small bowel obstruction

1. SMALL BOWEL
OBSTRUCTION

2. Definition .
Etiologies .
Pathophysiology .
Diagnosis .
Treatment .
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3. Mechanical small
bowel obstruction is
the most frequently
encountered surgical
disorder of the small
bowel .
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6. Pathophysiology :
With the onset of obstruction ,
gas and fluid accumulate within
the intestinal lumen proximal to
the site of obstruction.
The intestinal activity increase in
an effort to overcome the
obstruction , accounting for the
colicky pain and diarrhea that
some experience even in the
presence of complete intestinal
obstruction , most of the gases
that accumulates originates from
swallowed air , although some is
produced within the intestine
,obstruction stimulates intestinal
epithelial water secretion lead to
intramural and intraluminal
pressure rise……intestinal
microvascular perfusion
is impaired, leading to ischemia
and necrosis, this condition is
termed strangulated bowel
obstruction .
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8. Clinical
presentation:
Symptoms :
Colicky abdominal
pain .
Nausea.
Vomiting .
Obstipation .
Signs :
General examination
Abdominal distention
Hyperactive BS.
DO NOT FORGET
PR EXAM
BS
HERNIA
SCARS
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9. Laboratory finding :
Electrolytes
inbalance .
Leukocytosis .
Renal function test .
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10. Diagnosis :
The diagnostic evaluation
should focus on the
following goals :
1.Distinguishing
mechanical obstruction
from ileus .
2.Determining the etiology
3.Discriminate partial from
complete obstruction.
4.Discriminate simple from
strangulating obstruction .
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11. The diagnosis of SBO is
usually confirmed with
radiological examination.
The abdominal series
consists of a radiograph of
the abdomen with patient
in a supine position ,
upright position , and
radiograph of the chest
with patient in an upright
position .
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12. Despite the limitations of
abdominal radiograhs
remain an important study
in patients with suspected
small bowel obstruction .
CT scan is 80-90%
sensitive and 70-90%
specific in the detection of
small bowel obstruction .
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13. Management:
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14. Outcomes :
The majority of patients
with adhesive small bowel
obstruction treated
conservatively .
Less than 20%
readmission over
subsequent 5 years .
Mortality rate associated
with surgery for
nonstrangulating small
bowel obstruction is less
than 5% .
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15. Prevention :
•Good surgical technique.
•Careful handling of tissue.
•Use of laparoscopic
surgery.
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16. thank you…
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