INTESTINAL OBSTRUCTION

Dr. Mohammad Jamil Alhashlamon

 Intestinal Obstruction Causes
• Adhesions or Bands
– Resulting from previous surgery or intraperitonial
infection ( rarely congenital band)
• Strangulated external hernia
– Femoral or inguinal or umbilical

• Tumors
• Volvulus of small or large bowel
– A mobile or distended loop of bowel rotates causing
obstruction at its neck
• Inflammatory stricture
– e.g. diverticular disease , crohns disease ( obstruction
usually incomplete )
• Bolus obstruction
– e.g. impacted faeces , foreign body , gaalstone .
• Internal hernia

• Itussusception
– Usually initiated by a mass in the bowel
 Pathophysiology
• Obstruction lead to dilation of bowel
proximally and disrupt peristalsis .

• Presentation depend on :
– Level of obstruction
– Completeness of obstruction
 Symptoms of intestinal obstruction
• Vomiting
– The more proximal the obstruction the earlier it
develops .
– Nature of vomitus give important clues to the
level of obstruction .
– Change to faeculent vomiting usually take place
gradually after about 24 hours of complete
obstruction .
• Pain

– Fluid and swallowed air proximal to the

obstruction together with continuing peristalsis
cause the pain .
– Usually mild m colicky .
– Small intestine obstruction cause central
abdominal pain .
– Large intestine obstruction cause suprapupic
abdominal pain .
• Constipation

– Absolute constipation or obstipation

– The lower the obstruction the earlier the
obstipation develops .
• Symptoms develops more gradually in the
large bowel obstruction

• If the ileocecal valve remain competent , the

caecum will progressively distend and
eventually rupture .

• The ileocaecal valve become incompetent in

50% of the cases and this allow small intestine
distension and delay the onset of symptoms .
 Incomplete obstruction
• If the bowel partially obstructed , the clinical
features are less clearly defined .

• The pain is often accompanied by visible

peristalsis ( this is the hallmark of partial
obstruction )

• The most common cause is slowly growing

cancer in the colon .
 Physical signs of intestinal obstruction

• Dehydration
• Abdominal distension
• Visible peristalsis
• Signs of primary cause .
• Lack of tenderness “except in
strangulation “
• Mass “ if it is the cause “
• Bowel sounds will be “ loud , frequent , high
pitched and tinkling “

• Succession splash may be positive

 Investigation of suspected obstruction

• Plane abdominal X-Ray

• Abdominal X-Ray with contrast

 Adynamic intestinal obstruction
• Temporary disruption of normal peristaltic
activity without mechanical blockage .

• If happened in the small intestine called

“paralytic ileus “

• If happened in the large intestine called

“psudo-obstruction of the colon “
 Paralytic ileus

• Most commonly post surgery .

• May also happened in :

– Hypokalemia
– Side effect of anti-parkinson medications
 Psudo-obstruction of the colon
• Caused by :
– Retroperitonial inflammation or hemorrhage
– Neurological illnesses
– Anticholenergics
– Pregnancy
– Orthopedic injuries and surgery

• Physical signs : similar to those of the

mechanical obstruction except the absence of
bowel sounds
Management of intestinal obstruction

• Keep NPO
• IV fluid and correct electrolytes
• NG tube
• Treat the underlying pathology
 Bowel Strangulation
• Segment of the bowel trapped so that the
lumen becomes obstructed and its blood
supply compromised

• If unrelieved , this progress into infarction and

eventually perforation .

• This happened mostly in hernia and volvulus .

 symptoms and signs of strangulation

• Signs and symptoms of obstruction

• Abdominal tenderness
• The patient more unwell and tachycardia and
lucocytosis

• Management :
– If it is diagnosed or even suspected immediate
surgery .
THANK YOU