Surgical management of intestinal obstruction Shinjan Patra Medical College Kolkata
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.