Obstruction

Obstruction

Central colicky abdominal pain is a classic presentation of small bowel obstruction. The central distribution is because of the segmental nerve supply of the midgut. When the peristaltic waves hit an obstruction, the contractions increase to over come the resistance, producing the colic. The pain reaches a crescendo and then disappears in minutes when the peristaltic wave passes. This is di ff erent from that of biliary colic. When the gallbladder contracts against a stone, pain is relatively insidious in onset and reaches its peak in about half an hour and then eases o ff . A basal pain persists between the bouts of colic. Pain of ureteric colic is intense, lasting 1–2 minutes along the line of the ureter. Summary box 63.6 Colicky abdominal pain /uni25CF /uni25CF /uni25CF

Pain of ‘small bowel colic’ comes in waves and disappears completely in minutes when the peristaltic wave ceases Pain of biliary colic is insidious in onset, reaches the peak in half an hour or so and does not ease off completely between spasms Pain of ureteric colic is intense, lasting 1–2 minutes