Ritasman Baisya Medical College kolkata

1. Intestinal obstruction- clinical
aspects
Ritasman Baisya
Roll no – 85
8th semester

2. Factors affecting clinical feature
• Location of obstruction
• Age of the obstruction
• Underlying pathology
• Presence or absence of intestinal ischemia

3. Cardinal features of acute obstruction
Abdominal pain
Vomiting Cardinal features Distension
Absolute
constipation

4. Pain
• First symptom
• Onset -- Occurs suddenly and usually
severe
• Site - Around umbilicus or lower
abdomen
• Nature-Colicky in nature ,with increased
distension ,pain becomes mild, constant ,diffuse

5. Contd. pain
• Special points –
• Very severe pain indicates strangulation
• Pain may not be significant in post operative
simple mechanical obstruction
• Not present usually in paralytic ileus

6. Vomiting
• Onset – timing depends on site
• Character— alters from digested food, bile
stained food to faeculent matter
• Nature – projectile

7. Distension
• Degree of distension depends on site of
obstruction
• Visible peristalsis may be present
• Delayed in colonic obstruction & minimal
/absent in mesenteric vascular occlusion

8. Few images of
visible peristalsis in
obstruction

9. Constipation
Types -- 1. absolute (neither feces nor flatus )
2. relative (where only flatus is passed )
 Absolute constipation is cardinal feature of
complete obstruction
 Some patients pass feces or
flatus due to distal bowel content

10. Exceptions
• Richter hernia
• Gallstone obturation
• Mesenteric vascular occlusion
• Obstruction associated with a pelvic abscess
• Partial obstruction where diarrhea may often
occurs

11. Dehydration
• Mostly in small bowel obstruction due to
repeated vomiting
• Dry tongue, dry skin , sunken eye , oliguria
• Secondary polycythemia…

12. Abdominal tenderness
 Initially localised , later diffuse
 Rebound phenomenon & guarding will not
be present in simple obstruction

13. Temperature
• Fever signifies inflammation in bowel wall /
ischemia / perforation
• Hypothermia -- when septicemia due to poor
pyrogenic response

14. Bowel sounds
• High pitched metallic to metallic tinkling
sound of dilated bowel
• Once fatigue– silent abdomen peritonitis
• In paralytic ileus no return of bowel sound on
auscultation

15. Other features
• Pyrexia – onset of ischemia , intestinal
perforation
• Hypokalemia
• Increase in serum amylase ,LDH

16. Features of strangulation
• Continuous severe pain
• Shock indicates underlying ischemia
• Symptoms commence suddenly and recur
regularly
• Local tenderness associated with rigidity and
rebound tenderness ( Blumberg sign )

17. Comparison of clinical aspects
Proximal small Distal small bowel Large bowel
bowel
Severe vomiting Moderate vomiting Late vomiting
Less distension Central distension Early distension ,
pronounced
Colicky pain Central abdominal pain Less pain
Constipation late Varies in appearance Constipation is early
feature
Severe dehydration Moderate Less dehydration

18. Complications
• Peritonitis
• Shock
• Renal failure
• ARDS
• Intra abdominal abscess
• Moribund status