surgical management of intestinal obstruction shinjan patra medical college kolkata

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Surgical Management of Intestinal Obstruction Shinjan Patra Roll no-88

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Page 1: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Surgical Management of Intestinal Obstruction

Shinjan PatraRoll no-88

Page 2: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

When will we do surgery???

• No resolution even after 24-48 hours of conservative treatment in partial obstruction.

• Complete obstruction of bowel

• Strangulated & closed-loop obstruction.

Page 3: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

• Principle- laparotomy is to be done.

• Timing-after optimization of the patient for surgery after routine investigations.

• Anesthesia- General/Epidural

• Incision-according to the site of obstruction(mostly median)

Page 4: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Actual steps of Surgery

• At first most importantly the caecum is identified

collapsed distended (small gut obstruction) (large gut obstruction)

Page 5: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Site of obstruction is identified-junction betweencollapsed & distended part

Nature of the obstruction is identified & removed

Viability of the gut is assesed

Page 6: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Gut is viable it is not viable

Gut is put inside the Resection & AnastomosisAbdomen.• Abdomen closed in layers using Non-absorbable sutures.

Page 7: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Comparison between Viable & Non-viable Gut

Features of viable gut• Pinkish• Luster-present• Peristaltic movement-

present• When pricked by a needle-

bleeding from the surface• Pulsation-present in

mesenteric vessels

Features of non-viable gut• Blackish• Absent

• Absent

• There Is no bleeding• No pulsation

Page 8: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

If still we are doubtful-

• Warm saline soaked mop over the doubtful area & 100% O2 is administered

• If colour becomes normal with peristalsis,then it is viable.

Page 9: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Other means of checking Viability

1. Doppler study

2. Fluorescence study

Page 10: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata
Page 11: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata
Page 12: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Other Approaches

• Second look operation -in multiple segment obstructions

• Laparoscopic approach

Page 13: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Special consideration

• Procedure to prevent recurrences- 1.repair of the hernia 2.lysis of the offending adhesions.

• Bypass surgery

• Colostomy/ileostomy without anastomosis.

• Deferment of resection & anastomosis.

Page 14: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

Post-surgical Complications• Recurrences

• Burst abdomen

• Pelvic abscess

• Subphrenic abscess

• Biliary or faecal fistula

• Incisional hernia.

Page 15: Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

THANK YOU