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Diverticulitis
Adhesions
Incarcerated hernia
Pathological Derangement in
Intestinal Obstruction
Fluid and electrolyte disturbance
Bacterial proliferation
Vascular disturbance
Bowel wall changes
Intestinal Obstruction: Clinical
Diagnosis
Main symptoms:
Abdominal pain
Vomiting
Abdominal distention
Obstipation
Character/onset of Sx help determine
level of obstruction
Intestinal Obstruction: Clinical
Diagnosis
History of previous operation/cancer/hernia
Signs of strangulation/perforation
Signs of dehydration/shock
Abdominal distention
Operative scar
Visible peristalsis
Borborygmi
Abdominal/rectal mass
Incarcerated hernia
Visible Peristalsis
Strangulated Femoral
Hernia
Clinical Findings Suggestive of
Strangulation
Continuous pain
Fever
Tachycardia
Peritoneal irritation
Leukocytosis
C-reactive protein elevation
Increase in serum lactate
Supine Upright
Distal SBO: Plain
Radiograph and CT
Barium Radiograph:
Jejunojejunal Intussusception
Jejunojenunal
Intussusception
CT: Ileal Intussusception with
Typical Target Sign
UTZ: Dilated Jejunal Loops
Causes of SBO in Adults as to
Site
Extrinsic to bowel Intrinsic to bowel wall
wall Congenital
Adhesions (post-op Duplication/cysts
esp.) Inflammatory
Hernia TB
Neoplasms Diverticulitis
Carcinomatosis Neoplastic
Extra-intestinal tumor Primary/metastatic tumors
Intraluminal
Intra-abdominal Traumatic
Gallstone
abscess Hematoma
Bezoar
Miscellaneous
Foreign body Intussusception
SBO due to Adhesive Band
SBO due to Dense
Adhesions
SBO: Internal Hernia due to
Adhesive Bands
SBO due to Carcinoid Tumor
Causes of SBO in Adults
Cause Incidence (%)
Adhesion 50-75
Neoplasm 8-15
Hernia 8-15
Volvulus 3
Inflammatory bowel 1
disease <1
Intussusception
<1
Gallstone ileus
<1
Radiation enteritis
<1
Intra-abdominal abscess
<1
SBO: Management
Initial resuscitation and decompression
Conservative Tx reserved for partial SBO
Close monitoring mandatory if under
conservative Tx
Surgery generally indicated for:
Complete SBO
No improvement in 48 hours
Surgery urgent in suspected strangulation
- Abdominal pain
- Nausea/vomiting
- Abdominal distention
- Obstipation
- Clinical history
- Physical examination
Mx
- Abdominal radiographs
Algorith Partial
SBO
Complete
SBO
Large bowel
obstruction
SBO
appropriately
- Unrelenting pain
- Clinical deterioration
- Radiograph
deterioration
Previous Hx of
prohibitive reoperative
risks & successful
No Yes conservative Mx
elective resection
If complicated or with failed
endoscopic stenting:
Resection and anastomosis (if
feasible)
Resection and colostomy
Obstructed Distal Transverse
Colon with Competent
Ileocecal Valve
Obstructed
Proximal
Transverse
Colon with
Incompete
nt
Ileocecal
Valve
Obstructive Hepatic Flexure
CA
Volvulus of the Colon:
Predisposing Factors