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INTESTINAL OBSTRUCTION
DR. Mazen Kurdi Assiss. Prof. pediatric surgery
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INTESTINAL OBSTRUCTION History:
Age: e g :• Neonate: Meconium ileus. Hirschprung’s disease. Malrotation. Intestinal atresia.• 2 - 24 months : Intususception (>24 M) Hirschprung’s disease.• Children : Hernia
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Clinical features :• Pain.• Vomiting.• Distention.• Constipation.
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Features vary according to :• Site of obstruction .• Age of Presentation.• Underlying pathology.• The presence or absence of intestinal
ischemia.
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Other manifestations:• Dehydration.• Hypokalemia.• Pyrexia.• Abdominal distention.
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Definitions:• Ileus : Mechanical or functional intes.
Obstruction (Adynamic or paralytic).• Mechanical obstruction :complete or partial
blockage of the intes. Lumen.• Simple obstruction: one obstructing point.• Closed loop obstruction :both the afferent and
the efferent loops are obstructed.• Strangulation : where the blood supply to the
affected part of the intestine is impaired more likely to sustained increased intraluminal pressur.
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Intestinal obstruction
Dynamic Adynamic
Extrensic Absent peristalsiseg. paralytic ileus
Present peristalsiseg.
mesenteric v. occ.Pseudoobstruction
Intraluminal obst.Mural
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Mechanical Intestinal obstruction Small intestine Large intestine
Exterensic:•Adhesions•Hernias
AdhesionsHernias
•Congenital: Malrotation with ladds band
Volvulous: sigmoid 60-80% coecal 20-40%
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Malrotation
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Malrotation
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Malrotation
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Mechanical intestinal obstruction
•Annular pancreas (duodenal obstruction).
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Annular pancreas
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Duodenal obstruction
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Mechanical intestinal obstruction
Sup. mesenteric a. syndrome (compression of 3rd part of duodenum ).
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Ischemic bowel
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Mechanical intestinal obstruction
Mural: •Small bowel atresia.
• Imperforated anus.
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Multiple atresia
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Mechanical intestinal obstruction
•Stenosis.
•Webs (diaphragm).
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Duodenal web
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Duodenal web
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Duodenal web
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Mechanical intestinal obstructionInflamatory :
•Regional enteritis.(Crohn’s desease.)•Radiational enteritis, stricture.
Neoplastic :Small bowel neoplasms.
•Ulcerative collitis.•Diverticulitis.•Radiational enteritis.
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Mechanical intestinal obstruction
Intra luminal obstruction:
•F.B. (Barium , worms)
•Gallstone ileus (more common in elderly).
•F.B. (Constipation , Barium , worms)
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F.B in the G.I.T
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F.B in the G.I.T
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Mechanical intestinal obstruction
•Meconium ileus.
•Meconium ileus.
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Intussusception Intussusception
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Intussusception
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Medical causes of small & Large bowel obstruction
Medications
Response to localized
Inflammatory process
Diffuse peritonitis
Retroperitoneal process
Neuropathic disorders
Post. Operativeileus
Metabolic
cases
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Medical causes of small & Large bowel obstruction Metabolic:1. Hypokalemia.2. Hypomagnesemia.3. Hyponatremia.4. Ketoacidosis.5. Uremia.6. Porphyria.7. Heavy metal poisoning.
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Medications:1. Narcotics.2. Antipsychotics.3. Anticholinergics.4. Ganglionic blockers.5. Agents used to treat Parkinson’s
disease.
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For optimal treatment to be instituted, five questions must be answered:• Is the diagnosis intestinal obstruction?. Is
the obstruction is mechanical? .• What is the level of obstruction?.• Is there evidence of bowel wall ischemia or
perforation?.• How sever is the associated systemic
disorders?.
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Retroperitoneal process:1. Retroperitoneal hematoma.2. Pancreatitis.3. Spinal or pelvic fracture.
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Neuropathic disorders:1. Diabetes.2. Multiple sclerosis.3. Scleroderma.4. Lupus erythrematosis.5. Hirschsprung’s disease.
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Post. Operative ileus following intra-abdominal surgery:
AS the motility usually returns for the: small bowel within 24 – 48 hrs. gastric within 48 hrs. colonic within 3-5 days.
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SHOKRAN