Intestinal / Bowel obstruction (BO) occurs when the

normal propulsion and passage of intestinal contents

does not occur
BO can involve:
 Small intestine (SBO)
 Large intestine (LBO)
 Generalized Ileus
-via systemic alterations
-involving both the small and large intestine
Etiopathogenesis

1. Mechanical obstruction

Mechanical Obstruction /Dynamic ileus :

lack of passage due to an “obstruction of the
bowel”, which can be located anywhere in the bowel

2. Non mechanical (Functional ) obstruction

Non mechanical Obstruction /Paralytic /adynamic/

/Fungsional ileus :
Paralytic ileus refers to a lack of passage due to
“paralysis of the bowel”
 Intestinal /Bowel Obstruction

Classified according to :
Time of presentation and duration of
obstruction:
- Acute
- Chronic
The extent of obstruction
-Partial
-Complete
The type of obstruction
-Simple
-Closed-loop
-Strangulation
 Nonmechanical Obstruction
 Paralytic (adynamic) (Fungsional) ileus due to :
1. After abdominal operations
2. Inflammation Peritonitis
3. Systemic disorders e.g. sepsis, hyponatremia,
hypokalemia, hypomagnesemia
4. Retroperitoneal disorders e.g. ureter, spine fractures ,
hematoma
5. Thoracic conditions e.g. pneumonia, rib fractures
6. Drugs e.g opiates, psychotropics , General anesthesie

 Pseudo-Obstruction
Imbalance in the parasympathetic and sympathetic influences
on Colonic motility.
Acute colonic pseudo-obstruction, also known as Ogilvie
syndrome.
* Neonate
Congenital atresia * Middle age
Adhesesion and band
Volvulus neonatum
Strangulated Ing.hernia
Meconeum ileus
Strangulated fem.hernia
Hirschsprung”s disease Carcinoma colon
Imperforate anus Volvulus
* Infant
Stranggulated inguinal hernia
Intussuception * Elderly
Complication of Meckel”s
Adhesion and bands
Strangulated Ing.hernia
diverticulum Strangulated fem.hernia
Hischsprung”s diseases Carcinoma colon
* Young adult Volvulus
Impacted faeces
Adhesions and bands
Strangulated ing.hernia
 May occur at any age
 70 percent small bowel obstruction (SBO)
 30 percent large bowel obstruction (LBO)

Common Causes SBO Common Causes of LBO

Adhesion 60% Colon cancer 65 %

Neoplasma 20% Diverticulitis 20 %
Hernia 10% Volvulus 5%
Crohn 5% Miscellaneous 10 %
Miscellaneus 5%
 Pathophysiology
Dependent upon :
1. Degree of obstruction
2. Duration of obstruction
3. Presence and severity of ischaemia

Result in :
1. Accumulation of fluid and air(Sequestration within the
dilated loop)
Fluid disturbances massive third space losses
8 – 10 L of fluid are secreted
Hypovolumic shock oliguria,
hypotension,hemoconcentration
2. Electrolyte depletion
3. Bacterial overgrowth Rapid colonisation
-Maximal by 24 hrs after obstruction
-Bacterial translocation to node and portal system
4. Bowel distension
-Chest compression by pushing up diaghragma muscle
-Decreases the ability mucosa to absorb ,stasis intestinal
content of fluids and electrolytes
-Increased intraluminal pressure  oedematous
cyanosis
intraperitoneal exudation necrosis  perforation 
peritonitis
-ACS  impediment in venous returnarterial
insufficiency

5. LBO
Ileocaecal valve plays prominent role in pathophysiology
of LBO.
If competent valve = Closed loop obstruction
In 10 – 20 % of individual ICV incompetent
Caecal around 10 – 12 cm  the risk of perforation
The classic quartet
1. Abdominal distension
2. Colicky abdominal pain
3. Nausea and Vomiting
4. Decreased passage of
stool or flatus
Hypovolumic shock
Altered mental status
Vital Sign
Tachicardia
Hypotension
Tachipnoe
Fever
Oliguria
 Abdominal Examination

Patient Supine position with the legs flexed at the

hip

Abdominal Colicky pain

The periodicity of pain:
3 to 4 minutes pain from proximal intestinal
obstruction
15 to 20 minutes pain from distal small bowel or
colon

On Inspection
Abdominal distension
Visible peristalsis
Abdominal Scars  Adhesion
On Auscultation

Performed for at least 3 to 4 minutes

Metallic sound
Borborygmi
The absence of bowel tones :
Is typical of intestinal paralysis .
LateQuiet abdomen (may also indicate
intestinal fatigue from long-standing
obstruction).
On Palpation
Inguinal, Femoral, Umbilical or Incisional Hernias
Palpable mass

On Percuss
Dull  Fluid or Mass
Tympanic  Air (Intraluminal or not )
Peritoneal irritation

DRE (Digital Rectal Examination )

For Mass , Impacted faeces
Vomiting – NG tube Aspirates

Consists food and gastric chyme bile 

faeculent

GOO  Clear , food and gastric chyme

Mid to distal SBO  Bilious/Bile
Distal SBO to LBO  Feculent
 Laboratory test
 Fecal Occult Blood Test
 CBC
 Serum electrolyte concentrations
 The serum creatinine concentration / BUN
 The coagulation profile
 Urinalysis should be done to check for hematuria
 Liver function profile
Imaging

Chest x-ray
Exclude a pneumonic process
To look for subdiaphragmatic air.

Plain abdominal X ray

Erect and lying down  routinely

Water soluble enema to exclude

Colonic pseudo obstruction
LBO + incompetent ileocecal thereby mimicking small
bowel obstruction.
SBO
 SIGMOID VOLVULUS
bent inner tube = Coffe bean” appearance “Bird Beak “
 Fluid resuscitation
Requirements = Deficit + Maintenance + Ongoing losses
 Close monitoring hemodinamic
 Foley catheter urine output
 CVP
 Electrolyte, acid-base correction
 NGT decompression
 Antibiotics
 Diagnostic study
 Informed concent
 Refer to Surgeon
 Exploratory laporotomy