1. INTESTINAL OBSTRUCTION Dr. Mohammad Jamil Alhashlamon

2. Intestinal Obstruction Causes Adhesions or Bands – Resulting from previous surgery or intraperitonial infection ( rarely congenital band) Strangulated external hernia – Femoral or inguinal or umbilical Tumors

3. Volvulus of small or large bowel – A mobile or distended loop of bowel rotates causing obstruction at its neck Inflammatory stricture – e.g. diverticular disease, crohns disease ( obstruction usually incomplete ) Bolus obstruction – e.g. impacted faeces, foreign body, gaalstone. Internal hernia Itussusception – Usually initiated by a mass in the bowel

4. Pathophysiology Obstruction lead to dilation of bowel proximally and disrupt peristalsis. Presentation depend on : – Level of obstruction – Completeness of obstruction

5. Symptoms of intestinal obstruction Vomiting – The more proximal the obstruction the earlier it develops. – Nature of vomitus give important clues to the level of obstruction. – Change to faeculent vomiting usually take place gradually after about 24 hours of complete obstruction.

6. Pain – Fluid and swallowed air proximal to the obstruction together with continuing peristalsis cause the pain. – Usually mild m colicky. – Small intestine obstruction cause central abdominal pain. – Large intestine obstruction cause suprapupic abdominal pain.

7. Constipation – Absolute constipation or obstipation – The lower the obstruction the earlier the obstipation develops.

8. Symptoms develops more gradually in the large bowel obstruction If the ileocecal valve remain competent, the caecum will progressively distend and eventually rupture. The ileocaecal valve become incompetent in 50% of the cases and this allow small intestine distension and delay the onset of symptoms.

9. Incomplete obstruction If the bowel partially obstructed, the clinical features are less clearly defined. The pain is often accompanied by visible peristalsis ( this is the hallmark of partial obstruction ) The most common cause is slowly growing cancer in the colon.

10. Physical signs of intestinal obstruction Dehydration Abdominal distension Visible peristalsis Signs of primary cause. Lack of tenderness “except in strangulation “ Mass “ if it is the cause “

11. Bowel sounds will be “ loud, frequent, high pitched and tinkling “ Succession splash may be positive

12. Investigation of suspected obstruction Plane abdominal X-Ray Abdominal X-Ray with contrast

13. Adynamic intestinal obstruction Temporary disruption of normal peristaltic activity without mechanical blockage. If happened in the small intestine called “paralytic ileus “ If happened in the large intestine called “psudo-obstruction of the colon “

14. Paralytic ileus Most commonly post surgery. May also happened in : – Hypokalemia – Side effect of anti-parkinson medications

15. Psudo-obstruction of the colon Caused by : – Retroperitonial inflammation or hemorrhage – Neurological illnesses – Anticholenergics – Pregnancy – Orthopedic injuries and surgery Physical signs : similar to those of the mechanical obstruction except the absence of bowel sounds

16. Management of intestinal obstruction Keep NPO IV fluid and correct electrolytes NG tube Treat the underlying pathology

17. Bowel Strangulation Segment of the bowel trapped so that the lumen becomes obstructed and its blood supply compromised If unrelieved, this progress into infarction and eventually perforation. This happened mostly in hernia and volvulus.

18. symptoms and signs of strangulation Signs and symptoms of obstruction Abdominal tenderness The patient more unwell and tachycardia and lucocytosis Management : – If it is diagnosed or even suspected immediate surgery.

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