1. Chris Harmston Consultant Colorectal Surgeon UHCW
OBSTRUCTION
Chris Harmston
Consultant Colorectal Surgeon
UHCW

2. Learning objectives Recognise the types of bowel obstruction
Understand their symptoms and signs
Initiate basic management

3. The GI tract ! Foregut Midgut Hindgut Stomach and duodenum Small bowel
Colon (well most of it)

4. Obstruction Gastric outlet obstruction Small bowel obstruction
Large bowel obstruction

5. Symptoms
Signs
Management
Causes

6. Gastric outlet obstruction
What is it?
Mechanical obstruction to the gastric outflow
How does it present?
Elective
Emergency

7. Symptoms Vomiting Nature Type Timing Solids, then liquids
Bile stained or not
Timing
Usually within an hour of a meal

8. Symptoms Weight loss Early satiety Epigastric fullnes Pain? Insidious
Can lead to malnutrition
More significant in those with malignant disease
Early satiety
Epigastric fullnes
Pain?

9. Signs Look at the patient! Basic observations Examination Dehydrated
Cachectic
Basic observations
Tachycardia
Examination
Often unremarkable
Succusion splash

10. CO2 + H20 <= H2CO3 => HCO3- + H+
Investigations
Biochemical
CO2 + H20 <= H2CO3 => HCO3- + H+
Loss of
H+, Cl-, Na+
Hypokalaemic hypochloraemic alkalosis

11. Imaging

12. Imaging

13. Imaging

14. Initial Management Decompress the stomach
Correct biochemical abnormalities
Address the nutrition

15. Definitive management
Conservative
Surgical
Resect
Bypass
Stent

16. Causes
Benign
PUD
Caustic stricture
Malignant
Gastric Ca
Pancreatic CA

17. Small bowel obstruction
What is it?
Mechanical obstruction of the small bowel
How does it present?
Usually as an emergency

18. Symptoms Vomiting Abdominal pain Absolute constipation Nature Type
Usually to solids and liquids
Continuous
Type
Bile stained
Abdominal pain
Midgut
Colicky
Absolute constipation

19. Signs Look at the patient Baseline observations Examination
Abdominal distention
Check for hernias – twice!
Baseline observations
Be afraid of
Tachycardia, fever, hypotension
Examination
Should have a soft abdomen
Be afraid of peritonism

20. Investigations

22. Initial management Decompression Correct the biochemical abnormalities
Rule out ischaemia

23. Definitive management
Conservative – drip and suck
Operative

24. Causes Benign Malignant Adhesions Hernias Inflammatory bowel disease
Caecal tumour
Disseminated peritoneal disease
Primary small bowel tumour

25. Large bowel obstruction
What is it?
Mechanical outflow obstruction of the colon
How does it present?
Usually emergency

26. Symptoms Distention Abdominal pain Vomiting Constipation Colicky
Hindgut
Vomiting
Constipation

27. Signs Look at the patient Baseline observations Examination Distended
Be afraid if tachycardia,Fever,Hypotension
Examination
Distention
Be afraid of peritonism

28. Investigations

29. Investigations
Confirm large bowel obstruction with,
Contrast enema CT

30. Initial management Decompression (if possible)
Correct the biochemical disturbance
Rule out ischaemia or perforation

31. Definitive management
Conservative?
Endoscopically
Scope
Stent
Surgically
Stoma
Resection

32. Causes
Malignant
Colorectal cancer
Benign
Stricture
Volvulus

33. Have we met our objectives?
Do we know the different types of obstuction?
Do understand the symptomatology?
Do we know the concepts of initial management?

34. Questions?