1. 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”

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

3. Pathophysiology Pathophysiology

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

5. Investigations Investigations

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

7. 5’ Hs 5’ Hs  Hypothermia  Hypoxia  Hypovolemia  Hypoglycaemia  Hypoprothrombinaemia

8. Causes Causes

10. Infantile Hypertrophic Pyloric Stenosis Infantile Hypertrophic Pyloric Stenosis

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

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

13. Investigations Investigations

15. Management Management

17. Intestinal Malrotation Intestinal Malrotation

18. Embryology Embryology 5%

21. Presentation Presentation  1/200 – 1/500  Male: Female:- 2:1  Age at presentation: 40-50% 1st month 50-75% 1st year 75-100% >1 year of age

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

23. Presentation Presentation

24. 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

25. Investigations Investigations

26. Ladd’s Procedure Ladd’s Procedure