INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION

By: Maj Asrar AhmadBy: Maj Asrar Ahmad MBBS, FCPSMBBS, FCPS (Senior Registrar Paeds Surgery)(Senior Registrar Paeds Surgery)

“Neither sun shall rise nor set on patient of intestinal obstruction”

SequenceSequence

PathophysiologyPathophysiology PresentationPresentation ManagementManagement CausesCauses Hypertrophic pyloric stenosisHypertrophic pyloric stenosis Intestinal MalrotationIntestinal Malrotation

PathophysiologyPathophysiology

PresentationPresentation

PainPain vomitingvomiting Absolute constipationAbsolute constipation Abdominal distentionAbdominal distention

InvestigationsInvestigations

ManagementManagement

NPONPO Nasogastric aspirationNasogastric aspiration Intravenous fluidsIntravenous fluids AntibioticsAntibiotics SurgerySurgery

5’ Hs5’ Hs

HypothermiaHypothermia HypoxiaHypoxia HypovolemiaHypovolemia HypoglycaemiaHypoglycaemia HypoprothrombinaemiaHypoprothrombinaemia

CausesCauses

CausesCauses

Infantile Hypertrophic Pyloric StenosisInfantile Hypertrophic Pyloric Stenosis

Presentation Presentation

1-4/10001-4/1000 4 weeks4 weeks PolyhydramniosPolyhydramnios Non bilious vomitingNon bilious vomiting DehdrationDehdration Visible peristalsisVisible peristalsis Pyloric Pyloric OLIVEOLIVE

Metabolic Changes Metabolic Changes

HypokalaemiaHypokalaemia

HypocholraemiaHypocholraemia

AlkalosisAlkalosis

Paradoxical AciduriaParadoxical Aciduria

InvestigationsInvestigations

InvestigationsInvestigations

ManagementManagement

Intestinal MalrotationIntestinal Malrotation

EmbryologyEmbryology

5%

EmbryologyEmbryology

EmbryologyEmbryology

Presentation Presentation

1/200 – 1/500 1/200 – 1/500 Male: Female:- 2:1 Male: Female:- 2:1

Age at presentation:Age at presentation: 40-50% 1st month 50-75% 1st year 75-100% >1 year of age

Presentation Presentation Acute Midgut Volvulus Acute Midgut Volvulus Chronic Midgut volvulusChronic Midgut volvulus Acute duodenal obstructionAcute duodenal obstruction Chronic duodenal obstructionChronic duodenal obstruction Internal herniationInternal herniation Caecal volvulusCaecal volvulus AsymtomaticAsymtomatic

Presentation Presentation

Associated AnomaliesAssociated Anomalies Congenital diphragmatic herniaCongenital diphragmatic hernia

Abdominal wall defectsAbdominal wall defects Omphalocele or gastroschisis

Duodenal atresia 50%Duodenal atresia 50%Jejunal atresia 30%Jejunal atresia 30%Meckel’s diverticulumMeckel’s diverticulumHirschsprung’s diseaseHirschsprung’s diseaseImperforate anusImperforate anusEsophageal atresiaEsophageal atresia

InvestigationsInvestigations

Ladd’s ProcedureLadd’s Procedure

Ladd’s ProcedureLadd’s Procedure