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PERIOPERATIVE CONSIDERATIONS AND COMPLICATIONS
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Small Bowel Obstructions (SBO)
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Workup may include imaging (abdominal x-ray, CT scan), CBC, CMP, lactate level
Trial of conservative (nonsurgical) management appropriate if no evidence of perforation, ischemia, or strangulation
Bowel rest and decompression with nasogastric (NG) tube are appropriate first steps
Start GI prophylaxis with Ranitidine (Zantac) 50 mg IV every 8 hours or proton pump inhibitor [eg, pantoprazole (Protonix)]
Replace NG tube output [1 cc NS (or LR) per cc NG tube output every 4 hours] and replete electrolyte losses
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Note: If obstruction occurs acutely within 1 week of surgery, high likelihood of requiring surgical intervention
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Note: For women with ovarian cancer and bowel obstruction, data show 90% relieved with surgery, but major morbidity (fistulas and anastomotic leaks) occurred in 32% and perioperative death in 15%. Re-obstruction rate of 10–50%
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Large Bowel Obstruction (LBO)
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Rare in ovarian cancer patients
In general, considered a surgical emergency
Surgical management generally involves creation of an ostomy
Endoscopic management with rectal stent is possible in select patients (stable, no peritoneal signs, partially obstructed, poor surgical candidate)
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Closed Loop Obstruction
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In general, considered a surgical emergency
Commonly due to adhesions. Occurs when two points along the small bowel are obstructed at the same junction, causing necrosis and edema of the internal segment
May look like a gasless abdomen on plain films. CT usually diagnostic and may show ground glass haziness in mid-abdomen, displacement of adjacent bowel, dilated clumps of edematous bowel, or classic U or C signs (pathognomonic)
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First-Line Medications
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Bisacodyl (Dulcolax) 10 mg orally daily or 10 mg per rectum daily
Docusate sodium (Colace) 100 mg orally twice daily
Mineral oil 15–45 mL/day
Cascara 325 mg orally nightly
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Second-Line/More Aggressive Medications
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Polyethylene glycol (MiraLax) 240–720 mL/day
Lactulose 15–30 mL twice daily
Sorbitol 120 mL of 25% solution daily
Glycerin 3 g per rectum daily or 5–15 mL enemas
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Remember: All patients on ...