INTESTINAL OBSTRUCTION

Presented by 8th semester Roll no-83 to 88.

INTRODUCTION

ByPallavi ShekharRoll no -83

INTRODUCTION AND DEFINITION

Lack of transit of intestinal contents.

Accounts for 5% of all acute surgical admissions.

80% occurs in small bowel

20% occurs in colon

Mortality in 3% without strangulation which increases to 30% with strangulation.

CLASSIFICATION I(Aetiopathology based)

● DYNAMIC:- Where peristalsis is working against a mechanical obstruction. According to the site of obstruction it is further classified into ♦ Intraluminal ♦ Intramural ♦ Extramural

● ADYNAMIC:- It may occur in two forms:- ♦ Peristalsis absent ( eg. Paralytic ileus ). ♦ Peristalsis present in non-propulsive form(eg. Mesenteric vascular occlusion).

DYNAMIC

INTRALUMINAL

♦Impaction ♦Foreign bodies ♦Tricobezoar ♦ Gallstones

Trichobezoar Gallstones

INTRAMURAL

♦Stricture(tubercu- lous stricture)

♦Malignancy

♦ Crohn’s Disease

EXTRAMURAL

♦ Bands / Adhesions(40%)

♦ Hernia(25%) ♦ Volvulus

♦ Intussuception

Crohn’s disease

ADYNAMIC

♦ Paralytic ileus

♦ Diabetes Mellitus

♦ Pseudo – obstruction

♦ Postoperative period

♦ Electrolyte imbalance(hypokalemia)

♦ Retroperitoneal haemorrhage

♦ Spinal injuries

♦Mesenteric ischemia

CLASSIFICATION II :- Depending on site of obstruction

Proximal Small Bowel(Duodenum and jejunum)

Distal Small Bowel (Ileum)

Large Bowel

♦ Congenital

♦ Lipomas

♦Malignancy

♦ Bands and Adhesions

♦ Hernias- Common cause

♦Malignancy

♦ Crohn’s Disease

♦ Tuberculosis strictures

♦Malignancy

♦ Tuberculous strictures

♦ Anorectal malformation

♦ Volvulus

CLASSIFICATION III

CONGENITAL ACQUIRED

♦ Anorectal malformations

♦ Congenital megacolon

♦ Duodenal atresia

♦ Volvulus

♦ Bands and adhesions

♦ Intestinal atresia(ileal)

♦ Hernia(commonest)

♦ Postoperative

♦ Intussusceptions

♦ Gallstones

♦ Tuberculosis

♦Malignancy

♦ Roundworm

Intussusceptions

CLASSIFICATION IV:- According to Pathological Changes

Simple – where blood supply is intact

Strangulated – where there is direct interference to blood flow.

Closed loop obstruction – when bowel obstructed both at proximal and distal points.

Pie chart showing relative frequency of the underlying diagnosis of intestinal obstruction.

Adhesions

Obstructed Hernia

Carcinoma

Fecal impaction

8%5%

Pseudo - obstruction

40%

12%15%

Inflammatory

15%

5%

Miscellaneous