Differentiating Bowel Obstruction from History

To differentiate the level of bowel obstruction from the patient's pain, it is important to first bear in mind the embryological divisions of the alimentary canal:

Pain - area of presentation:

Foregut – Epigastric pain

Midgut – Central abdominal pain

Hindgut – lower abdominal pain

 

Therefore the pain originates from:

Foregut:

  • Distal 1/3 of oesophagus
  • Stomach
  • 1st and 2nd part of duodenum
    • To ampulla of Vater
    • Liver
    • Gallbladder
    • Pancreas
    • (Spleen)

Midgut:

  • Duodenum
    • Distal to ampulla of Vater
    • Jejunum
    • Ileum
    • Cecum
    • Appendix
    • Ascending Colon
    • Hepatic Flexure of Colon
    • Transverse Colon
      • Proximal 2/3

Hindgut:

  • Transverse Colon
    • Distal 1/3
    • Splenic Flexure
    • Descending Colon
    • Sigmoid Colon
    • Rectum