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1. CLINICAL FEATURES OF INTESTINAL
OBSTRUCTION

2. Dynamic obstruction
• Pain
• Vomiting
• Distension
• Constipation
• Other manifestations

3. Pain
• 1st symptom, usually sudden
• Colicky nature
• Centered on the umbilicus (small bowel) or
lower abdomen (large bowel)
• Coincides with increased peristaltic activity
• Severe pain indicates presence of
strangulation

4. Vomiting
• The more distal the obstruction ,the longer the
interval between the onset of symptoms and
the appearance of nausea and vomiting.
• As obstruction progresses the character of
vomitus alters from digested food to faeculent
material.

5. Distension
• Degree of distension dependent on site
• The more distal the lesion greater is the
distension

6. Constipation
• Absolute (neither faeces nor flatus is passed)
cardinal feature of complete intestinal
obstruction
• Relative (only flatus is passed)

7. Other manifestations
• Dehydration : in small bowel obstruction
because of repeated vomiting
• Hypokalaemia
• Pyrexia : onset of ischemia
intestinal perforation
associated inflammation
hypothermia indicates septicaemic shock
• Abdominal tenderness

9. Clinical features of strangulation
• Constant pain –pain never completely absent
• Tenderness with rigidity –indicates early
laparotomy
• Shock –indicates underlying ischaemia

10. Clinical features of intussusception
• Classical presentation –episodes of screaming
and drawing up of legs in previously well male
infant
• Vomiting –conspicuous and bile
stained
• ‘Redcurrant jelly’ stool

11. • Lump which hardens on palpation in 60%
• Feeling of emptiness in the right iliac fossa
(the sign of dance)
• On rectal examination blood stained mucus
may be found on the finger
• Unrelieved, progressive dehydration and
abdominal distension, followed by peritonitis
secondary to gangrene.
• D/D : a/c gastroenteritis
Henoch-Schoenlein purpura
Rectal prolapse

12. Clinical features of volvulus
• Volvulus of the small intestine

13. • Caecal volvulus: usually a clockwise twist
in 25% ,a palpable tympanic swelling in
midline or left side of abdomen

14. Sigmoid volvulus:
large bowel obstruction
abdominal distension
vomiting
absolute constipation