Academic Unit of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals.
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
Curr Opin Gastroenterol. 2023 May 1;39(3):234-241. doi: 10.1097/MOG.0000000000000924. Epub 2023 Mar 2.
Intrabdominal adhesions and intestinal hernias are the commonest cause of small bowel obstruction. Small bowel diseases, which cause small bowel obstruction, are rarer and often poses a challenge to gastroenterologists to diagnose and treat. In this review, small bowel diseases, which predispose to small bowel obstruction, are focused on, and their challenges in diagnosis and treatment.
Diagnosis of causes of partial small bowel obstruction is improved with computed tomography (CT) and magnetic resonance (MR) enterography. In fibrostenotic Crohn's strictures and NSAID diaphragm disease, endoscopic balloon dilatation can delay the need for surgery if the lesion is short and accessible; however, many may still inevitably require surgery. Biologic therapy may reduce the need for surgery in symptomatic small bowel Crohn's disease wherein the strictures are predominantly inflammatory. In chronic radiation enteropathy, only refractory small bowel obstruction and those with nutritional difficulties warrant surgery.
Small bowel diseases causing bowel obstruction are often challenging to diagnose and require numerous investigations over a period of time, which often culminate with surgery. Use of biologics and endoscopic balloon dilatation can help to delay and prevent surgery in some instances.
腹腔内粘连和肠疝是小肠梗阻最常见的原因。引起小肠梗阻的小肠疾病则较为少见，且往往对胃肠病学家的诊断和治疗构成挑战。本文重点关注易致小肠梗阻的小肠疾病，并探讨其在诊断和治疗方面的难点。
计算机断层扫描（CT）和磁共振肠造影术提高了部分小肠梗阻病因的诊断水平。在纤维狭窄性克罗恩病和 NSAID 膈膜病中，如果病变短且可及，内镜球囊扩张可延迟手术需求；然而，许多患者仍不可避免地需要手术。生物疗法可能会减少症状性小肠克罗恩病中需要手术的病例，因为这些狭窄主要是炎症性的。在慢性放射性肠炎中，只有难治性小肠梗阻和有营养困难的患者才需要手术。
导致肠梗阻的小肠疾病的诊断往往具有挑战性，需要在一段时间内进行多次检查，最终往往需要手术。在某些情况下，使用生物制剂和内镜球囊扩张可以帮助延迟和预防手术。
