INTESTINAL OBSTRUCTION By: Maj Asrar Ahmad MBBS, FCPS MBBS, FCPS (Senior Registrar Paeds Surgery) (Senior Registrar Paeds Surgery) “Neither sun shall rise nor set on patient of intestinal obstruction”

Sequence Sequence  Pathophysiology  Presentation  Management  Causes  Hypertrophic pyloric stenosis  Intestinal Malrotation

Pathophysiology Pathophysiology

Presentation Presentation  Pain  vomiting  Absolute constipation  Abdominal distention

Investigations Investigations

Management Management  NPO  Nasogastric aspiration  Intravenous fluids  Antibiotics  Surgery

5’ Hs 5’ Hs  Hypothermia  Hypoxia  Hypovolemia  Hypoglycaemia  Hypoprothrombinaemia

Causes Causes

Infantile Hypertrophic Pyloric Stenosis Infantile Hypertrophic Pyloric Stenosis

Presentation Presentation  1-4/1000  4 weeks  Polyhydramnios  Non bilious vomiting  Dehdration  Visible peristalsis  Pyloric OLIVE

Metabolic Changes Metabolic Changes  Hypokalaemia  Hypocholraemia  Alkalosis  Paradoxical Aciduria

Investigations Investigations

Management Management

Intestinal Malrotation Intestinal Malrotation

Embryology Embryology 5%

Presentation Presentation  1/200 – 1/500  Male: Female:- 2:1  Age at presentation: 40-50% 1st month 50-75% 1st year % >1 year of age

Presentation Presentation  Acute Midgut Volvulus  Chronic Midgut volvulus  Acute duodenal obstruction  Chronic duodenal obstruction  Internal herniation  Caecal volvulus  Asymtomatic

Presentation Presentation

Associated Anomalies Associated Anomalies  Congenital diphragmatic hernia  Abdominal wall defects Omphalocele or gastroschisis  Duodenal atresia 50%  Jejunal atresia 30%  Meckel’s diverticulum  Hirschsprung’s disease  Imperforate anus  Esophageal atresia

Investigations Investigations

Ladd’s Procedure Ladd’s Procedure