The document discusses various causes of small bowel obstruction including adhesions, tumors, hernias, gallstones, bezoars, worms, intussusception, and volvulus. It provides details on the typical presentations and treatments for each cause. For example, it notes that adhesions are a common cause in western countries due to peritoneal irritation from ischemia, infection, inflammation or surgery which leads to fibrous bands between tissues. It also describes intussusception as a condition where one part of the gut invaginates within an adjacent segment, commonly affecting children under 1 year old.

2. Dynamic
 Extramural
 Intraluminal
bands/adhesions
impaction
hernia
foreign bodies
Volvulus
bezoars
Intussusception
gallstones
 Intramural
Adynamic
stricture
Paralytic ileus
malignancy
Mesenteric vascular
occlusion
Pseudo -obstruct

3. ADHESION
TUMOR

4. A portion of the SI becomes entrapped in one
of the retroperitoneal fossae or in a congenital
mesenteric defect
Sites
Foramen of Winslow
Holes in the mesentery or transverse
mesocolon
Defect in the broad ligament
Diaphragmatic hernia
Duodenal/caecal/appendiceal
retroperitoneal fossae

6. Secondary to tuberculosis or crohn’s disease
Treatment- Resection & anastomosis

7. 1. Gall stones
In the elderly
20 to erosion of a large gallstone through
the gallbladder into the duodenum
Classically there is impaction about 60 cm
proximal to the ileocaecal valve

8. 2. Food
Occur after partial or total gastrectomy when
unchewed articles can pass into the small
bowel
3. Stercolith
In association with jejunal diverticulum or ileal
stricture

9. 4. Trichobezoar
Firm masses of undigested hair balls
Associated with an underlying psychiatric
abnormality

10. 5. Phytobezoar
Firm masses of fruit or vegetable fibres
Predisposing factors
High fibre intake
Inadequate chewing
Previous gastric surgery
Hypochlorhydria
Loss of the gastric pump mechanism

11. 6. Worms
Ascaris Lumbricoides
In children
An attack frequently follows the initiation of
antihelminthic therapy

12. Common cause of intestinal obstruction in
western countries
Any peritoneal irritation → local fibrin
production → adhesions between opposed
surfaces
Causes
 Ischemic areas- Sites of anastomoses, trauma
vascular occlusion
 Foreign material- Talc , starch, gauze, silk
 Infection- Peritonitis, tuberculosis
 Inflammatory conditions- Crohn’s disease
 Radiation enteritis

15. INTUSSUSCEPTION
One portion of the gut becomes invaginated
within an immediately adjacent segment
Commonly in children(5-10 months)
90% idiopathic
Secondary to intestinal pathology. Eg.
Polyp, Meckels diverticulum
Hyperplasia of the Peyer’s patch in the terminal
ileum may be the initiating event

17. Twisting or axial rotation of a portion of bowel
about its mesentery
Primary or secondary
10 – occurs secondary to congenital malrotation
of the gut, abnormal mesenteric
attachments, congenital bands
20 – rotation of a piece of bowel around an
acquired adhesion or stoma