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Bowel obstruction occurs when the normal flow of intraluminal contents is interrupted.

Obstruction can be functional (due to abnormal intestinal physiology) or due to a mechanical


obstruction, which can be acute or chronic

Epidemiology

Mechanical small bowel obstruction is the most frequently encountered surgical disorder of the small
intestine.

Different classifications of small bowel obstruction:

1) Intraluminal
- e.g., foreign bodies, parasites, gallstones, or meconium

- (REPORTER MENTION THIS, BUT DO NOT PUT IN PPT) the obstruction is found inside
small intestines. For example a foreign body such as 50 santol seeds. Or a patient with
ascariasis ball (tens to thousands in number) which can cause obstruction. The patient
can also have an obstruction due to a large gallstone

2) Intramural
- e.g., tumors, Crohns diseaseassociated inflammatory strictures
- (REPORTER MENTION THIS, BUT DO NOT PUT IN PPT) if you have a tumor in the wall of
the small intestines. Before it can cause symptoms, the tumor should be huge because
the content of the small intestine is liquid. So it requires an almost complete obstruction
before it can have symptoms.

3) Extrinsic
- (e.g., adhesions, hernias, or carcinomatosis) - inspect the inguinal hernia because it
causes obstruction

- (REPORTER MENTION THIS, BUT DO NOT PUT IN PPT)Intra-abdominal adhesions related


to prior abdominal surgery account for up to 75% of cases of small bowel obstruction
Small bowel obstruction: common etiologies

1. Adhesions 4. Crohns disease


2. Neoplasms 5. Volvulus
Primary small bowel neoplasms 6. Intussusception
Secondary small bowel cancer (e.g., 7. Radiation-induced stricture
melanoma-derived metastasis) 8. Postischemic stricture
9. Foreign body
Local invasion by intra-abdominal 10. Gallstone ileus
malignancy (e.g., desmoid tumors)
11. Diverticulitis
Carcinomatosis 12. Meckels diverticulum
3. Hernias 13. Hematoma
External (e.g., inguinal and femoral) 14. Congenital abnormalities (e.g., webs,
Internal (e.g., following Roux-en-Y gastric duplications, and malrotation)
bypass surgery)

Less prevalent etiologies for small bowel obstruction include hernias, malignant bowel
obstruction, and Crohns disease.
A rare etiology of obstruction is the superior mesenteric artery syndrome, characterized by
compression of the third portion of the duodenum by the superior mesenteric artery as it crosses
over this portion of the duodenum.