries an overall mortality rate of 15%. Rigler's triad, which includes small bowel obstruction, ectopic gallstones, and pneumobilia, characterizes this disorder. Enterolithotomy, which carries an operative mortality of 12%, is the procedure of choice (21). A one-stage procedure of enterolithotomy, cholecystectomy, and fistula repair carries a mortality of 17% (22).

4.4. Carcinoma of the Colon

Cancer of the colon and rectum is the second most common cancer in western countries with an incidence of 150,000 new cases per year. The incidence increases with age, with up to three-quarters of the cases occurring in patients 65 yr and older. Colorectal cancers may present with obstruction and/or peritonitis. The mortality from complicated obstruction from colorectal cancer is as high as 50%, and long-term survival after resection is greatly reduced. This is partially due to more advanced disease and metastasis in patients with this complication (23). In the critically ill elderly patient with perforation or obstruction, a bypass or diversionary procedure should be considered. Definitive treatment may then be performed on an elective basis.

5. ACUTE MESENTERIC INFARCTION 5.1. Epidemiology and Clinical Relevance

Acute mesenteric infarction can lead to a catastrophic intraabdominal infection in the elderly with mortality rates as high as 90%. Arterial emboli to the mesenteric vessels occur in 30% of patients with this disorder. These emboli originate most commonly from a mural thrombus in an infarcted left ventricle or a fibrillating left atrium. Thrombosis of a mesenteric vessel occurs in 25% of patients and is due to atherosclerotic stenosis. This is usually preceded by intestinal angina. Other less common causes of acute mesenteric infarction are thrombosis of mesenteric veins, dissecting aneurysms, fusiform aneurysms, and connective tissue disorders. Mesenteric vascular occlusion leads to necrosis of villi, mucosal sloughing, ulceration, and bleeding. Even without full-thickness necrosis, perforation, sepsis, multiorgan failure, and death may occur.

5.2. Clinical Manifestation

Pain out of proportion to the physical examination is one of the hallmarks of acute mesenteric ischemia. This pain is severe, poorly localized, and can be associated with nausea, vomiting, diarrhea, and/or constipation. When late in the presentation or when perforation occurs the patient may develop abdominal distention, tenderness to palpation, hypotension, and/or generalized peritonitis. Guaiac-positive stools are present in 75-95% of patients. Leukocytosis, hyperamylasemia, increased alkaline phosphatase, elevated serum lactate, hyperphosphatemia, and acidosis may be observed.

5.3. Diagnostic Tests

Acute abdominal radiographic series are commonly unremarkable early in ischemia. However, as the disease progresses the radiographs can show dilated loops of small intestine containing air-fluid levels, "thumbprinting" of the bowel wall, intramural gas, and/or free air (24). CT scans of the abdomen can be useful, especially to exclude other abdominal pathology. Findings on CT scan may show bowel wall thickening, intramural gas, dilatation of bowel loops, fluid-filled loops, increase attenuation of mesenteric fat, and/or mesenteric or portal venous gas. In evaluation of mesenteric venous thrombosis CT scan is the study of choice and may detect superior mesenteric artery thrombosis. Despite large numbers of negative studies angiography can be a precise method for diagnosing occlusive intestinal ischemia (25).

5.4. Treatment

If peritoneal signs are present, exploratory laparotomy is warranted. Treatment will be focused on resection of nonviable bowel and restoration of intestinal blood flow. Transarterial embolectomy may be attempted in the stable patient. Thrombolytic therapy has yet to be proven an effective treatment, however, anticoagulant therapy may be used for prophylaxis against further emboli.

Was this article helpful?

0 0
Unraveling Alzheimers Disease

Unraveling Alzheimers Disease

I leave absolutely nothing out! Everything that I learned about Alzheimer’s I share with you. This is the most comprehensive report on Alzheimer’s you will ever read. No stone is left unturned in this comprehensive report.

