Intestinal Obstruction

Principles of mgt of Intestinal
obstruction and
Intussusception
Innocent Okello MD
MBChB, MMed General Surgery, FCS Pediatric Surgery
Classification of IO
• Dynamic
Mechanical obstruction
• Adynamic
No mechanical obstruction- paralytic ileus, pseudo-obstruction
PATHOPHYSIOLOGY of IO
• The bowel proximal to the obstruction dilates and the bowel below the
obstruction exhibits normal peristalsis and absorption until it becomes empty
and collapses.
• Initially, proximal peristalsis is increased in an attempt to overcome the
obstruction.
• The distension proximal to an obstruction is caused by two factors:
Gas: Overgrowth of both aerobic and anaerobic organisms, resulting in
considerable gas production. Following the reabsorption of oxygen and carbon
dioxide, the majority is made up of nitrogen (90%) and hydrogen sulphide.
Fluid: Digestive juices. (saliva 500 mL, bile 500 mL, pancreatic secretions
500 mL, gastric secretions 1 litre – all per 24 hours).
Causes of dehydration and electrolyte loss
• Reduced oral intake
• Defective intestinal absorption
• Losses as a result of vomiting
• Sequestration in the bowel lumen
• Transudation of fluid into the peritoneal cavity
Mechanical intestinal obstruction
• Bolus
• Gallstones
• Obstruction from enteric strictures
• Worms
• Stercoliths/fecolith
• Trychobezoars and phytobezoars
• Internal hernia
• Adhesions and bands
• Intussusception
• Volvulus
 Compound volvulus
 Sigmoid volvulus
 Volvulus neonatorum/malrotation with midgut volvulus
Omega ”Coffee-bean”
sign
Double bubble in
Duodenal atresia
Features of IO
• Abdominal distension
• Abdominal Pain
• Vomiting
• Dehydration
• Constipation
 Absolute
 Relative
• Pyrexia
• High-pitched/Reduced/Absent bowel sounds
• Abdominal tenderness
• Hypokalemia
Investigations in IO
• Blood
CBC
Serum Electrolytes/Extended electrolytes
ABGs
• Imaging
Plain Erect abdominal Xray/Babygram(in neonates)
Abdominal CT scan
Abdominal US
Erect abd xray showing air-fluid levels in IO
INTUSSUSCEPTION
• It is telescoping or invagination of one portion (segment) of bowel into the

adjacent segment.
• Types
1. Antegrade: Most common.
2. Retrograde: Rare (jejunogastric in gastrojejunostomy stoma).
• It can be ileo-colic (most common type, 75%), colocolic, ileoileocolic, colocolic.

• It is common in weaning period of a child (common in male), between the period
of 6–9 months.
Causes of intussusception
• Idiopathic
• Meckel’s diverticulum
• Change in diet during weaning
• Upper respiratory tract viral infection
• Intestinal polyps
• Submucous lipoma
• Leiomyoma of intestine
• Meckel’s diverticulum
• Carcinoma
• Purpuric submucosal haemorrhages
Features of intussusception
• Colicky abdominal pain
• Sudden onset of pain in a child
• Progressive distension of the abdomen
• Vomiting
• Passage of “red currant-jelly” stool
Abdominal exam findings in ISS
• Palpable mass (85%)
• Sausage-shaped smooth, firm mass
• Mass does not move with respiration
• Mobile in all directions
• Resonant
• Mass contracts under the palpating fingers
• Mass appears and disappears
• Empty right iliac fossa
• Features of intestinal obstruction/peritonitis—later
Investigations
• Barium enema shows typical claw sign or coiled spring sign (Pincer
end).
• Ultrasound shows target sign or pseudokidney sign or bull’s eye sign,
which is diagnostic.
• Doppler may show mass with doughnut sign and is useful to check
blood supply of bowel.
• Plain X-ray abdomen shows multiple air fluid levels.
• CT abdomen is needed.
Management
• IV Cannula
• NGT
• Fluid resuscitation
• IV antibiotics
• IV analgesia
• Urinary catheter
• Intussusception
 Conservative(Hydrostatic, pneumonic reduction)
 Surgical (Laparotomy, laparoscopy)
• IO, Surgical-correct the anatomical anomaly/Relieve the obstruction

 Resection and anastomosis
 Resection and stoma placement
 Bypass surgery
Post op care
• IV fluids
• IV Antibiotics
• Urinary catheter
• NGT
• Pain medications
Questions
• What are the sites of possible internal herniation?
• Explain Rigler’s triad of gallstone ileus
• What are the indications of pneumonic/hemostatic reduction in
intussusception?
• What are the contraindications of non-operative reduction in
intussusception?

Intestinal Obstruction

Uploaded by

Copyright:

Available Formats

Intestinal Obstruction

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Intestinal Obstruction

Uploaded by

Copyright:

Available Formats

Principles of mgt of Intestinal

• It is telescoping or invagination of one portion (segment) of bowel into the

• It can be ileo-colic (most common type, 75%), colocolic, ileoileocolic, colocolic.

• IO, Surgical-correct the anatomical anomaly/Relieve the obstruction

You might also like