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Obstruction
GAYM G.
Small Bowel
Obstruction(SBO)
Classified
Mechanical obstruction =luminal contents cannot pass
through the gut tube because the lumen is physically
blocked or obstructed
simple/strangulation
Proximal /Intermediate/Distal
open-loop /closed-loop
Etiology of Mechanical Small Bowel
Obstruction
Extrinsic Intrinsic
*Adhesions (usu postop) Inflammatory
Hernia -Crohn's disease
*Neoplastic -Infections
-Carcinomatosis Tuberculosis
-Extraintestinal neoplasms Actinomycosis
Intra-abdominal abscess Diverticulitis
*Volvulus Neoplastic
Primary
Metastatic
Intussusception
Etiology cont…
Intraluminal
• Gallstone ileus
• Enterolith
• Bezoar
• Swallowed foreign body
• Parasites-tapeworm and
Ascaris species
Pathophysiology
Sns
• abdominal distention- most pronounced if site of
obstruction is in the distal ileum
Goals
(a) distinguish mechanical obstruction from ileus
(b) determine the etiology of the obstruction
(c) discriminate partial from complete obstruction, and
(d) discriminate simple from strangulating obstruction
Dx...
Hx-prior abdominal operations, presence of abdominal
disorders (e.g., intra-abdominal cancer )
Strangulation suggested by –
thickening of the bowel wall,
pneumatosis intestinalis,
portal venous gas,
mesenteric haziness, and
poor uptake of IV contrast into the wall of the affected bowel
NG tube
Treatment...
for complete SBO-surgery
4. Carcinomatosis
Operative Management
Males(M:F=8.8:1)
Farmers
Hypermobility
Hyper motility
o Rx
laparoscopic approach
Early Postoperative Adhesions
Etilogies
Clinical Presentation
entirely supportive
Epidural anesthesia
1. Intraluminal 3. Extraluminal
fecal impaction *Volvulus
inspissated barium hernias
foreign bodies
tumors in adjacent
2. Intramural organs
*carcinoma abscesses &
inflammation
adhesions
(diverticulitis, Crohn's
disease, tuberculosis, and
schistosomiasis)
ischemia
radiation
intussusception, and
anastomotic stricture
Pathophysiology
Abdominal examination
Distension
Tenderness or guarding
Mass may represent a palpable tumor
Hyper-tympanitic abdomen
Visible or palpable colonic loops
Bowel sounds -Hypoactive below the obstruction and
hyper active above the obstruction
Rectal examination
Usually empty and ballooned
Blood may suggest presence of a carcinoma
A rectal cancer may be palpable
A mass in the Pouch of Douglas may suggest
carcinomatosis peritonea
Investigations
Hct
Serum electrolytes
Radiology:
1. Erect and supine abdominal x-ray
2. Plain chest x/ray
3. Barium enema
4. CT scan
5. Rigid sigmoidoscopy
6. Flexible Colonoscopy
Treatment
Resuscitation
Volume replacement: IV crystalloids,may require blood
transfusion
Nasogastric suction
Peri-operative antibiotics:
Operative Rx for rt colonic obstruction
rural area
ETIOLOGY
Long and floppy sigmoid colon
a lengthy mesentery
narrow mesenteric root
Associated factors:
chronic constipation
• hx of previous attacks
and chronic constipation
Acute fulminating… subacute progressive
early vomiting, diffuse • Vomiting occurs late, pain
abdominal pain and is minimal, and signs of
tenderness, marked peritonitis are usually not
prostration, and early present
appearance of gangrene
• Abdominal distention is
Distention may be minimal extreme
• appropriate resuscitation
Always operative
Viable colon
If colon gangrenous
NG decompression
Replacement of EC fluid deficits
correction of electrolyte abnormalities
All medications that inhibit bowel motility-should be
D/C
Patient response is monitored by serial abdominal
examinations and radiographs
failure to resolve with supportive measures:
colonoscopic decompression