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1. PROF. DR. ATEF ABDEL-LATIF

2. AETIOLOGY

3. DYNAMIC CAUSES
 INTRALUMINAL IMPACTION
• Foreign Bodies
• Gallstones
 INTRAMURAL
• Stricture
• Malignancy
 EXTRAMURAL
• Bands / Adhesions
• Hernia
• Volvulus
• Intussusception
ADYNAMIC CAUSES
• Paralytic ileus
• Mesenteric vascular
occlusion “MVO”
• Pseudo -obstruction

4. Small Bowel
(85%)
 Cancer (75%)
 Diverticulosis. (10%)
 Volvulus (10%)
 Miscellanous. (10%)
Colon
(15%)
 Adhesions (80%)
 Hernia (10%)
 Tumors (5%)
 Miscellanous. (5%)
Incidence

5. Commonest causes of obstruction
ADHESION
TUMOR HERNIA

6. Common causes of obstruction

7. CLINICAL FEATURES OF OBSTRUCTION
Classic quartet
 Pain
 Distension
 Vomiting
 Absolute Constipation

8. Pain
 Sudden, severe
 Colicky → mild, constant diffuse pain on umbilicus or lower
abdomen
 Not significant in paralytic ileus
Vomiting
 Appear late in distal obstruction
 Digested food → faeculent material

9. Distension
 SI: Increases the more distal
 LI: Delayed
Constipation
 Absolute or relative
 Does not apply in :
• Richter’s hernia
• Gallstone obstruction
• Mesentric vascular occlusion,
• Associated with pelvic abscess

10. ADHESIVE INTESTINAL OBSTRUCTION (40%)

11. ADHESIVE INTESTINAL OBSTRUCTION

12. Strangulated Hernia (12%)

13. Strangulated Hernia

14. • 75% occur in Recto-sigmoid colon
• 15-20% of colorectal cancer present
with obstruction
• LT colon commonest site of
obstruction due to constricting lesion
& solid faeces
Neoplasms (15%)

15. Abdominal X-Ray
Errect abdomen x-ray with air fluid levels

16. Extramural intestinal obstruction

17. Volvulus
Twisting or axial rotation of a portion of bowel about its mesentery

18. Sigmoid volvulus
 Intermittent symptoms followed by
passage of large quantities of flatus and
feces
 Early progressive abdominal distension,
hiccough, retching, late vomiting,
constipation

20. INVESTIGATIONS
X-RAY of Sigmoid volvulus
Massive colonic distension Dilated
loop running diagonally from right
to left with one fluid level within
each loop.

21.  Invagination of segment of bowel
(intussusceptum) into another
(intussuscepien).
 it is often antegrade
 Most common in : ileocolic
(ileocaecal) & Ileo-ileal
Intussusception

23. There may be absence of bowel
in the right lower quadrant
Dehydration, pallor, shock.
Irritability, sweating.
Later Red Current Jelly Stool
pyrexia

24. INVESTIGATIONS
X-RAY
Abdominal X-ray - may show
dilated gas-filled proximal bowel,
paucity of gas
Distally, multiple fluid levels (but
may be normal in the early stages).

25. Ultrasound
May show :
• Doughnut
• Target Sign
• Pseudo-kidney
• Sandwich Appearance
It is a very effective modality and
many consider it the investigation
of choice.

26. Evaluation and
Management of
Intestinal
Obstruction

27. INDICATIONS FOR SURGERY
Absolute
 Generalised peritonitis
 Localised peritonitis
 Visceral perforation
 Irreducible hernia
Relative
 Palpable mass lesion
 'Virgin' abdomen
 Failure to improve
Conservative
 Incomplete obstruction
 Previous surgery
 Advanced malignancy
 Diagnostic doubt - possible ileus

28. Neonatal intestinal obstruction
An intestinal obstruction
occurring during the first month of
life.

29. Causes
Esophageal:
Atresia (TOF)
Gastric:
Congenital hypertrophic Pyloric
Stenosis
Duodenal:
Atresia
Stenosis
Diaphragm
Malrotation with bands or
volvulus
Annular pancrease

30. Causes
 Jeujunal & ileal obstruction:
Obstructed inguinal hernia
Intussusception
Atresia
Stenosis
Meconium ileus
Peritoneal bands or hernia
Duplication cysts
 Large bowl obstruction:
◦ Hirschsprung’s disease
◦ Anorectal anomalies
◦ Meconium plug syndrome
◦ Atresia (rarest)
 Necrotizing enterocolitis
 Complicated Inguinal Hernias

31. Any baby presenting
with persistent, bile
stained vomiting
should be
considered to be
surgical until proven
otherwise.
Clinical picture:
The cardinal signs are
2C, 2V, 2D
 Colics, Constipation
 Vomiting, Visible peristalsis
 Distention, Dehydration

32. Management
 Gastric decompression (naso-gastric tube)
 IV line (for fluid replacement)
 Urinary catheter (to monitor urine output)
 Fluids: 10-20ml/kg over an hour, to be repeated according to
 Response.
 Drugs: To cover anaerobes as well as Gram stained bacteria

33. After initial resuscitation, every effort is
directed towards rapid diagnosis and
treatment of the specific cause
Imaging:
Plain X ray.
Contrast studies.