Bowel obstruction

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Presented at AWS General Hospital under supervision of dr Saiful Mukhtar SpB(K)BD

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Bowel obstruction

  1. 1. most common intra-abdominal problems
  2. 2. normal propulsion passage of intestinal contents
  3. 3. • Partial narrowed • Complete totally obstructed
  4. 4. Lesions Extrinsic to the IntestinalWall Lesions Intrinsic to the IntestinalWall ADHESIONS CONGENITAL Postoperative Intestinal atresia Congenital Meckel's diverticulum Postinflammatory Duplications/cysts HERNIA INFLAMMATORY External abdominal wall (congenital or acquired) Crohn's disease Internal Eosinophilic granuloma Incisional INFECTIONS CONGENITAL Tuberculosis Annular pancreas Actinomycosis Malrotation Complicated diverticulitis Omphalomesenteric duct remnant NEOPLASTIC NEOPLASTIC Primary neoplasms Carcinomatosis Metastatic neoplasms Extraintestinal neoplasm Appendicitis
  5. 5. Lesions Extrinsic to the IntestinalWall Lesions Intrinsic to the IntestinalWall INFLAMMATORY MISCELLANEOUS Intra-abdominal abscess Intussusception "Starch" peritonitis Endometriosis MISCELLANEOUS Radiation enteropathy/stricture Volvulus Intramural hematoma Gossypiboma Ischemic stricture Superior mesenteric artery syndrome INTRALUMINAL/OBTURATOROBSTRUCTION Gallstone Enterolith Phytobezoar Parasite infestation Swallowed foreign body
  6. 6. • 80% small intestine
  7. 7. normal autonomic parasympathetic (vagal) sympathetic splanchnic innervation
  8. 8. proximal to the point of obstruction impairment of the barrier function
  9. 9. peritoneal carcinomatosis
  10. 10. chronic transmural inflammatory
  11. 11. Crohn Disease Crohn disease is an idiopathic infl ammatory bowel disease that can affect any segment of the GI tract but usually involves the small intestine (terminal ileum) and colon. Young adults of northern European ancestry are more commonly affected. Transmural edema, follicular lymphocytic infiltrates, epithelioid cell granulomas, and fistulation characterize this disease. Signs and symptoms include the following: • Diffuse abdominal pain (paraumbilical and lower-right quadrant) • Diarrhea • Fever • Dyspareunia (pain during sexual intercourse) • Urinary tract infection (UTI) • Malabsorption
  12. 12. primary volvulus of the small intestine abrupt dietary changes Ramadan fast
  13. 13. Sigmoid volvulus. A. Supine abdominal radiograph showing the dilated, volvulated segment of redundant sigmoid colon pointing toward the right upper quadrant; arrows show the space between the sigmoid and hepatic and splenic flexures. B. Contrast enema in sigmoid volvulus showing cut off at distal site of volvulated sigmoid having a "bird-beak" appearance
  14. 14. Cecal volvulus. Dilated volvulated cecum pointing to left upper quadrant. Arrows indicate the cecal tip
  15. 15. Complete small bowel obstruction. A. Supine abdominal radiograph shows multiple loops of dilated small bowel with colonic gas. B. Upright radiograph shows multiple air-fluid levels in the small intestine (arrows).
  16. 16. strangulation perforation
  17. 17. Barium enema showing complete large bowel obstruction in the ascending colon
  18. 18. 25 mm
  19. 19. 25 mm transition zone
  20. 20. • Acidosis leukocytosis increased serum amylase lactate
  21. 21. 82%
  22. 22. Maingot’s Abdominal Operations Netter’s Clinical Anatomy SabistonTextbook of Surgery

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