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    Acute Intestinal Obstruction

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    Anonymous O4fTKXvIL
    Intestinal obstruction can occur from mechanical causes like adhesions, bands or hernias, or tumors blocking the intestines. It can present with abdominal pain, vomiting, constipation and distension. Diagnosis involves imaging like x-rays to locate the obstruction. Treatment depends on the cause but may include conservative management, surgery to remove or bypass the blockage, or resections of affected parts of the intestines. The most common sites of obstruction are the small and large intestines.

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    Acute Intestinal Obstruction

    Uploaded by

    Anonymous O4fTKXvIL
    71 views38 pages
    Intestinal obstruction can occur from mechanical causes like adhesions, bands or hernias, or tumors blocking the intestines. It can present with abdominal pain, vomiting, constipation and distension. Diagnosis involves imaging like x-rays to locate the obstruction. Treatment depends on the cause but may include conservative management, surgery to remove or bypass the blockage, or resections of affected parts of the intestines. The most common sites of obstruction are the small and large intestines.

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    acut abd obs

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    Intestinal obstruction can occur from mechanical causes like adhesions, bands or hernias, or tumors blocking the intestines. It can present with abdominal pain, vomiting, constipation and distension. Diagnosis involves imaging like x-rays to locate the obstruction. Treatment depends on the cause but may include conservative management, surgery to remove or bypass the blockage, or resections of affected parts of the intestines. The most common sites of obstruction are the small and large intestines.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    71 views38 pages

    Acute Intestinal Obstruction

    Uploaded by

    Anonymous O4fTKXvIL
    Intestinal obstruction can occur from mechanical causes like adhesions, bands or hernias, or tumors blocking the intestines. It can present with abdominal pain, vomiting, constipation and distension. Diagnosis involves imaging like x-rays to locate the obstruction. Treatment depends on the cause but may include conservative management, surgery to remove or bypass the blockage, or resections of affected parts of the intestines. The most common sites of obstruction are the small and large intestines.

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    © All Rights Reserved
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    of 38

    INTESTINAL OBSTRUCTION

    SYAHBUDDIN HARAHAP

    INTESTINAL OBSTRUCTION
    SYAHARA

    NEUROGENIC paralytic
    MECHANICAL
    MECHANICAL :
    - Simplex
    - Stranggulata
    Aetilogy:
    -In the lumen
    -In the wall
    -Outside the wall
    Site :
    - High
    - Low
    Speed of onset :
    - Acute
    - Chronic

    What Causes Intestinal Strangulation?

    Intestinal strangulation (cutting off of the blood supply to the intestine)


    usually results from one of three causes.

    MECHANICAL INTESTINAL
    OBSTRUCTION
    Common causes of obtruction at each age group

    Neonate -Congenital atresia


    -Volvulus neonatum
    -Meconeum ileus
    -Hirschsprungs disease
    -Imperforate anus
    -Stranggulated inguinal hernia
    Infant
    -Intussuception
    -Complication of Meckels diverticulum
    -Hischsprungs diseases

    Young adult

    -Adhesions and bands


    -Strangulated ing.hernia

    Middle age

    -Adhesesion and band


    -Strangulated Ing.hernia
    -Strangulated fem.hernia
    -Carcinoma colon
    -Volvulus

    Elderly

    -Adhesion and bands


    -Strangulated Ing.hernia
    -Strangulated fem.hernia
    -Carcinoma colon
    -Volvulus
    -Impacted faeces

    Incidence
    May occur at any age
    70 percent small bowel,
    30 percent large bowel

    Physiologic and Pathologic


    Derangement
    Fluid and electrolyte disturbances
    -8 10 L of fluid are secreted
    -Sequestration within the dilated loop--

    hypovolumic shock --> SIRS MODS


    Bacteriology
    -Rapid colonisation
    Pathology
    -High intra luminar pressure- oedematous--
    cyanosis intraperitoneal exudation necrosis
    perforation--peritonitis -> SIRS -> MODS

    Clinical Manifestations
    Sign - the classic quartet->pain,vomiting,constipation,abd
    dist

    Abdominal pain is colicky

    -On Auscultation -borborygmi


    -metalic sound
    Vomiting
    - Consists food and gastric chyme- bile faeculent
    Absolute constipation
    Abdominal distension - ACS
    -Inspection distended visible peristalsis and colicky pain
    Scars-- Adhesion or Band
    Vital Sign---Pulse - SBP RR Temp-- hypovolumic shock ?
    Palpation--- palpable mass - DRE

    Diagnoctic Studies

    Laboratory test--fecal occult blood test


    Sigmoidoscopy
    X ray examination
    Plain X ray --- Erect and lying down -
    routinely
    Follow-through studies after ingestion of
    radiopague meal --- gastrografin
    Barium enema X ray

    Treatment

    NGT
    Rehydration
    Foley bag Catheter
    Antibiotics
    Informed concent
    Exploratory laporotomy

    Exploratory Laparotomy
    Inspected and palpated the Caecum
    -Distended--- colon obstruction
    -Collapsed--- small bowel obstruction
    Distended SBO - Prevent Abd.Comp.syndrom
    -Retrograde milkingby Jones and Matheson(1968)
    -canula inserted + pursetring suture ?
    -Enterostomy
    Distended LBO- Prevent Abd.Comp.Syndrom
    -canula inserted + pursestring suture
    -Caecostomy

    Emergency Intestinal obstruction due


    to Colon Cancer

    Right Hemicolectomy
    Extended Right Hemicolectomy
    Hartmants procedures
    Proximal colostomy
    By Pass
    On-table antegrade irigation of the large

    bowel-- one staged colon operation ?

