Signs and symptoms
Depending on the level of obstruction, bowel obstruction can present with abdominal pain, swollen abdomen, abdominal distension, and constipation. Bowel obstruction may be complicated by dehydration and electrolyte abnormalities due to vomiting; respiratory compromise from pressure on the diaphragm by a distended abdomen, or aspiration of vomitus; bowel ischemia or perforation from prolonged distension or pressure from a foreign body.In small bowel obstruction, the pain tends to be colicky (cramping and intermittent) in nature, with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting may occur before constipation.In large bowel obstruction, the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction. Causes
Small bowel obstruction
Causes of small bowel obstruction include:
Adhesions from previous abdominal surgery (most common cause)
Barbed sutures
Pseudoobstruction
Hernias containing bowel
Crohns disease causing adhesions or inflammatory strictures
Neoplasms, benign or malignant
Intussusception
Volvulus
Superior mesenteric artery syndrome, a compression of the duodenum by the superior mesenteric artery and the abdominal aorta
Ischemic strictures
Foreign bodies (e.g. gallstones in gallstone ileus, swallowed objects such as expandable water toys)
Intestinal atresiaAfter abdominal surgery, the incidence of small bowel obstruction from any cause is 9%. In those where the cause of the obstruction was clear, adhesions are the single most common cause (more than half).
The trial measured the total number of hours over 270 days spent outdoors between 10 am and 3 pm on days with no pain for which "most of the day" was spent in direct sunlight.In Trial 3 subjects were randomized to receive a total of three afamelanotide or vehicle implants administered subcutaneously every two months and were followed for 180 days. Data from this trial were used primarily for assessment of side effects.The FDA approved afamelanotide based on evidence from three clinical trials (Trial 1/ NCT 01605136, Trial 2/ NCT00979745 and Trial 3/ NCT01097044) of 244 adults 18–74 years of age with EPP. The trials were conducted at 22 sites in the US and Europe.In October 2019, afamelanotide was approved by the US Food and Drug Administration (FDA) as a medicine to reduce pain caused by light exposure (particularly sunlight) as experienced by people with erythropoietic protoporphyria. Society and culture
Usage in general public
A number of products are sold online and in gyms and beauty salons as "melanotan" or "melanotan-1" which discuss afamelanotide in their marketing.Without a prescription, these drugs are not legally sold in many jurisdictions and are potentially dangerous.Starting in 2007, health agencies in various countries began issuing warnings against their use.Unlicensed and untested powders sold as "melanotan" are found on the Internet (marketed for tanning and other purposes). Multiple regulatory bodies have warned consumers that the peptides may be unsafe and ineffective. Research
Ongoing research is underway for other skin disorders. Afamelanotide causes skin to turn darker by causing skin to produce more melanin.