Strangulated intestinal obstruction is a relatively common type of acute abdomen and requires urgent surgical treatment. The causes of strangulated intestinal obstruction are many including primary volvulus, hernias, adhesions, bands, and intussusceptions.

1. SMOLENSK STATE MEDICAL
UNIVERSITY
Topic-Acute Strangulated
Intestinal Obstruction
Submitted by- Penothil Bhadra Sudheer Dev
504

2. INTRODUCTION
• Intestinal obstruction occurs when the passage of
intestinal contents through the lumen is impaired.
• Intestinal obstruction is an interruption in the normal
flow of intestinal contents along the intestinal tract.
• The block may occur in the small or large intestine, may
be complete or incomplete, may be mechanical or
paralytic, and may or may not compromise the vascular
supply.
• Obstruction most frequently occurs in the young and
the old.

3. • The small bowel is most commonly affected, with
the ileum as the most common site of obstruction.
• Large bowel obstruction accounts for only 15% of
cases of bowel obstruction and the sigmoid colon is
the most common site of obstruction.
• Types of Intestinal Obstruction:
• Mechanical obstruction
• Paralytic (adynamic, neurogenic) ileus
• Strangulation obstruction

5. Acute Strangulated Intestinal
Obstruction
• It compromises blood supply, leading to gangrene of the intestinal
wall,Caused by prolonged mechanical obstruction.
• Physiology:Increased peristalsis, distention by fluid and gas, and
increased bacterial growth proximal to obstruction. The intestine
empties distally.
• Increased secretions into the intestine are associated with
diminution in the bowel's absorptive capacity.
• The accumulation of gases, secretions, and oral intake above the
obstruction causes increasing intraluminal pressure.
• Venous pressure in the affected area increases, and circulatory stasis
and edema result.
• Bowel necrosis may occur because of anoxia and compression of the
terminal branches of the mesenteric artery.
• Bacteria and toxins pass across the intestinal membranes into the
abdominal cavity, thereby leading to peritonitis.

7. CLINICAL MANIFESTATIONS
• Abdominal distention.
• Abdominal fullness, gas.
• Abdominal pain and cramping.
• Breath odor.
• Constipation.
• Diarrhea.
• Vomiting.
• Fever
• peritoneal irritation
• increased WBC count
• toxicity,
• shock may develop with all types of intestinal obstruction.

8. RISK FACTORS
• Abdominal or pelvic surgery, which often causes
adhesions.
• Crohn's disease.
• Cancer within your abdomen

9. DIAGNOSTICS
• Physical exam:
• Fecal material aspiration from NG tube
• Abdominal and chest X-rays:
• May show presence and location of small or large
intestinal distention, gas or fluid.
• Bird beak lesion in colonic volvulus.
• Foreign body visualization.

11. • Laboratory Tests:
• May show decreased sodium, potassium, and
chloride levels due to vomiting.
• Elevated WBC counts due to inflammation; marked
increase with necrosis, strangulation, or peritonitis.
• Serum amylase may be elevated from irritation of
the pancreas by the bowel loop.
• Flexible sigmoidoscopy or colonoscopy may identify
the source of the obstruction such as tumor or
stricture.

12. SURGICAL TREATMENT
• Closed bowel procedures: lysis of adhesions,
reduction of volvulus, intussusception, or
incarcerated hernia
• Enterotomy for removal of foreign bodies.
• Resection of bowel for obstructing lesions, or
strangulated bowel with end-to-end anastomosis
• Intestinal bypass around obstruction
• Temporary ostomy may be indicated.

14. COMPLICATIONS
• Dehydration due to loss of water, sodium, and
chloride.
• Peritonitis.
• Shock due to loss of electrolytes and dehydration.
• Death due to shock.

15. REFERENCE
• Slideplayer https://slideplayer.com/slide/5673035/

16. •THANK YOU!!!