ILEUS

Disusun Oleh :
Fini Amalia

Karimah Ihda Husnayain

Magista Vivi Anisa

Stevan Wedi Kurniawan

Pembimbing:

dr. Pirma Hutauruk., Sp.B(K)Trauma

ANATOMY & PHYSIOLOGY

DIGESTIVE TRACT

THE DIGESTIVE ORGANS AND THE

PERITONEUM
Lined with serous membrane consisting
of

Superficial mesothelium covering a layer of

areolar tissue
Serosa, or visceral peritoneum:
covers organs within peritoneal cavity
Parietal peritoneum:
lines inner surfaces of body wall

HISTOLOGICAL STRUCTURE OF
THE DIGESTIVE (GI) TRACT

PERISTALSIS

SMALL INTESTINE

90% of absorption occurs in the small intestine

ILEUS
Paralytic/
Adynamic Ileus
Paralysis of
intestinal
motility

Obstructive/
Mechanical/
Dynamic Ileus
implies a
physical barrier
that impedes
aboral progress
of intestinal
contents

OBSTRUCTIVE ILEUS

CLASSIFICATION
Simple mechanical obstruction

A.

Bowel lumen is obstructed

No vascular compromise

Closed loop obstruction

B.

Both ends of a bowel loop are obstructed

Results in strangulated obstruction if untreated
Rapid rise in intraluminal pressure

Strangulated obstruction

C.

Bowel lumen and vascular supply is compromised

CLASSIFICATION
Intrinsic

bowel lesions
Extrinsic bowel lesions
Idiopathic bowel lesions

INTRINSIC BOWEL LESIONS

1.

Congenital anomalies (Pediatric)

a.
b.
c.

2.

Atresia
Stenosis
Bowel duplication

Strictures

INTRINSIC BOWEL LESIONS

Strictures
Inflammatory Bowel Disease
Colon Cancer
Intussusception
Gallstones that have entered the bowel lumen
Bezoar
Barium
Ascaris infection
Tuberculosis
Actinomycosis
Diverticulitis

EXTRINSIC BOWEL LESIONS

Adhesion
a.
b.

Abdominal or pelvic surgery

Presence of peritonitis or trauma

Hernia (higher risk for strangulation)

c.
d.
e.

Inguinal hernia (direct ,indirect)

Internal hernias via mesenteric defects
Obturator hernia

Small bowel volvulus

a.
b.

Rare compared to colon volvulus

Occurs in intestinal malrotation or adhesions

SYMPTOMS
Frequent

and recurrent Generalized

Abdominal Pain

Duration: Seconds to minutes

1.
2.

Character: Spasms of crampy

abdominal pain
Frequency

a.
b.
c.

Intermittent pain initially

Every few minutes in proximal obstruction
Constant pain suggests ischemia or
perforation

SYMPTOMS

Stool passage

Initially may be present despite complete

obstruction
2. Later, obstipation (no stool) in complete
obstruction
1.

Symptoms more severe in proximal obstruction

a.
b.
c.
d.
e.

Severe, colicky abdominal pain

Constant pain suggests ischemia or perforation
Develops over hours and occurs every few minutes
Bilious Emesis
Mild abdominal distention

SIGNS

Bowel sounds

Initial: High pitched, hyperactive bowel sounds

Later: hypoactive or absent bowel sounds

Tender

abdominal mass

Closed loop Bowel Obstruction may be palpable

Abdominal

distention and tympany on percussion

Indicates distal obstruction

Rectal

examination for blood

DARM CONTOUR

RADIOLOGY: ABDOMINAL X-RAY

1.
2.
3.
4.

Bowel distention proximal to obstruction

Bowel collapsed distal to obstruction
Upright or decubitus view: Air-fluid levels
Supine view findings

Sharply angulated distended bowel loops

Step-ladder arrangement or parallel bowel

loops

String of pearls sign (specific for

obstruction)

Pseudotumor Sign

Small Bowel Gas Pattern

Centrally located
Soft tissue across entire
lumen
Colon Gas Pattern
Peripheral Located
Mostly not overlapping
Haustra markings

HERRING BONE

COFFEE BEAN

STEP LADDER

 Dilated Loops of Small Bowel with Air-Fluid levels

Area of non-dilated small bowel.
Absence of Air in the Colon.

MANAGEMENT: CONSERVATIVE
THERAPY

Fluid replacement

Bowel decompression
1.
Nasogastric Tube
2.
Long intestinal tube (eg. Cantor) offers no advantage

1.

2.

Antibiotic
Indications (Not for routine use)
Surgery planned
Bowel ischemia or infarction
Bowel perforation
Cover Gram Negatives and Anaerobes
Second-generation Cephalosporin

MANAGEMENT: SURGICAL
INTERVENTION
1.
2.
3.
4.

Simple correction
By-pass
Entero-cutaneus fistule
Bowel ressection

OBSTRUCTIVE ILEUS
Predictors of resolution without surgery

A.
1.
2.
3.

Early postoperative bowel obstruction

Adhesive obstruction (prior laparotomy)
Crohn's disease

Indications for surgery

B.
1.
2.
3.

Inadequate relief with Nasogastric tube

placement
Persistant symptoms >48 hours despite
treatment (strangulation)
Neoplasms

COMPLICATIONS
Intestinal Ischemia or infarction

Bowel necrosis, perforation and bacterial

peritonitis

Hypovolemia

Complications of surgical intervention if

needed

PROGNOSIS: RECURRENCE OF
OBSTRUCTION DUE TO ADHESIONS
Risk after first episode: 53%
Risk after more than one episode:
83%

REFERENCIES
Souba Wiley. ACS Surgery : Principles and
practice. 6th Edition
Gerard M. Doherty: CURRENT DiaGNOSIS &
Treatment: Surgery, 13th Edition

THANK FOR YOUR

ATTENTIONS!!!