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Dynamic Adynamic
Present peristalsis
eg.
Intraluminal Absent peristalsis
Extrensic Mural mesenteric v. occ.
obst. eg. paralytic ileus
Pseudoobstruction
Mechanical Intestinal obstruction
Small intestine Large intestine
Exterensic:
•Adhesions Adhesions
•Hernias Hernias
•Congenital:
•Annular
pancreas
(duodenal obstruction).
Annular pancreas
Duodenal obstruction
Mechanical intestinal obstruction
Sup. mesenteric
a. syndrome
(compression of
3rd part of
duodenum ).
Ischemic bowel
Mechanical intestinal obstruction
Mural:
•Small • Imperforated
bowel anus.
atresia.
Multiple atresia
Mechanical intestinal obstruction
•Stenosis.
•Webs
(diaphragm).
Duodenal web
Duodenal web
Duodenal web
Mechanical intestinal obstruction
Inflamatory :
•Regional enteritis.
•Ulcerative collitis.
(Crohn’s desease.)
•Diverticulitis.
•Radiational
•Radiational enteritis.
enteritis, stricture.
Neoplastic :
Small bowel
neoplasms.
Mechanical intestinal obstruction
Intraluminal
obstruction:
F.B. (Barium ,
• •F.B.(Constipation ,
worms) Barium , worms)
•Gallstone ileus
(more common
in elderly).
F.B in the G.I.T
F.B in the G.I.T
Mechanical intestinal obstruction
•Meconium •Meconium
ileus. ileus.
Intussusception Intussusception
Intussusception
Medical causes of small & Large
bowel obstruction
Metabolic
cases
Response to
localized Neuropathic
Inflammatory disorders
process
Diffuse Retroperitoneal
peritonitis process
Medical causes of small & Large
bowel obstruction
Metabolic:
1. Hypokalemia.
2. Hypomagnesemia.
3. Hyponatremia.
4. Ketoacidosis.
5. Uremia.
6. Porphyria.
7. Heavy metal poisoning.
Medications:
1. Narcotics.
2. Antipsychotics.
3. Anticholinergics.
4. Ganglionic blockers.
5. Agents used to treat Parkinson’s
disease.
For optimal treatment to be instituted,
five questions must be answered:
• Is the diagnosis intestinal obstruction?. Is
the obstruction is mechanical? .
• What is the level of obstruction?.
• Is there evidence of bowel wall ischemia or
perforation?.
• How sever is the associated systemic
disorders?.
Retroperitoneal process:
1. Retroperitoneal hematoma.
2. Pancreatitis.
3. Spinal or pelvic fracture.
Neuropathic disorders:
1. Diabetes.
2. Multiple sclerosis.
3. Scleroderma.
4. Lupus erythrematosis.
5. Hirschsprung’s disease.
Post. Operative ileus following
intra-abdominal surgery:
AS the motility usually returns for
the:
small bowel within 24 – 48 hrs.
gastric within 48 hrs.
colonic within 3-5 days.
SHOKRAN