2. Introduction
• Emergency surgery of small bowel puzzle the surgeon with
varied pathologies
• Present study is to share our clinical experience with
emergencies in small bowel in tertiary care hospital
2
3. Introduction
• Acute mechanical obstruction of the intestine is a common
surgical emergency
• Adynamic ileus presents the same symptoms of mechanical
obstruction but the underlying problem is disordered motility
3
4. Introduction
• One of the keys to management of intestinal obstruction is
early diagnosis
• Particularly accurate early recognition of strangulation is
crucial because this emergency causes bowel ischemia,
necrosis and perforation.
4
5. Aim
The present study is to analyse the
various presentation of small bowel
emergencies
5
6. Methods
• Study period - January 1st to June 30th 2017
• Retrospective study
• Demographic data collected from MRD
Age
Sex
Body mass index (BMI)
Previous operations
Co morbidities
(smoking, alcohol, diabetes, hypertension, bronchial
asthma, tuberculosis history , immunosuppression,
COPD, renal failure)
6
7. Clinical data
• Main symptoms are abdominal pain, nausea vomiting ,
constipation and obstipation
• Trauma to abdomen either blunt or penetrating injuries
requires high index of suspicion for small bowel
involvement and immediate intervention prevents morbidity
7
8. Clinical data
Pre operative data
• X rays and CT films – Radiology
Intra operative findings and photos-surgery DP
Post operative
• HP- pathology
• Post operative management and out come- Patient records
8
9. Study population
• Inclusion criteria:
1.All patients treated surgically for small bowel emergencies
.
• Exclusion criteria:
1.Paediatric emergency small bowel pathologies
2. duodenal perforations.
9
11. Results
• Total number of patients- 78
obstruction – 50 (64.1%)
peritonitis - 28 (35.9%)
• Most common cause for obstruction - adhesions
• Most common cause peritonitis typhoid ileal perforation
11
19. Conclusion
• Mortality high in old age associated with bowel perforation
(peritonitis) 6 cases (7.69%)
• Out of which 3 members >65years of age
• One is associated with solid organ injury(spleen)
• Remaining 2 cases late presentation
19
20. Conclusion
• In obstruction mortality rate(3) 3.84%
• In which 2(2.56%) are due to mesenteric ischemia
• One is associated with multiple adhesions age >50 years
not associated with previous surgical procedure
20
21. References
1.Norton JA, Bollinger RR, Chang AE, et al: Surgery. Basic science and
clinical evidence. Springer-Verlag New York, Inc.; 2001.
2. Wangenstein O: Intestinal obstructions. Springfield, Thomas,; 1955.
3.Cheadle WG, Garr EE, Richardson JD: The importance of early diagnosis in
small bowel obstruction. Am Surg 1988, 54:565-569.
4.Lock G: Acute intestinal ischaemia. Best Pract Res Clin Gastroeterol 2001,
15:83-98.
5. Barclay TH, Schapira DV: Malignant tumors of the small intestine. Cancer
1983, 51 :878-881.
21
23. Pre operative
• Mortality for small bowel obstruction has decreased
during the past 50 to 60 years from 25% to 5%
• Initial therapy aims at correction of depletion of
intravascular fluids and electrolyte abnormalities
• The patient were managed nil orally and nasogastric
tube
23
24. Results
• Mortality in peritonitis (n=6, 7.69%) cases
• In which half cases old age is risk factor
• In obstruction mortality (n=3, 3.8%)
• Mesenteric ischemia the mortality is high
(3cases)
24
25. Discussion
• where as in young adults and adults adhesions
and groin hernia are common
• In small bowel obstruction the normal
mechanisms of intestinal absorption are
compromised, so an excess of fluid loss occurs.
• Initially vomiting, bowel wall edema and
transudation into the peritoneal cavity are
present, whereas in the later stages venous
pressure increases with consequent bleeding
into the lumen and aggravation of hypovolemia
25
