Internal hernia portion of the small intestine becomes entrapped in the retroperitoneal fossae other Sites of Internal Hernia :-• the foramen of Winslow• a hole in the mesentery• hole in the transverse mesocolon• diaphragmatic hernia
transverse colon volvulus Volvulus Twist in axis of bowel loop type CV Each arrow on the diagram of the normal colon represents a possible torsion mechanism bascule type ceacal volvulus(Constricting Band Around Ascending Colon) bascule = Sea Saw
loop type CVCaecum distended andfound in centre of Abdomen
Intussusceptionportion of the gut becomes invaginatedwithin an immediately adjacent segmentpart that advances = apexMass = IntussusceptionNeck =junction of the entering layer with the massstrangulating obstruction as the blood supply of the inner layerdegree of greatest at ileocaecal valveIn children intussusception is ileocolic(50cm terminaL Ileum)In Adult colocolic intussusception is common
CausesObstruction by adhesions • Ischaemic areas • Reperitonealisation of raw areas • trauma, vascular occlusion • Foreign material Talc, • Infection Peritonitis, tuberculosis • Crohn’s disease types – • ‘avscular’ flimsy • ‘poorly vascular’ dense
Obstruction by BandsStrangulation of Bowel loops by Knotting Diverticulum Dense Fibrous String attaching one portion of abdo to other; entraping intestine into Strangulation Causes:- • following previous bacterial peritonitis • a portion of greater omentum adherent to the parietes.
Gallstones Ileuspassage of a GBstone from the biliary tract into the intestinal tract (by fistulousconnection between the GB & duodenum) usual location is at or 60 cm proximal to the ileocaecal valve obstruction is frequently incomplete or relapsing as a result of a ball-valve effect.
AscariasisObstruction of the small intestine due to Ascaris lumbricoides
Trychobezoars & phytobezoars firm masses of undigested hair balls & fruit/vegetable fibre associated with an underlying psychiatric abnormality Phytobezoars Predisposition to phytobezoars • high fibre intake •inadequate chewing •previous gastric surgery • hypochlorhydriaTrychobezoars
Food Bolus obstruction • may occur after partial or total gastrectomy • when unchewed articles can pass directly into the small bowel. • Fruit and vegetables are particularly liable to cause obstruction
Stercolith associated withFaecal Impaction Diverticulosis and ileal stricture
Meconeum IleusMeconium becomes thickened and causes mechanical obstruction in ileum(associated with cystic fibrosis )Hypertrophy dialatation of Proximal BowelDistal ileum contains Pellets and gets narrowed