    Emergency Intestinal obstruction due


    to Sigmoid volvulus

    The upper limb of the loop descends

    in front of the lower, twisting on its


    mesenteric axis from one half to two
    turns in counterclock-wise direction
    Predisposing condition-long and
    freely movable meso sigmoid

    Radiologic Examination
    Plain abdominal foto --Bent inner tube sign 0r

    Coffe bean apperance


    Barium enema ---Bird beak apperance
    - Contrast agent and air fills rectum and distal
    sigmoid colon.
    - The contrast agent stops abruptly at the
    point of
    torsion.
    (Courtesy of Dina F. Caroline, M.D., Ph.D., Temple
    University Hospital.)

    Plain film of sigmoid volvulus.


    Note appearance of

    bent inner tube.


    (Courtesy of Dina F.
    Caroline, M.D.,
    Ph.D., Temple
    University Hospital.)

    Coffe bean

    appearance

    Barium enema of sigmoid


    volvulus.
    Contrast agent and

    air fills rectum and


    distal sigmoid colon.
    The contrast agent
    stops abruptly at
    the point of torsion.
    (Courtesy of Dina F.
    Caroline, M.D.,
    Ph.D., Temple
    University Hospital

    Treatment
    Consevative
    - Barium enema
    - LLD + general anestesi -
    sigmoidocopy rectal tube lubbricated
    - left in place 48 hours
    Operative
    - Resection Hartmantns operation
    - After conservative bowel preparation-
    resection end to end
    anastomosis

    Emergency Intestinal obstruction


    due to Caecum volvolus

    The caecum passing upward and

    then to the left , twist 90 degrees to


    as many as three complete twist a
    clock wise direction
    Mobile caecum

    Radiologic examination

    Plain abdominal foto


    Barium enema

    Caecum Volvulus
    The contrast stops abruptly
    at the proximal end of the
    hepatic flexure
    (arrowhead). The dilated,
    air-filled cecum crosses the
    midline of the abdomen
    toward the left upper
    quadrant (arrows).
    (Courtesy of Dina F.
    Caroline, M.D., Ph.D.,
    Temple University
    Hospital.)

    Treatment

    Caecopexy
    Rigth Hemicolectomy

    Emergency Intestinal obstruction due to


    ADHESIONS AND BANDS

    Classification :
    - Congenital
    - Acquired

    Aetiology :
    1. infection -> fibrin --- fibroblast -fibrous
    adhesion
    2. tissue ischaemia -vascular collateral
    fibrous
    matrix-- fibrous adhesion
    3. corpus alienum

    A. fibrin --- fibroblast -fibrous adhesion

    B. tissue ischaemia -vascular collateral fibrous matrix--


    fibrous adhesion

    Attempts to Prevent Adhesions


    To prevent Fibrin deposit --Anti coagulan
    Dextran , Trasylol
    Remove fibrin exudat Peritoneal lavage
    Separate bowel surfaces - peristalsis
    Inhibit fiboblast proliferation - Anti
    histamin , Steroid

    Treatment
    Trial of conservative --- Spontaneus
    remmision

    Exploratory laporotomy
    - simple lysis
    - resection
    - by pass
    - plication

    Plication small bowel seromuscular

    complete small bowel obstruction.


    Upright film shows

    multiple, short, airfluid levels arranged


    in a stepwise
    pattern. (Courtesy
    of Melvyn H.
    Schreiber, M.D., The
    University of Texas
    Medical Branch

    complete small bowel obstruction.

    Supine film

    shows dilated
    loops of small
    bowel in an
    orderly
    arrangement,
    without evidence
    of colon gas.

    Surgical management of carcinoma of the small


    bowel
    . A, Malignant tumors should

    be resected with a wide


    margin of normal bowel and a
    wedge of mesentery to
    remove the immediate
    draining lymph nodes.
    B, End-to-end anastomosis of
    the small bowel and repair of
    the mesentery.
    (Adapted from Thompson JC:
    Atlas of Surgery of the
    Stomach, Duodenum and
    Small Bowel. St. Louis, Mosby
    Year Book, 1992, p 299.)

    constricting carcinoma.
    Barium enema

    demonstrating
    apple core or
    napkin ring
    lesion, caused by a
    constricting
    carcinoma.

    polypoid carcinoma
    Barium enema

    demonstrating a
    polypoid carcinoma
    arising in the cecum of
    a 35-year-old woman
    (arrows). (Courtesy of
    Dina F. Caroline, M.D.,
    Ph.D., Temple
    University Hospital.)

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