This document discusses the causes, clinical features, investigations, and management of intestinal obstruction. The major causes discussed are adhesions, tumors, hernias, volvulus, intussusception, and paralytic ileus. The classic clinical features of obstruction are pain, distension, vomiting, and constipation. Investigations include abdominal x-rays and ultrasound. Surgery is indicated for complications like peritonitis, perforation, or irreducible hernias. Conservative management is used for incomplete or high-risk obstructions. Neonatal intestinal obstruction has specific etiologies and requires resuscitation and rapid diagnosis/treatment.

1. PROF. DR. ATEF ABDEL-LATIF

2. AETIOLOGY

3. DYNAMIC CAUSES
 INTRALUMINAL IMPACTION
• Foreign Bodies
• Gallstones
 INTRAMURAL
• Stricture
• Malignancy
 EXTRAMURAL
• Bands / Adhesions
• Hernia
• Volvulus
• Intussusception
ADYNAMIC CAUSES
• Paralytic ileus
• Mesenteric vascular
occlusion “MVO”
• Pseudo -obstruction

4. Small Bowel
(85%)
 Cancer (75%)
 Diverticulosis. (10%)
 Volvulus (10%)
 Miscellanous. (10%)
Colon
(15%)
 Adhesions (80%)
 Hernia (10%)
 Tumors (5%)
 Miscellanous. (5%)
Incidence

5. Commonest causes of obstruction
ADHESION
TUMOR HERNIA

6. Common causes of obstruction

7. CLINICAL FEATURES OF OBSTRUCTION
Classic quartet
 Pain
 Distension
 Vomiting
 Absolute Constipation

8. Pain
 Sudden, severe
 Colicky → mild, constant diffuse pain on umbilicus or lower
abdomen
 Not significant in paralytic ileus
Vomiting
 Appear late in distal obstruction
 Digested food → faeculent material

9. Distension
 SI: Increases the more distal
 LI: Delayed
Constipation
 Absolute or relative
 Does not apply in :
• Richter’s hernia
• Gallstone obstruction
• Mesentric vascular occlusion,
• Associated with pelvic abscess

10. ADHESIVE INTESTINAL OBSTRUCTION (40%)

11. ADHESIVE INTESTINAL OBSTRUCTION

12. Strangulated Hernia (12%)

13. Strangulated Hernia

14. • 75% occur in Recto-sigmoid colon
• 15-20% of colorectal cancer present
with obstruction
• LT colon commonest site of
obstruction due to constricting lesion
& solid faeces
Neoplasms (15%)

15. Abdominal X-Ray
Errect abdomen x-ray with air fluid levels

16. Extramural intestinal obstruction

17. Volvulus
Twisting or axial rotation of a portion of bowel about its mesentery

18. Sigmoid volvulus
 Intermittent symptoms followed by
passage of large quantities of flatus and
feces
 Early progressive abdominal distension,
hiccough, retching, late vomiting,
constipation

20. INVESTIGATIONS
X-RAY of Sigmoid volvulus
Massive colonic distension Dilated
loop running diagonally from right
to left with one fluid level within
each loop.

21.  Invagination of segment of bowel
(intussusceptum) into another
(intussuscepien).
 it is often antegrade
 Most common in : ileocolic
(ileocaecal) & Ileo-ileal
Intussusception

23. There may be absence of bowel
in the right lower quadrant
Dehydration, pallor, shock.
Irritability, sweating.
Later Red Current Jelly Stool
pyrexia

24. INVESTIGATIONS
X-RAY
Abdominal X-ray - may show
dilated gas-filled proximal bowel,
paucity of gas
Distally, multiple fluid levels (but
may be normal in the early stages).

25. Ultrasound
May show :
• Doughnut
• Target Sign
• Pseudo-kidney
• Sandwich Appearance
It is a very effective modality and
many consider it the investigation
of choice.

26. Evaluation and
Management of
Intestinal
Obstruction

27. INDICATIONS FOR SURGERY
Absolute
 Generalised peritonitis
 Localised peritonitis
 Visceral perforation
 Irreducible hernia
Relative
 Palpable mass lesion
 'Virgin' abdomen
 Failure to improve
Conservative
 Incomplete obstruction
 Previous surgery
 Advanced malignancy
 Diagnostic doubt - possible ileus

28. Neonatal intestinal obstruction
An intestinal obstruction
occurring during the first month of
life.

29. Causes
Esophageal:
Atresia (TOF)
Gastric:
Congenital hypertrophic Pyloric
Stenosis
Duodenal:
Atresia
Stenosis
Diaphragm
Malrotation with bands or
volvulus
Annular pancrease

30. Causes
 Jeujunal & ileal obstruction:
Obstructed inguinal hernia
Intussusception
Atresia
Stenosis
Meconium ileus
Peritoneal bands or hernia
Duplication cysts
 Large bowl obstruction:
◦ Hirschsprung’s disease
◦ Anorectal anomalies
◦ Meconium plug syndrome
◦ Atresia (rarest)
 Necrotizing enterocolitis
 Complicated Inguinal Hernias

31. Any baby presenting
with persistent, bile
stained vomiting
should be
considered to be
surgical until proven
otherwise.
Clinical picture:
The cardinal signs are
2C, 2V, 2D
 Colics, Constipation
 Vomiting, Visible peristalsis
 Distention, Dehydration

32. Management
 Gastric decompression (naso-gastric tube)
 IV line (for fluid replacement)
 Urinary catheter (to monitor urine output)
 Fluids: 10-20ml/kg over an hour, to be repeated according to
 Response.
 Drugs: To cover anaerobes as well as Gram stained bacteria

33. After initial resuscitation, every effort is
directed towards rapid diagnosis and
treatment of the specific cause
Imaging:
Plain X ray.
Contrast studies.