A 18-year old male presented with severe abdominal pain, loose stools, and vomiting, which were symptoms of small intestinal obstruction. There are two types of small bowel obstruction - partial and complete. Causes include adhesions, hernias, infections, tumors, and volvulus. Clinical features depend on the level of obstruction and include pain, vomiting, distension, and constipation. Diagnosis involves x-rays and CT scans. Treatment for partial non-strangulated obstruction is usually non-operative with decompression and fluids, while surgery is often required for complete or strangulated obstructions.

1. SMALL INTESTINAL
OBSTRUCTION
PRESENTED BY : DR . PALAK NARULA

2. Clinical case
• 18 years old male presented with chief complains of
central non radiating abdominal pain extremely
severe crampy in nature started last night intermittent
every few minutes 10/10 in severity aggravated by
movement not relieved and associated with loose
stools and vomiting

3. TYPES OF SMALL BOWEL OBSTRUCTION
• PARTIAL OBSTRUCTION : INTESTINAL LUMEN IS NOT
COMPLETELY OCCLUDED
Gas and fluids can still pass
• COMPLETE OBSTRUCTION : LUMEN IS COMPLETELY BLOCKED
Gas and fluids cannot pass
Closed loop obstruction : proximal and distal segments are
blocked or occluded
Non strangulated and strangulated

5. Causes of small bowel obstruction
•ADHESIONS M/C
• HERNIA
• NEOPLASMS
• INFECTIONS/IBD
• VOLVULUS
• INTUSSEPTION
• ATRESIAS
• GALL STONES LARGE

6. CLINICAL FEATURES
• BASED ON THE CLASSIC QUARTET pain, vomiting, distension
constipation
• High small bowel obstruction vomiting occurs early profuse
and billious causes rapid dehydration . Distension is minimal
• with less evidence of dilated loops on abdominal x ray
• Low small bowel distension pain is predominant with central
distension
• Multiple dilated loops seen on radiograph

7. Diagnosis
• Plain x ray supine and erect
• Dilated loops and air fluid
levels >2.5cm
• stepladder pattern
• Valvulae conniventes jejunum
• Adjacent loops be separated
by variable distance edema
• Absent gas in large bowel
• Ct imaging with contrast

8. HAEMATOLOGICAL
• RAISED WBC
• INCREASED LACTATE
• ABG METABOLIC ACIDOSIS ELECTROLYTE
DISTURBANCES
• SERUM AMYLASE MAY BE RAISED
• RULE OUT COLORECTAL CANCER

9. TREATEMENT
• PARTIAL NON STRANGULATED OBSTRUCTION : NON
operative
• Nasogastric decompression
• 70% are due to adhesions heals spontaneously
• Fluid management
• ANALGESICS
• ANTIEMETICS
• UPTO 72 HRS IF NO RESOLUTION OR STRANGULATED
• SURGERY OPEN OR LAPROSCOPY