Intestinal obstruction Dr Hatem El Gohary
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Transcript of Intestinal obstruction Dr Hatem El Gohary
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Intestinal ObstructionDr Hatem El GoharyLecturer of General Surgery
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Types
• Dynamic peristalsis is working against a mechanical obstruction.
• Adynamic peristalsis may be absent.
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CausesDynamic
■ IntraluminalImpactionForeign bodiesBezoarsGallstones
■ IntramuralStrictureMalignancy
■ ExtramuralBands/adhesionsHerniaVolvulusIntussusception
Adynamic ■Paralytic ileus
■Mesenteric vascular
occlusion
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Mechanism of Dynamic obstruction
• Proximal loop dilatation (Gas and Fluid) + increased peristalsis.• Distal loop normal peristalsis and
absorption until it become empty collapse immotile.
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STRANGULATION• The venous return is compromised before the
arterial supply.
• Edema and accumulation of toxic fluid Impaired arterial supply infarction.
• viability of the bowel is compromised there is marked translocation and systemic exposure to anaerobic organisms with their associated toxins.
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Clinical features of strangulation
■ Constant pain ■ Tenderness with rigidity ■ Shock
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Acute intussusception• Definition:One portion of the gut becomes invaginated within an immediately adjacent segment (the proximal into the distal) due to lead point.
• commonly in children.
• Pathological lead point such as Meckel’s diverticulum, polyp.
• Ilio –colic is the most common.• blood supply of the inner layer is usually impaired
strangulation.
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Parts of intussusception.
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Acute Volvulus
• Definition: twisting or axial rotation of a portion of bowel around its mesentery.• Causes: -Primary congenital bands. -Secondary Sigmoid volvulus.
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Sigmoid vovulous
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CLINICAL FEATURES OF INTESTINAL OBSTRUCTION• General Dehydration – Fever.
• Local pain, distension, vomiting and absolute constipation.
Small bowel vomiting early + distension minimal. Large bowel vomiting late + distension is evident.
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INVESTIGATIONS•Plain x ray abdomen ERECT Multiple air – fluid levels.
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Supine Dilated bowel loops (small intestinal central-large intestinal peripheral).
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Other Investigations
• Laboratory: CBC – Serum Electrolytes• Radiological: - Ultrasound abdomen and Pelvis Peritoneal collection. - CT abdomen and pelvis (may show obstructing tumor).
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Treatment of intestinal obstruction
■Gastrointestinal drainage Nasogastric tube (Ryle).
■Fluid and electrolyte replacement.
■Surgical treatment is necessary for most cases of intestinal obstruction but should be delayed
until resuscitation is Complete except in STRANGULATION.
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Surgical Operations for Intestinal Obstruction• Intussusception Reduction of the obstructed
loop.• Obstructed Hernia Reduction of the viable loops
+ Repair of Hernia.• Strangulated Gangrenous Hernia Resection
anastomosis of the non-viable loops + Repair of Hernia.• Volvulus Surgical Untwisting.• Obstructing Tumor Resection of the tumor
(resectable) or Bypass surgery (irresectable) + anastomosis or colostomy.