Get My Free Ebook


  • anna
    What cause increase red blood cell in patient with bowel obstruction?
    8 years ago
  • agata
    How to rectal tube decompression?
    8 years ago
    What causes bowel obstruction in the elderly?
    7 years ago
  • maarit
    HOW TO TREAT Intestinal blockage or obstruction IN THE ELDERLY?
    7 years ago
  • layla
    What causes bowel obstruction in geriatric patients?
    7 years ago
  • pasquale napolitani
    Can dementia cause ileus of bowel?
    7 years ago
  • cosimo
    How to clear bowel obstruction in elderly?
    7 years ago
  • Steve
    Can bowel obstruction cause death in the elderly?
    7 years ago
  • Ettore
    How to stimulate bowel in elderly people?
    7 years ago
  • asmeret aatifa
    What causes asppiration in the elderly with bowels?
    7 years ago
  • albert
    How to repair a bowel obstruction on the elderly?
    7 years ago
  • bertha
    Can obstructed bowel cause delerium in elderly?
    7 years ago
  • brenda
    Can an ileus cause death in the elderly?
    4 years ago
  • Hildigard Took-Took
    What causes bowel blockage in elderly?
    4 years ago
  • gwen long
    What causes bowel obsstruction in ederly patients?
    3 years ago
  • ari tervo
    How to clear bowel of old people?
    3 years ago
  • kiros
    How long do elderly survive with a blocked bowel?
    2 years ago
  • tom
    What causes bowl blockage in ealdrly people?
    1 year ago
  • lalli
    How to Releive a Bowel Obstruction in an elderly Patient?
    1 year ago
  • Jose
    Are intestinal blockages common in the elderly?
    1 year ago
  • amaranth hogpen
    What does a bowel obstruction do in an elderly person?
    1 year ago
  • Ethan
    Do bowel obstructions kill older people?
    1 year ago
  • Mark
    What causees bowel obstruction in elderly with colon cancer history?
    1 year ago
  • zula
    How to clear bowel in bed ridden state?
    1 year ago
    How do you treat a bowel blockage in a senior citizen?
    1 year ago
  • Tom
    Is intestinal blockage fatal for an elderly?
    1 year ago
  • Hilda
    What causes volvulus in elderly?
    1 year ago
  • stefania russo
    What happens to senior with bowel obstructions?
    1 year ago
  • lauri
    What causes twisted bowel in the elderly?
    1 year ago
  • filibert
    Can bowel blockage cause death?
    1 year ago
  • v
    Why do older people get bowell obstructions?
    1 year ago
  • berylla
    What is the best less invasive proceedure for bowel blockage in the weak ans elderly patient?
    1 year ago
  • ulrich friedmann
    How to fix bowel obstructions on elderly patients?
    1 year ago
    What are the possible causes of a blocked intestine in old age?
    1 year ago
  • Reeta
    What happens to an eldery person who has a intestinal blockage?
    10 months ago
  • max
    What are the symptoms of a bowel blockage?
    10 months ago
  • harding
    Is blockage in intestines common with old people?
    10 months ago
  • segan
    What causes bowel obstruction in elderly people?
    9 months ago
  • quadrato sabbatini
    Can iliues be caused by old age?
    9 months ago
  • Amanuel
    How long does it take bowel obstruction to dwvelop in elderly patient?
    9 months ago
  • Klaus
    What causes volvulus in older people?
    8 months ago
  • luukas
    Why older people get bowel obstruction?
    8 months ago
  • Awet Amanuel
    How to treat blockages in elderly people?
    8 months ago
  • isengrin
    Do bowel obstructions in nonambulatory patients cause death?
    8 months ago
  • bungo took
    Why do small bowel obstructions occur in older people?
    7 months ago
  • Costanzo
    What causes bowel blockage in elderly people?
    6 months ago
  • christine barth
    What are the causes of an ileus in a 75 year old ?
    6 months ago
  • flavus
    How can bowel obstruction cause death in 102 year old female?
    6 months ago
  • jennifer
    What is the risk of a upper bowel obstruction surgery if you are 90 years old?
    6 months ago
  • dominik
    What is the life expectancy of a 90 year old with a small bowel blockage?
    5 months ago
  • Aleksander
    What causes blockage in 65 year old women?
    5 months ago
  • catone
    Are bowel obstructions more common in the aged?
    5 months ago
  • jamie
    Is bowel obsturction surgery dangerous on eldery?
    5 months ago
  • Mathias Muller
    What cause repeated bowel obstruction in the elderly?
    5 months ago
  • Adaldrida
    Why do old people get a bowe bockage?
    5 months ago
  • tuula
    How to treat a small intestintal obstruction in an 82 year old patient?
    5 months ago
  • baldassarre
    What is the prognosis of a bowel obstruction in a 90 year old?
    4 months ago
  • Patrizia
    3 months ago
  • myley clark
    What causes bowel blockages in old people?
    3 months ago
  • Zahra
    3 months ago
  • BOYD
    How serious is an intestinal fold in older adults?
    3 months ago
  • Ruta
    How is colonic volvulus in the elderly treated?
    2 months ago
  • Saba
    Can you do surgery on a 87 year old male with a bowel onstruction?
    2 months ago
  • juliane strauss
    Does older age increases the risk for developping small bowel obstruction?
    2 months ago
    How aging can lead to intestinal obstruction?
    2 months ago
  • Aatifa
    What is the life expentancy of a woman with untreatable intestinal blockage.?
    2 months ago
  • Fredegar Sandyman
    What causes a perforated bowel in elderly?
    2 months ago
  • Frank Best
    2 months ago
    What causes a bowel perforation in the elderly?
    26 days ago
  • reima julin
    How long can an elderly last with a partially blocked small intestine?
    15 days ago
  • geronimo barese
    Can a 90 year old patient survive a large intestine obstruction?
    9 days ago

Post a comment