Pallavi Shekhar Medical College kolkata

1. INTESTINAL
OBSTRUCTION
Presented by
8th semester
Roll no-83 to 88.

2. INTRODUCTION
By
Pallavi Shekhar
Roll no -83

3. INTRODUCTION AND DEFINITION
 Lack of transit of intestinal contents.
 Accounts for 5% of all acute surgical admissions.
 80% occurs in small bowel
 20% occurs in colon
 Mortality in 3% without strangulation which increases to 30% with
strangulation.

4. CLASSIFICATION I(Aetiopathology based)
DYNAMIC:- Where peristalsis is working against a mechanical obstruction.
According to the site of obstruction it is further classified into
Intraluminal
Intramural
Extramural
ADYNAMIC:- It may occur in two forms:-
Peristalsis absent ( eg. Paralytic ileus ).
Peristalsis present in non-propulsive form(eg. Mesenteric
vascular occlusion).

5. DYNAMIC
INTRALUMINAL
♦Impaction
♦Foreign bodies Trichobezoar Gallstones
♦Tricobezoar
♦ Gallstones

6. INTRAMURAL EXTRAMURAL
♦ Bands /
♦ Stricture(tubercu- Adhesions(40%)
lous stricture)
♦ Hernia(25%)
♦ Malignancy
♦ Volvulus
♦ Crohn’s Disease
♦ Intussuception
Crohn’s disease

7. ADYNAMIC
♦ Paralytic ileus
♦ Diabetes Mellitus
♦ Pseudo – obstruction
♦ Postoperative period
♦ Electrolyte imbalance(hypokalemia)
♦ Retroperitoneal haemorrhage
♦ Spinal injuries
♦ Mesenteric ischemia

8. CLASSIFICATION II :- Depending on site of
obstruction
Proximal Small Distal Small Bowel Large Bowel
Bowel(Duodenum (Ileum)
and jejunum)
♦ Congenital ♦ Hernias- Common ♦ Malignancy
cause
♦ Lipomas ♦ Tuberculous
♦ Malignancy strictures
♦ Malignancy
♦ Crohn’s Disease ♦ Anorectal
♦ Bands and malformation
Adhesions ♦ Tuberculosis
strictures ♦ Volvulus

9. CLASSIFICATION III
CONGENITAL ACQUIRED
♦ Anorectal ♦ Hernia(commonest)
malformations
♦ Postoperative
♦ Congenital
megacolon ♦ Intussusceptions
Intussusceptions
♦ Duodenal atresia ♦ Gallstones
♦ Volvulus ♦ Tuberculosis
♦ Bands and adhesions ♦ Malignancy
♦ Intestinal atresia(ileal) ♦ Roundworm

10. CLASSIFICATION IV:- According to
Pathological Changes
Simple – where blood supply is intact
Strangulated – where there is direct interference to
blood flow.
Closed loop obstruction – when bowel obstructed
both at proximal and distal points.

11. Pie chart showing relative frequency of the underlying
diagnosis of intestinal obstruction.
Pseudo - obstruction
Miscellaneous
Fecal impaction
5% 5% Adhesions
8%
Carcinoma
40%
15%
15%
12%
Obstructed Hernia
Inflammatory