This document discusses intestinal obstruction, including its definition, classification, etiology, pathophysiology, symptoms, signs, diagnosis, and management. Intestinal obstruction can be dynamic or mechanical in nature. Mechanical obstructions are further classified as luminal, intramural, or extrinsic lesions. Common causes include adhesions, hernias, tumors, and gallstones. Symptoms include abdominal cramps, vomiting, and constipation or diarrhea. Diagnosis involves examination of the abdomen and imaging tests. Initial management is conservative with NG tube, IV fluids, and antibiotics. Surgery is indicated for peritonism, deterioration, or failure of conservative treatment and may involve lysis of adhesions, resection, or

1. SURGERY
INTESTINAL OBSTRUCTION
DR. CHONGO SHAPI (BSc. HB, MBChB)

2. INTESTINAL OBSTRUCTTION
Definition
Failure, reversal or impairment of the normal transit of intestinal contents.
Classification & Etiology
A dynamic obstruction
Due to failure of peristalsis. May be caused by:
1. Neuronal defect eg spinal injuries
2. Electrolyte imbalances especially hypokalemia, acid and base in balances, Uraemia
3. Ischemic causes venous or arterial defects
4. Infections-peritonitis
5. Retroperitoneal hematomas
Mechanical intestinal obstruction
1.Luminal lesions
a) Impactions
b) Gallstones
c) Bezoars and other foreign matter
d) Meconium in newborns
e) Intussusception in infants
2.Intramura lesions
a) Congenital (e.g., atresia and stenosis, imperforate anus, duplications, Meckel's
diverticulum)
b) Trauma
c) Inflammatory (e.g., Crohn's disease, diverticulitis, ulcerative colitis, radiation,
toxic [ingestions]
d) Neuromuscular defect (e.g., megacolon, neuro/myopathic motility disorders)
e) Neoplastic (most common etiology of colon obstruction)
3.Extrinsic lesions
a) Adhesions (most common etiology of small bowel obstruction)
b) Hernia and wound dehiscence
c) Masses (e.g., annular pancreas, anomalous vasculature, abscess and hematoma,
neoplasms)
d) Volvulus
Pathophysiology
In simple mechanical obstruction, blockage occurs without vascular or neurological
compromise.
Ingested fluid and food, digestive secretions, and gas accumulate in excessive amounts if
obstruction is complete causing proximal bowel distension and blockade of the venous
drainage.
There is impaired circulation leading to ischemia and inflammation ensues with more
secretions into the lumen.
The normal secretory and absorptive functions of the mucous membrane are depressed, and
the bowel wall becomes edematous and congested. Severe intestinal distention is self-
Symptoms, Signs, and Diagnosis
Obstruction of the small bowel:
Diagnosis of simple obstruction is based on a triad of symptoms:
(1) Abdominal cramps are centered around the umbilicus or in the epigastrium; if cramps become
severe and steady, strangulation probably has occurred.
(2) Vomiting starts early with small-bowel and late with large-bowel obstruction.
(3) Obstipation occurs with complete obstruction, but diarrhea may be present with partial
obstruction. Strangulating obstruction occurs in nearly 25% of cases of small-bowel obstruction
and can progress to gangrene in as little as 6 h; it is manifested by steady, severe abdominal pain
from the outset or beginning a few hours after the onset of crampy pain.
On thorough examination of the abdomen, groin, and rectum.
Abdominal examination done like in acute abdome
- Inspection
What is the abdominal contour?
Distension – intestinal obstruction or ascites
Does the abdomen move with respiration?
Rigid abdomen – peritonitis
Can the patient blow out/suck in the abdomen?
Rigid abdomen – peritonitis
Does the patient lie still or writhe about?
Fear of movement – peritonitis
Writhe about – colic
Are there visible abnormalities?
Scars – relevant previous illness, adhesions
Hernia – intestinal obstruction
Visible peristalsis – intestinal obstruction
Visible masses – relevant pathology
Gentle palpation
Is there tenderness, guarding or rigidity? Tenderness/guarding – inflamed parietal peritoneum
Rigidity – peritonitis
Deep palpation
Are there abnormal masses/palpable organs?
Palpable organs/masses – relevant pathology
Is there rebound tenderness?
Rebound tenderness – peritonitis
Percussion
Is the percussion note abnormal?
Resonance – intestinal obstruction
Loss of liver dullness – gastrointestinal perforation
Dullness – free fluid, full bladder
Shifting dullness – free fluid
Auscultation
Are bowel sounds present /abnormal?
Absent sounds – paralytic ileus

3. perpetuating and progressive, intensifying peristaltic and secretory derangements and
increasing the risks of dehydration, electrolyte imbalances ischemia, necrosis, perforation,
peritonitis, and death.
Examination of inguinal and femoral regions
This should be an integral part of the examination.
Incarcerated hernias represent a frequently missed cause of bowel obstruction.
Digital rectal examination
-Hard stools suggest impaction.
-Soft stools suggest obstipation.
-An empty vault suggests obstruction proximal to the level that the examining finger can
reach.
-Fecal occult blood testing should be performed, and a positive result may suggest the
possibility of a more proximal neoplasm.
Do a vaginal examination when appropriate
Examine the chest
Laboratory Tests
1.FHG:A rising white blood cell count may herald the development of strangulation, but
strangulation may be present in the absence of leukocytosis
2.Electrolyte
3.Urea and creatinine
Imaging
Plain films of the abdomen (KUB) show dilated loops of bowel. Air fluid levels more than 3
in adults
Upright films of the abdomen or of the chest should be obtained also, to look for the free air
under the diaphragm if a perforation has occurred
MANAGEMENT
Initial conservative management
1.Nasogastric tube for decompression
2.Intravenous fluids for dehydration
3.Catheterize and monitor input and output
4.Visualization of foreign material
5. Prophylactic antibiotics.
6. Soapy enema may be used in partial distal obstruction.
Double contract barium enema has a role in intussseption reduction
Surgical management
Indication
1.Peritonism
2.Contiued deterioration of general condition of the patient
Closed bowel procedures: lysis of adhesions, reduction of intussusception, reduction of
Hyperactive sounds – mechanical obstruction
– gastroenteritis
Is there a bruit? Bruit – vascular disease

4. volvulus, reduction of incarcerated hernia
-Enterotomy for removal of bezoars, foreign bodies, gallstones
-Resection of bowel for obstructing lesions, strangulated bowel
-Bypasses of intestine around obstruction
-Enterocutaneous fistulae proximal to obstruction: colostomy, cecostomy