This document summarizes intestinal obstruction, including:
1. The pathology and clinical features of mechanical obstruction proximal and distal to the obstruction site. Distension results from gas, fluid, and electrolyte imbalances.
2. Types of obstruction include internal and external strangulation, closed loop, and special types like internal hernia, strictures, and intussusception.
3. Clinical features include the classic pain, vomiting, distension, and constipation quartet. Treatment involves gastrointestinal drainage, fluid replacement, and surgical relief of the obstruction.
6. Distension
Gas
– Swallowed air
– Diffusion from blood
– Products of digestion and bacterial activity
– O2 & CO2 reabsorbed
– Nitrogen 90% and H2S
Fluid
– Digestive juice
– No absorption of food
11. Closed loop obstruction
• Obstruction both at proximal and
distal point
– Strangulated loops
– Colonic obstruction with a
competent ileocecal valve
12. Special types
• Internal hernia
• Entric stricture
• Bolus obstruction
• Adhesion and bands
• Intussusception
• volvulus
31. Timing of surgery
• Emergent
Obstructed/strangulated Ext hernia
Internal intestinal strangulation
Acute obstruction
• Other cases
Atleast within 24 hrs
• Adhesions
upto 72hrs
32. Principles of Surgical intervention
• Mt. of the segment at the site of
obstruction
• The distended proximal bowel
• Underlying cause of obstruction
36. Viability of bowel
Viable
Dark color – Light Dark persists
Mesentery bleeds
on pricking
No bleeding
Peritoneum – Shiny Dull & Lustreless
Int Musc – Firm,
Peristalsis seen
Flabby, thin, friable
Non viable
Mesenteric pulsation + Absent
37. Doubtful – Resected ends as stomas
No resection / Multiple ischaemic areas
(Mesenteric Vasc Occlusion)
2nd
look laparotomy after 24-48hrs
39. Operative decompression
• Compromise of Exposure / Viability /
Closure
• Septic complications of spillage
• Savage’s decompressor / NG tube
• Replace fluid
40. Large bowel obstruction
Caecum to Prox trans colon
– Rt. Hemicolectomy, if resectable
– Ileotransverse bypass if not
resectable
Splenic flexure
– Extended Rt.Hemicolectomy
41. Left colon / Rectosigmoid
• Decompression proximal colostomy
• Resection with
– Anastamosis with covering colostomy
– Paul Mikulicz procedure
– Hartmann’s procedure