INTESTINAL OBSTRUCTION

DR. Mazen Kurdi

Assiss. Prof. pediatric surgery
 INTESTINAL OBSTRUCTION
 History:
 Age: e g :
• Neonate: Meconium ileus.
Hirschprung’s disease.
Malrotation.
Intestinal atresia.
• 2 - 24 months : Intususception (>24 M)
Hirschprung’s disease.
• Children : Hernia
Clinical features :
• Pain.
• Vomiting.
• Distention.
• Constipation.
Features vary according to :
• Site of obstruction .
• Age of Presentation.
• Underlying pathology.
• The presence or absence of intestinal
ischemia.
 Other manifestations:
• Dehydration.
• Hypokalemia.
• Pyrexia.
• Abdominal distention.
 Definitions:
• Ileus : Mechanical or functional intes.
Obstruction (Adynamic or paralytic).
• Mechanical obstruction :complete or partial
blockage of the intes. Lumen.
• Simple obstruction: one obstructing point.
• Closed loop obstruction :both the afferent and
the efferent loops are obstructed.
• Strangulation : where the blood supply to the
affected part of the intestine is impaired more
likely to sustained increased intraluminal
pressur.
 Intestinal
obstruction

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

Medications Post. Operative

ileus

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