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Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata
 

Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata

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Shinjan Patra

Shinjan Patra

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    Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata Presentation Transcript

    • Surgical Management of Intestinal Obstruction Shinjan Patra Roll no-88
    • When will we do surgery???• No resolution even after 24-48 hours of conservative treatment in partial obstruction.• Complete obstruction of bowel• Strangulated & closed-loop obstruction.
    • • Principle- laparotomy is to be done.• Timing-after optimization of the patient for surgery after routine investigations.• Anesthesia- General/Epidural• Incision-according to the site of obstruction(mostly median)
    • Actual steps of Surgery• At first most importantly the caecum is identified collapsed distended (small gut obstruction) (large gut obstruction)
    • Site of obstruction is identified-junction between collapsed & distended partNature of the obstruction is identified & removed Viability of the gut is assesed
    • Gut is viable it is not viableGut is put inside the Resection & AnastomosisAbdomen.• Abdomen closed in layers using Non-absorbable sutures.
    • Comparison between Viable & Non- viable GutFeatures of viable gut Features of non-viable gut• Pinkish • Blackish• Luster-present • Absent• Peristaltic movement- present • Absent• When pricked by a needle- bleeding from the surface • There Is no bleeding• Pulsation-present in • No pulsation mesenteric vessels
    • If still we are doubtful-• Warm saline soaked mop over the doubtful area & 100% O2 is administered• If colour becomes normal with peristalsis,then it is viable.
    • Other means of checking Viability1. Doppler study2. Fluorescence study
    • Other Approaches• Second look operation -in multiple segment obstructions• Laparoscopic approach
    • Special consideration• Procedure to prevent recurrences- 1.repair of the hernia 2.lysis of the offending adhesions.• Bypass surgery• Colostomy/ileostomy without anastomosis.• Deferment of resection & anastomosis.
    • Post-surgical Complications• Recurrences• Burst abdomen• Pelvic abscess• Subphrenic abscess• Biliary or faecal fistula• Incisional hernia.