Dr.Dinesh.M.G Professor of Surgery J.J.M.M.C Davangere

1. Dr. Dinesh. M.G
Professor of Surgery
J.J.M.M.C.
Davangere

2. Intestinal obstruction
Types
 Dynamic
 Peristalsis works against mechanical obstruction
 Intraluminal e.g. Impacted faeces, round worms, bezoars
 Intramural e.g. malignant or inflammatory stricture
 Extramural e.g. hernias, bands and adhesions, volvulus
 Adynamic
 Paralytic ileus
 Mesenteric ischaemia, pseudo-obstruction

3. Dynamic obstruction
Classical features of intestinal obstruction are
1. Pain abdomen (colicky)
2. Distension of abdomen
3. Vomiting
4. Absolute constipation
Clinical types
 Small bowel obstruction
 High
 low
 Large bowel obstruction

4. Dynamic obstruction
Types based on the onset
 Acute intestinal obstruction
 Chronic intestinal obstruction
 Acute on chronic intestinal obstruction
 Subacute
Types based on blood supply to intestine
 Simple obstruction
 Strangulated obstruction

5. Dynamic obstruction
Some of common causes of intestinal obstruction are
 Adhesions
 Obstructed hernia
 Strictures
 Carcinoma
 Faecal impaction
 Intussusception
 Volvulus
 Worms
 Bezoars
 Bolus
 Gall stones

6. Adhesions

7. Dynamic obstruction
Pathophysiology
 Proximal bowel dilates
 Distal bowel empties and remains contracted
Distension of proximal bowel occurs due to
 Gas
 Swallowed air
 Gas produced in intestine
 Fluid
 Saliva
 Gastric juice
 Bile
 Pancreatic juice
 Succus enterricus

8. Acute intestinal obstruction
Clinical features
 Colicky Pain abdomen
 Vomiting
 Distension
 Absolute constipation
 Step-ladder peristalsis
 Borborygmi on auscultation
Late manifestations
 Dehydration
 Oliguria
 Shock
 Pyrexia
 Septicaemia
 Respiratory embarrassment
 Peritonitis

9. Dynamic obstruction
Features of strangulated obstruction
 Presence of shock
 Constant pain
 Tenderness or rebound tenderness
 Guarding and rigidity

10. Management of Dynamic obstruction
Investigations
 Plain x-ray erect abdomen
 Dilated loops of intestine
 Multiple air-fluid levels
 Ultrasound abdomen for peritonitis
 CBC & Electrolytes
 Serum creatinine

11. Plain x-ray erect abdomen

12. Acute intestinal obstruction
Treatment
 Nil by mouth
 Nasogastric decompression
 Fluids and electrolyte replacement
 Antibiotics
 Relief of obstruction by surgery
 Division of band or adhesions
 Resection and anastomosis

13. Adynamic obstruction
Paralytic ileus
 Failure of transmission of peristaltic waves secondary to
neuromuscular failure
 Clinical features include
 Distension of abdomen
 Vomiting
 Absence of bowel sounds
 Absolute constipation

14. Paralytic ileus
Varieties
 Postoperative
 Infection
 Peritonitis
 Reflex ileus
 Fracture of spine or ribs
 Retroperitoneal haemorrhage
 Metabolic
 Uraemia
 Hypokalaemia

15. Paralytic ileus
Clinical features
 Distension of abdomen
 Vomiting
 Absolute constipation
 Absent bowel sounds
Management
 Treatment of Primary cause
 Ryle’s tube aspiration
 Fluid and electrolyte replacement
 Laparotomy as a last resort

16. Acute intussusception
Invagination of a portion of gut within an immediately
adjacent segment
Aetiology
 Children 3-9 months
 Adults
 Submucosal lipoma
 Polyp
 Meckel’s diverticulum

17. Acute intussusception
Parts of intussusception

18. Acute intussusception
Types
 Ileo-ileal
 Ileo-colic
 Ileo-ileo-colic
 Colo-colic
 Retrograde
 Multiple

19. Acute intussusception
Clinical features
 Attacks of screaming with drawing up of legs
 Vomiting
 ‘Redcurrant’ jelly stools
 Sausage-shaped lump abdomen
 Sign of Dance
 Emptiness of right iliac fossa
 Blood stained finger stall on PR examination
 Abdominal distension

20. Acute intussusception
Sausage shaped lump around umbilicus

21. Acute intussusception
Investigations
 Plain x-ray erect abdomen
 Small bowel obstruction with absent caecal gas shadow
 Barium enema
 Claw sign

22. Acute intussusception
Ultrasound abdomen
 ‘Target’ sign

23. Acute intussusception
Treatment
 Hydrostatic reduction
 Operative management
 Manual reduction
 Resection and end to end anastomosis

24. Points to remember
 Cardinal features of acute intestinal obstruction are--
 Colicky pain abdomen
 Vomiting
 Distension of abdomen
 Absolute constipation
 Preliminary treatment of acute intestinal obstruction
includes
 Nil by mouth
 Nasogastric decompression by Ryle’s tube
 Intravenous fluid and electrolyte replacement
 Antibiotics

25. Points to remember
 Plain x-ray erect abdomen in acute intestinal obstruction
reveals
 Dilated loops of intestine
 Multiple air-fluid levels
 Claw sign is seen in ---
 Barium enema in ileo-colic intussusception
 Treatment of acute intussusception include--
 Hydrostatic reduction
 Operative management
 Manual reduction
 Resection and end to end anastomosis

26. Thank you