 Any condition interferes with normal propulsion and

passage of intestinal contents.

 This mechanical obstruction can be partial ( lumen
narrowed but allow transit some content) or complete
( lumen totally obstruction) this classify to:
A. Simple obstruction (no vascular impairment)
B. Closed loop ( both ends are obstructed e.g volvulus)
C. Strangulation obstruction
 Either paralysis or dysmotility of intestinal
peristalsis.
 1% of all hospitalization
 3% of emergency surgical admissions
 Adhesion is the most common cause of intestinal
obstruction
 Mortality rate range between
 3% for simple bowel obstruction to
 30% when there is strangulation or perforation
 Intestinal obstruction
Pattern in Africa
Adhesions
H ernia
Small Intest volvolus
80% with gangrenous bowel segments Intussusception
3% 3% Sigmoid volvolus
10% Ascaris
Large bowel tumor

40%
14%

14%

16%

70 % of the patients were below the age of 15 years

 Small bowel obstruction:
 Adhesion 60%
 Hernia 20%
 Neoplasm 5%
 Volvulus 5%.
 Others: - gall stone - foreign body - intussusception.

 Large bowel obstruction :

 Cancer 60%.
 Diverticular disease 15%.
 Volvulus 15%.
 Others: – fecal impaction .
11
Trichobezoar
Undigested hair balls due to persistent hair chewing and
sucking and may be associated with an underlying
psychiatric abnormality.

12
Corpus Alienum

13
1. Vascular occlusion ileus.
2. Adynamic or inhibition ileus :
 Post operative.
 Metabolic causes: DKA- hyponateremia-hypokalemia – hypomagnesaemia.
 Drugs: morphine –TCA-antacid-anticonvulsant.
 Intra-abdominal inflammation—sepsis—occult wound infection.
 Pneumonia—renal stone—retroperitoneal hematoma—fracture spine and
ribs.
3. Spastic ileus. ( intestine remain contracted and no propulsive) causes
are:
 Uremia.
 Porphyria.
 Heavy metal poison.
 Vomiting
Nausea

Partial
obstruction

Obstipation Closed-loop
Complete No flatus/stool beyond 6-12 hrs obstruction
obstruction
 Diagnosis
History and physical examination
 Four cardinal symptoms
1. Pain
2. Vomiting
3. Distension
4. obstipation.
 Location and characteristic of pain??
 Examination :
o Vital signs.( PR-Temp-BP)
o Hydration status.
o Abdominal and rectal examinations
 Physical Examination
 INSPECTION
 Abdominal distention, scars, visible peristalsis.
 PALPATION
 Mass, tenderness, guarding
 Examination of hernial orifices
 PERCUSSION
 Tympanic, dullness
 AUSCULTATION
 Bowel sound are high pitch and increase in frequency
 Or silent.
 CBC:
 Increase PCV (dehydration ) and increase in WBC.
 Lactate concentration-amylase-lactic
dehydrogenase useful but not sensitive
 To rule out necrosis
 ABG:
 metabolic alkalosis and respiratory acidosis.
 CXR :
 Detect extra-abdominal condition present with bowel
obstruction e.g. pneumonia.
 Presence of pneumoperitoneum indicates perforated
viscus.
 Abdominal X-RAY
 Small bowel considered dilated when diameter more than 3 cm
while proximal colon 9 cm and the sigmoid 5 cm.
 The cause of bowel obstruction can often determined
 Presence of pneumobilia suggest G.S ileus.
 Sigmoid and cecal volvulus produce pathognomnic images
  Prone radiograph from a patient with
Fluid levels with gas above;
complete large bowel obstruction
‘stepladder pattern’. Ileal
shows distended lagre bowel in the
obstruction by adhesions; patient
periphery of abdomen with
erect.
haustration.
 Barium should not be used in
 Contrast studies: a patient with peritonitis
 Indications are controversial.
 Identify site and often the cause of obstruction.
 Differentiate between colonic and distal small bowel
obstruction
 Differentiate between ileus-partial and complete obstruction.
 Computed tomography:
 Recently become valuable in B.O especially when plain films
failed in diagnosis or suspect strangulation.
 Sensitivity 93% and specificity 100%
 Accuracy 94% in diagnosis of BO
 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 severe is the associated systemic disorders?.
A. Resuscitation.
B. Conservative treatment
1. Incomplete obstruction.
2. Advanced malignancy.
C. Indications for surgery
1. Generalized or localized peritonitis.
2. Perforation.
3. Strangulated hernia.
4. Closed loop
5. Failure to improve on conservative treatment.
• Peritoneal irritation local fibrin production
adhesions
• As early as 4 weeks post laparotomy. The
majority of patients present between 1-5 years
Colorectal Surgery 25%
Gynaecological 20%
Appendectomy 14%
• Prevention:
• good surgical technique, washing of the
peritoneal cavity with saline to remove clots, etc,
minimizing contact w/ gauze, covering
anastomosis & raw peritoneal surfaces
 Conservatively provided there is no signs of
strangulation; should rarely continue
conservative treatment for longer than 72 hours
 At operation, divide only the causative adhesion
and limit dissection.
 Features: palpable tympanic lump
 A twisting or axial (sausage shape) in the midline or
rotation of a portion of left side of abdomen.
Constipation, abdominal
bowel about its distension (early & progressive)
mesentery. When
complete it forms a
closed loop obstruction
 Relieved by
decompression per
anum.
 Surgery is required to
prevent or relieve
ischaemia
 Occurs when one portion of
the gut becomes invaginated
within an immediately
adjacent segment.
 Common in 1st year of life
 Common after viral illness
enlargement of Peyer’s
patches
 Ileocolic is the commonest
variety in child.
 Colocolic intussusception
commonest in adult
Classically, a previously
healthy infant presents
with colicky pain and
vomiting (milk then bile).
Between episodes the
child initially appears
well.
Later, they may pass a
‘red currant jelly’ stool.

Red currant
jelly stools
Head of intussusception Partial reduction Free flow of contrast into
is at hepatic flexure distal small bowel indicates
complete reduction
• Prevention
 Use of nasogastric suction and
 Restriction of oral intake until bowel sound and passage
of flatus return
 Maintain electrolyte balance
• Specific treatment:
 Removed primary cause
 Decompressed GI distension
 If prolong paralytic ileus , consider laparotomy exclude
hidden cause and facilitate bowel decompression