1. Abdul-WAHID M Salih
Dept. of surgery / School of Medicine
University of Sulaimani.

2. Intestinal Obstruction/ Types
Dr.AbdulWAHID M Salih

3. Intestinal obstruction
Definition : arrest of downward propulsion of intestinal content ;

5. Classification A) pathological cause: 1) simple intestinal obstruction
2) strangulated intestinal obstruction
B) level of obstruction:
1) high small intestinal obstruction
2) low small intestinal obstruction
3) large intestinal obstruction
C) onset and course of obstruction
1) acute
2) chronic
D) mechanical Vs Adynamic
E) complete Vs incomplete

7. Causes of Small Bowel Obstruction in Adults

8. Causes- Small Bowel Extraluminal Mural Luminal Postoperative adhesions
Congenital
Hernia
Volvulus
Neoplasims Lipoma
Polyps Leiyomayoma
Hematoma Lymphoma
Carcimoid Carinoma
Crohns TB
Stricture Intussusception
secondary Tumors
F. Body
Bezoars
Gall stone
Food Particles
A. lumbricoides

9. Causes of Colonic Obstruction

10. Etiology according to age
- Neonates: congenital atresia , volvulus neonatorum, anorectal malformation ,mechonium ileus and Hirschsprung`s disease - infant : ileocaecal intussusception , Hirschsprung`s disease and strangulated hernia - Adult : adhesion, strangulated hernia - Elderly : colon carcinoma, adhesion and strangulated hernia

11. Adynamic obstruction * Paralytic ileus
* Mesenteric vascular obstruction
* Pseudo-obstruction

12. Small bowel obstruction

13. Small Bowel Adhesions * Accounts for 60-70% of All SBO
* Results from peritoneal injury, platelet activation
and fibrin formation.
* starch covered gloves, intraperitoneal sepsis,
haemorrhage irritant solutions iodine and other
foreign bodies.
* As early as 4 weeks post laparotomy.
* The majority of patients present between 1-5 years
* Readmission in surgically treated patients is 35%

14. Hernia - Accounts for 20% of SBO - Commonest : 1. Femoral hernia
2. ID inguinal
3. Umbilical
4. Others: incisional and internal H.
Ischaemia occurs initially by venous
occlusion, followed by oedema and
arterialc ompromise.

15. Strangulation
* Obstruction  increase in capillary pressure  venous return is compromise  arterial supply is impaired  hemorrhagic infarction
* Translocation and
* systemic organisms
* with toxin

16. In stragulation
 constant pain, tenderness with rigidity , shock

17. Other causes
Intussusception
Gall stone Ileus
IBD

18. Close loop obstruction
* Bowel obstructed at both proximal and distal points
* Many case present with intestinal strangulation

19. Sigmoid Volvulus

20. Large Bowel Obstruction
- Carcinoma
- Diverticular disease
- Volvulus
- Hernia
- Pseudoobstruction
- Benign stricture
- Congenital : Hirschusbrung, anal stenosis and agenesis

21. Large Bowel Obstruction
According to Leplac’s law: maximum pressure is at the it’s
maximum diameter. Cecum is at the greatest risk of
perforation
Perforation results in the release of formed feaces with
heavy bacterial contamination

22. Non-Mechanical Obstruction

24. Intestinal pseudo - obstruction
- is decreased ability of the intestines to push food through
- indicate a syndrome characterized by a clinical picture suggestive of mechanical obstruction in the absence of any demonstrable evidence of such an obstruction in the intestine

25. Causes * There is some evidence of a genetic association
* It can occur in conjunction with Kawasaki disease[6]
* Parkinson's disease.
* Enteric neuropathy if a neurological cause is suspected

26. Acute intestinal obstruction
* Cardinal features of obstruction
- Abdominal pain
- Distension
- Vomiting
- Absolute constipation

27. Mechanical Obstruction
* Location – mid-abdomen (others diffuse)
* Character – colicky
* Proximal – periodicity every mins
* Distal SB or Colon – every minutes
* Between episodes of nausea, vomiting, cramping
* Severity of pain – generally severe, worsens
over time (ileus tends to be constant)

29. Clinical * Pain - First symptom - Suddenly and usually severe
- Colicky
- Around umbilicus , lower abdomen
- Development of severe pain is indicative of the presence of strangulation

30. Clinical * Vomiting - Relate to location of obstruction
- Obstruction progresses 
the vomitus alters from digested food to faeculent

31. Clinical
* Distension
- Degree of distension is dependent on the site of the obstruction
- Visible peristalsis may be present

32. Clinical * Constipation - Absolute or relative
- infrequent bowel movements (typically three times or fewer per week)
- difficulty during defecation (straining during more than 25% of bowel movements or a subjective sensation of hard stools),
- the sensation of incomplete bowel evacuation

33. Clinical * Other manifestations : - Dehydration - Hypokalemia
- Pyrexia
- Abdominal tenderness

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35. THANKS