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Intestinal
Obstruction
“Never let the sun rise or set on
small-bowel obstruction”
Hernia 15
Tumors 15
miscellaneous 10
Diverticulitis 20
Volvolus 5
miscellaneous 10
Clinical Presentation
Clinical Presentation
HISTORY - The diagnosis of intestinal obstruction is based on its “cardinal
symptoms” of Pain, Distension, Vomiting and Absolute Constipation.
II. Chronic obstruction is usually seen in large bowel obstruction with lower
abdominal colic and absolute constipation, followed by distension.
2) PAIN - The Pain of intestinal obstruction is true colic, and it is the first
symptom encountered.
7) Late Manifestations…
Pyrexia
Respiratory Distress
Dehydration
Hypovolemic Shock
Peritonism
Clinical Presentation
EXAMINATION
1) INSPECTION - We Look For…
i. Surgical Scars
ii. Hernias
iii. Distention
EXAMINATION
2) PALPATION – Palpate for…
i. Masses
ii. Hernias
iii. Tenderness
EXAMINATION
3) PERCUSSION – Percuss to hear any
Dullness or Resonance related to site of
obstruction.
Clinical Presentation
EXAMINATION
4) AUSCULTATION – Bowel Sounds are
Initially Loud and frequent→ Then as
bowel distends the sounds become more
→
resonant and high pitched→ Eventually
becoming Amphoric.
Clinical Presentation
DEFERENTIAL DIAGNOSIS
1) In The Small Bowel
I. Gallstone Ileus
II. TB
III. Tumor
IV. Adhesions
V. Volvulus
Clinical Presentation
DEFERENTIAL DIAGNOSIS
2) In The Large Bowel
I. Feces
II. Diverticulae
III. CA
IV. Hirshsprung’s Diseases
V. Adhesions
VI. Volvulus
X-RAY
Small Bowel
Obstruction is
suggested by a
“ladder” pattern, when
obstruction occurs,
both fluid and gas
collect in the intestine.
They produce a
characteristic pattern
called air-fluid levels.
The air rises above
the fluid and there is a
flat surface at the air-
fluid interface.
X-RAY
Distended Large
Bowel Tends to lie
peripherally and to
show the
Hustrations of the
Taenia Coli.
X-RAY- “Barium Follow-Through”
Patient drinks a contrast medium containing
barium sulfate. Contrast medium appears
white on x-rays, and shows the outline of the
internal lining of the bowel.
X-ray images are taken at intervals as the
contrast moves through the intestine, (@ 0
minutes→@ 20 minutes→@ 40 minutes →
@90 minutes);
The bowel is accessed as it becomes visible.
The test is completed when the Barium is
visualized at the Caecum.
CT
Useful to detect…
• Lesions
• Colonic Tumors
• Hernias
• Bolus
Although the treatment of
specific causes of intestinal
obstruction is considered
accordingly, there are some
general principles applied.
Signs of Strangulation
• Toxic Appearance, Rapid Pulse, Temperature drop
• Shock
Strangulation
Causes of strangulation-
Closed-loop obstruction
This occurs when the bowel is
obstructed at both the proximal
and distal point. There is no
early distension of the proximal
intestine.
When gangrene of the
strangulated segment is
imminent, retrograde thrombosis
of the mesenteric veins results
in distension on both sides of
the strangulated segment.
Unrelieved, this may result in
necrosis and perforation.
Dynamic (Mechanical) Obstruction
Classification according to source
A: Intraluminal
i. Impaction
ii. Foreign Bodies
iii. Bezoars
iv. Gallstones
B: Intramural
i. Stricture
ii. Malignancy
C: Extramural
i. Adhesions/Bands
ii. Hernia
iii. Volvulus
iv. Intussusceptions
Adhesions
Most common cause of obstruction in the west.
Adhesions may he classified into various types whether they are early
(fibrinous), late (fibrous) or by the underlying etiology. From a practical
perspective, there are only two types — ‘easy’ weak ones and ‘difficult’
dense ones.
II. Washing of the peritoneal cavity with saline to remove clots, etc.
Spontaneously or secondary
A clockwise twist ·
F>M .
II. Pseudo-Obstruction
2. Infection: Peritonitis
4. Metabolic : Hypokalemia, DM