A portion of the SI becomes entrapped in oneof the retroperitoneal fossae or in a congenitalmesenteric defectSites Foramen of Winslow Holes in the mesentery or transversemesocolon Defect in the broad ligament Diaphragmatic hernia Duodenal/caecal/appendicealretroperitoneal fossae
Secondary to tuberculosis or crohn’s diseaseTreatment- Resection & anastomosis
1. Gall stones In the elderly 20 to erosion of a large gallstone through the gallbladder into the duodenum Classically there is impaction about 60 cm proximal to the ileocaecal valve
2. Food Occur after partial or total gastrectomy when unchewed articles can pass into the small bowel3. Stercolith In association with jejunal diverticulum or ileal stricture
4. Trichobezoar Firm masses of undigested hair balls Associated with an underlying psychiatric abnormality
5. Phytobezoar Firm masses of fruit or vegetable fibres Predisposing factors High fibre intake Inadequate chewing Previous gastric surgery Hypochlorhydria Loss of the gastric pump mechanism
6. Worms Ascaris Lumbricoides In children An attack frequently follows the initiation of antihelminthic therapy
Common cause of intestinal obstruction inwestern countriesAny peritoneal irritation → local fibrinproduction → adhesions between opposedsurfacesCauses Ischemic areas- Sites of anastomoses, trauma vascular occlusion Foreign material- Talc , starch, gauze, silk Infection- Peritonitis, tuberculosis Inflammatory conditions- Crohn’s disease Radiation enteritis
INTUSSUSCEPTION One portion of the gut becomes invaginated within an immediately adjacent segment Commonly in children(5-10 months) 90% idiopathic Secondary to intestinal pathology. Eg. Polyp, Meckels diverticulum Hyperplasia of the Peyer’s patch in the terminal ileum may be the initiating event
Twisting or axial rotation of a portion of bowelabout its mesenteryPrimary or secondary10 – occurs secondary to congenital malrotationof the gut, abnormal mesentericattachments, congenital bands20 – rotation of a piece of bowel around anacquired adhesion or stoma
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