Shinjan Patra

1. Surgical Management of
Intestinal Obstruction
Shinjan Patra
Roll no-88

2. 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.

3. • 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)

4. Actual steps of Surgery
• At first most importantly the caecum is
identified
collapsed distended
(small gut obstruction) (large gut obstruction)

5. Site of obstruction is identified-junction between
collapsed & distended part
Nature of the obstruction is identified & removed
Viability of the gut is assesed

6. Gut is viable it is not viable
Gut is put inside the Resection & Anastomosis
Abdomen.
• Abdomen closed in layers using Non-absorbable sutures.

7. Comparison between Viable & Non-
viable Gut
Features of viable gut Features of non-viable gut
• Pinkish • Blackish
• Luster-present • Absent
• Peristaltic movement-
present • Absent
• When pricked by a needle-
bleeding from the surface • There Is no bleeding
• Pulsation-present in • No pulsation
mesenteric vessels

8. 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.

9. Other means of checking Viability
1. Doppler study
2. Fluorescence study

12. Other Approaches
• Second look operation
-in multiple segment obstructions
• Laparoscopic approach

13. 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.

14. Post-surgical Complications
• Recurrences
• Burst abdomen
• Pelvic abscess
• Subphrenic abscess
• Biliary or faecal fistula
• Incisional hernia.