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Obstruksi Intestinal Materi
Obstruksi Intestinal Materi
40%
14%
14%
16%
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