Presented at AWS General Hospital under supervision of dr Saiful Mukhtar SpB(K)BD

2. most common intra-abdominal problems

3. normal propulsion passage of
intestinal contents

18. • Partial narrowed
• Complete totally obstructed

19. Lesions Extrinsic to the IntestinalWall Lesions Intrinsic to the IntestinalWall
ADHESIONS CONGENITAL
Postoperative Intestinal atresia
Congenital Meckel's diverticulum
Postinflammatory Duplications/cysts
HERNIA INFLAMMATORY
External abdominal wall (congenital or
acquired)
Crohn's disease
Internal Eosinophilic granuloma
Incisional INFECTIONS
CONGENITAL Tuberculosis
Annular pancreas Actinomycosis
Malrotation Complicated diverticulitis
Omphalomesenteric duct remnant NEOPLASTIC
NEOPLASTIC Primary neoplasms
Carcinomatosis Metastatic neoplasms
Extraintestinal neoplasm Appendicitis

20. Lesions Extrinsic to the IntestinalWall Lesions Intrinsic to the IntestinalWall
INFLAMMATORY MISCELLANEOUS
Intra-abdominal abscess Intussusception
"Starch" peritonitis Endometriosis
MISCELLANEOUS Radiation enteropathy/stricture
Volvulus Intramural hematoma
Gossypiboma Ischemic stricture
Superior mesenteric artery syndrome INTRALUMINAL/OBTURATOROBSTRUCTION
Gallstone
Enterolith
Phytobezoar
Parasite infestation
Swallowed foreign body

21. • 80% small intestine

24. normal autonomic
parasympathetic (vagal) sympathetic splanchnic innervation

26. proximal to the point of obstruction
impairment of the barrier function

31. peritoneal carcinomatosis

33. chronic transmural inflammatory

34. Crohn Disease
Crohn disease is an idiopathic infl ammatory bowel
disease that can affect any segment of the GI tract
but usually involves the small intestine (terminal
ileum) and colon.
Young adults of northern European ancestry are
more commonly affected.
Transmural edema, follicular lymphocytic
infiltrates, epithelioid cell granulomas, and
fistulation characterize this disease.
Signs and symptoms include the following:
• Diffuse abdominal pain (paraumbilical and
lower-right quadrant)
• Diarrhea
• Fever
• Dyspareunia (pain during sexual intercourse)
• Urinary tract infection (UTI)
• Malabsorption

37. primary volvulus of the small
intestine abrupt dietary changes
Ramadan
fast

39. Sigmoid volvulus. A. Supine abdominal radiograph showing the
dilated, volvulated segment of redundant sigmoid colon pointing
toward the right upper quadrant; arrows show the space between
the sigmoid and hepatic and splenic flexures. B. Contrast enema in
sigmoid volvulus showing cut off at distal site of volvulated
sigmoid having a "bird-beak" appearance

40. Cecal volvulus. Dilated volvulated cecum pointing to left upper quadrant. Arrows indicate the cecal tip

45. Complete small bowel obstruction. A. Supine abdominal radiograph shows multiple loops of dilated small bowel with
colonic gas. B. Upright radiograph shows multiple air-fluid levels in the small intestine (arrows).

47. strangulation perforation

48. Barium enema showing complete large bowel obstruction in the ascending colon

49. 25 mm

50. 25 mm transition zone

51. • Acidosis leukocytosis increased serum amylase
lactate

54. 82%

60. Maingot’s Abdominal Operations
Netter’s Clinical Anatomy
SabistonTextbook
of Surgery