Dynamic Adynamic
Present peristalsis
eg.
Intraluminal Absent peristalsis
Extrensic Mural mesenteric v. occ.
obst. eg. paralytic ileus
Pseudoobstruction
Mechanical Intestinal obstruction
Small intestine Large intestine
Exterensic:
•Adhesions Adhesions
•Hernias Hernias
•Congenital:
Malrotation with Volvulous:
ladds band sigmoid 60-80%
coecal 20-40%
Malrotation
Malrotation
Malrotation
Mechanical intestinal obstruction
•Annular pancreas
(duodenal obstruction).
Annular pancreas
Duodenal obstruction
Mechanical intestinal obstruction
Sup. mesenteric
a. syndrome
(compression of
3rd part of
duodenum ).
Ischemic bowel
Mechanical intestinal obstruction
Mural:
•Small • Imperforated
bowel anus.
atresia.
Multiple atresia
Mechanical intestinal obstruction
•Stenosis.
•Webs
(diaphragm).
Duodenal web
Duodenal web
Duodenal web
Mechanical intestinal obstruction
Inflamatory :
•Regional
enteritis. •Ulcerative collitis.
(Crohn’s desease.) •Diverticulitis.
•Radiational enteritis.
•Radiational
enteritis, stricture.
Neoplastic :
Small bowel
neoplasms.
Mechanical intestinal obstruction
Intra luminal
obstruction:
•F.B. (Barium , •F.B. (Constipation
worms) , Barium , worms)
•Gallstone ileus
(more common
in elderly).
F.B in the G.I.T
F.B in the G.I.T
Mechanical intestinal obstruction
•Meconium •Meconium
ileus. ileus.
Intussusception Intussusception
Intussusception
Medical causes of small & Large
bowel obstruction
Metabolic
cases
Response to
localized Neuropathic
Inflammatory disorders
process
Diffuse Retroperitoneal
peritonitis process
Medical causes of small & Large
bowel obstruction
Metabolic:
1. Hypokalemia.
2. Hypomagnesemia.
3. Hyponatremia.
4. Ketoacidosis.
5. Uremia.
6. Porphyria.
7. Heavy metal poisoning.
Medications:
1. Narcotics.
2. Antipsychotics.
3. Anticholinergics.
4. Ganglionic blockers.
5. Agents used to treat Parkinson’s
disease.
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 sever is the associated systemic
disorders?.
Retroperitoneal process:
1. Retroperitoneal hematoma.
2. Pancreatitis.
3. Spinal or pelvic fracture.
Neuropathic disorders:
1. Diabetes.
2. Multiple sclerosis.
3. Scleroderma.
4. Lupus erythrematosis.
5. Hirschsprung’s disease.
Post. Operative ileus following
intra-abdominal surgery:
AS the motility usually returns for
the:
small bowel within 24 – 48 hrs.
gastric within 48 hrs.
colonic within 3-5 days.
SHOKRAN