How to treat

1. Intestinal Obstruction
Presenter: Dr PHIRI Bwalya Kapululuke
Moderator: Dr MITI R

2. Outline
• Definition
• Classification
• Etiology
• Pathophysiology
• Clinical Features
• Complication
• Investigation
• Pictorial depiction of imaging results
• Management
• References

3. Definition
Intestinal obstruction refers to the interruption of
the normal passage of bowel contents through the
bowel, either due to a functional or mechanical
obstruction.

4. Classification
• Etiological: Dynamic or adynamic
• Type: acute, subacute, chronic,acute on chronic
• Anatomical or site:Gastric outlet obstruction, small
bowel obstruction and large bowel obstrustion.

5. Etiology
• Obstruction arising from extraluminal causes such
as adhesions, hernias, carcinomas, and abscesses.
• Obstruction intrinsic to the bowel wall (e.g.,
primary tumors).
• Intraluminal obstruction (e.g., gallstones,
enteroliths, foreign bodies,etc)

6. Pathophysiology
• Bowel obstruction > stasis of luminal contents and
gas proximal to the obstruction >intraluminal
pressure, which leads to the following
1. Gaseous abdominal distention >third
spacing>dehydration and hypovolemia
2. Vomiting > loss of fluids, electrolyte,
hypovolemia, metabolic alkalosis
3. Compression of intestinal veins and lymphatics >
bowel wall edema > compression of intestinal
arterioles and capillaries > bowel ischemia
>necrosis/ gangrene> sepsis.

7. Clinical Features
• cardinal features of bowel obstruction are abdominal
pain, vomiting, constipation, abdominal distention, and
decreased bowel sounds.
• Signs icludedes
1. Dehydration and possible hypovolemia (hypotension,
dry mucous membranes)
2. Diffuse abdominal tenderness
3. Tympanic percussion
4. Increased high-pitched bowel sounds (early) or the
absence of any bowel sounds (late)
5. Collapsed, empty rectum or impacted feces on DRE

8. Complications
• Sepsis.
• Peritonitis
• Abdominal compartment syndrome

9. Investigations
• Laboratory.
• Fbc,
• Urea, creatinine and electrolytes.
• Imaging
• Plain xray: erect and supine
• Abdominal US
• CT abdomen and Pelvis and MRI

10. Pictorial depiction of xrays.

11. • Erect abdominal x-ray • Erect CXR

12. Management
1. ABCDE approach: Evaluate vital signs, volume status,
and the need for invasive monitoring
2. NPO status
3. Obtain IV access with two large-bore
4. IV fluid resuscitation
5. Electrolyte repletion as needed
6. Insert a nasogastric tube in patients with recurrent
vomiting and/or significant abdominal distention.
7. Insert flatus tube
8. Catheterise
9. Supplemental oxygen if needed

13. References
• Prakash GV, et al. A descriptive study on
conservative management of subacute intestinal
obstruction and its outcome in Tirupati. J Evid
Based Med Healthc 2021;8(33):3150-3155. DOI:
10.18410/jebmh/2021/573
• Diamond M, Lee J, LeBedis CA. Small Bowel
Obstruction and Ischemia. Radiol Clin North Am.
2019; 57(4): pp. 689–703. doi:
10.1016/j.rcl.2019.02.002

14. Zikomo