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INTESTINAL OBSTRUCTION

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INTESTINAL OBSTRUCTION DR. Mazen Kurdi Assiss. Prof. pediatric surgery INTESTINAL OBSTRUCTION History: Age: e g : Neonate: Meconium ileus ... – PowerPoint PPT presentation

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Title: INTESTINAL OBSTRUCTION


1
INTESTINAL OBSTRUCTION
  • DR. Mazen Kurdi
  • Assiss.
    Prof. pediatric surgery

2
INTESTINAL OBSTRUCTION
  • History
  • Age e g
  • Neonate Meconium ileus.
  • Hirschprungs disease.
  • Malrotation.
  • Intestinal atresia.
  • 2 - 24 months Intususception (gt24 M)
  • Hirschprungs
    disease.
  • Children Hernia

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  • Clinical features
  • Pain.
  • Vomiting.
  • Distention.
  • Constipation.

5
  • Features vary according to
  • Site of obstruction .
  • Age of Presentation.
  • Underlying pathology.
  • The presence or absence of intestinal ischemia.

6
  • Other manifestations
  • Dehydration.
  • Hypokalemia.
  • Pyrexia.
  • Abdominal distention.

7
  • 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.

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Mechanical Intestinal obstruction
Small intestine Large intestine
Exterensic Adhesions Hernias Adhesions Hernias
Congenital Malrotation with ladds band Volvulous sigmoid 60-80 coecal 20-40

12
Malrotation
13
Malrotation
14
Malrotation
15
Mechanical intestinal obstruction
Annular pancreas (duodenal obstruction).

16
Annular pancreas
17
Duodenal obstruction
18
Mechanical intestinal obstruction
Sup. mesenteric a. syndrome (compression of 3rd part of duodenum ).

19
Ischemic bowel
20
Mechanical intestinal obstruction
Mural Small bowel atresia. Imperforated anus.
21
Multiple atresia
22
Mechanical intestinal obstruction
Stenosis. Webs (diaphragm).
23
Duodenal web
24
Duodenal web
25
Duodenal web
26
Mechanical intestinal obstruction
Inflamatory Regional enteritis. (Crohns desease.) Radiational enteritis, stricture. Neoplastic Small bowel neoplasms. Ulcerative collitis. Diverticulitis. Radiational enteritis.
27
Mechanical intestinal obstruction
Intra luminal obstruction F.B. (Barium , worms) Gallstone ileus (more common in elderly). F.B. (Constipation , Barium , worms)
28
F.B in the G.I.T
29
F.B in the G.I.T
30
Mechanical intestinal obstruction
Meconium ileus. Meconium ileus.
31
Intussusception Intussusception
32

Intussusception
33
Medical causes of small Large bowel
obstruction
34
Medical causes of small Large bowel obstruction
  • Metabolic
  • Hypokalemia.
  • Hypomagnesemia.
  • Hyponatremia.
  • Ketoacidosis.
  • Uremia.
  • Porphyria.
  • Heavy metal poisoning.

35
  • Medications
  • Narcotics.
  • Antipsychotics.
  • Anticholinergics.
  • Ganglionic blockers.
  • Agents used to treat Parkinsons disease.

36
  • 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?.

37
  • Retroperitoneal process
  • Retroperitoneal hematoma.
  • Pancreatitis.
  • Spinal or pelvic fracture.

38
  • Neuropathic disorders
  • Diabetes.
  • Multiple sclerosis.
  • Scleroderma.
  • Lupus erythrematosis.
  • Hirschsprungs disease.

39
  • 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.

40
  • SHOKRAN

41
  • GIT symptoms
  • Appetite.
  • Nausea.
  • Vomiting Colour of the vomitous
  • frequent nature depends upon
    level
  • At pylorus ?
    watery acidic
  • High SBO ?
    bile stained
  • Low SBO
  • ?brownish
  • foul smelling
  • Large BO

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  • Diet.
  • Taste.
  • Swallowing.
  • Regurgitation.
  • Hematemesis.

44
  • Blood in stool
  • colour Redcurrent jelly or fresh blood.
  • Painless or painfull .
  • Indigestion .
  • Distention (Heartburn or Abdominal pain).
  • Nature of the stool.
  • Jaundice.

45
Other condition that mimic the clinical picture of SBO Adynamic obstruction (functional). Hirschsprungs disease ( enterocolitis). Right colonic obstruction If near ileocecal valve may indistinguishable from SBO Adynamic obstruction. Hirschsprung s disease.
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Mechanical intestinal obstruction
Other remnants of the Omphalo-mesenteric duct.
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  • Response to localized inflammatory process within
    or adjacent to the peritoneal cavity eg.
  • Appendicitis.
  • Cholyceystitis.
  • Diverticulitis.
  • Abscess.
  • Pyelonephritis.

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