Sunteți pe pagina 1din 26

ILEUS

OTJE HUDAJA
FK UKM
2007

TYPES OF ILEUS

MECHANICAL OBSTRUCTION (ILEUS)


- IN THE LUMEN (OBSTRUCTIVE) : FOOD
BOLUS, GALLSTONES, BIG POLYP (CAUSES
INTUSSUSCEPTION)
- IN THE WALL (OCCLUSIVE) : CONGENITAL
ATRESIA, CROHNS DISEASE, TUMOURS
(LYMPHOMA CAUSES INTUSSUSCEPTION)
- OUT SIDE THE WALL : HERNIAE, ADHESIONS,
VOLVULUS, INTUSSUSCEPTION

TYPES OF ILEUS

FUNCTIONAL ILEUS
- PARALYTIC ILEUS, THE CESSATION OF
GI MOTILITY (PARALYSSIS)
- SPASTIC ILEUS, SPASM OF THE BOWEL
DUE TO INTOXICATION, PORPHYRIA
ASCARIS

PATHOLOGY
OBSTRUCTION CAUSES DISTENSION OF THE
BOWEL WALL DECREASE OF THE
VASCULARISATION LOCAL HYPOXIA LOCAL
DECREASE OF THE FUNCTION
OBSTRUCTION PENETRATION OF THE
BACTERIA INTO THE DARM WALL
TOXICAEMIA
OEDEMA OF THE WALL HYPOVOLAEMIA
FLUID IN THE LUMEN HYPOVOLAEMIA,
SHOCK

PATHOLOGY
IN 20% OF THE PATIENTS THE
ILEOCAECAL VALVE IS COMPETENT AND
DECOMPRESSION INTO THE SMALL
BOWEL DOES NOT OCCUR.
CLOSED-LOOP OBSTRUCTION
THEREFORE OCCURS, THE CAECUM
PROGRESSIVELY DISTENDING (LAPLACE)
ISCHAEMIA AND PERFORATION OF THE
CAECUM MAY OCCUR

SYMPTOMS AND SIGNS

COLICKY ABDOMINAL PAIN


CANNOT GO INTO COMFORTABLE POSITION
VOMITING, CONSTIPATION
HIGH OBSTRUCTION CAUSES EARLY VOMITING
(BILIOUS) AND LATE CONSTIPATION
LOW OBSTRUCTION CAUSES EARLY
CONSTIPATION AND LATE VOMITING
(FAECULENT)

SYMPTOMS AND SIGNS

DISTENSION, TYMPANITIC ABDOMEN


( METEORISMUS )
DARMKONTUR, DARMSTEIFUNG
HERNIAL ORIFICES ?
HIGH-PICHED TINKLING BOWEL SOUNDS
BORBORYGMUS
BY PALPATION THE ABDOMEN IS ELASTIC LIKE
SPRING
PYREXIA, TACHYCARDIA, CONTINUOS PAIN
AND LOCALIZED TENDERNESS SUGGEST
ACTUAL OR IMPENDING STRANGULATION

INVESTIGATIONS
Hb, FULL BLOOD COUNT
WHITE CELL COUNT, NEUTROPHILIA MAY
INDICATE STRANGULATION
UREUM, ELECTROLYTS, AMILASE

X-RAY (SMALL BOWEL OBS.)


AXR :DISTENDED LOOPS OF SMALL BOWEL IN CENTRAL
ABDOMEN
ERECT FILMS SHOW
- AIR/FLUID LEVELS
- ABSENT OR DIMINISHED COLONIC GAS
- DILATED PROXIMAL SMALL BOWEL SHOWS
LINES CLOSE TOGETHER (VALVULAE
CONNIVENTES) CROSSING COMPLETELY THE
LUMEN OF THE BOWEL
THESE GET PROGRESSIVELY FEWER THE
MORE DISTAL THE DISTENDED LOOP AND ARE
ABSENT IN THE TERMINAL ILEUS

X-RAY (LARGE BOWEL OBS.)

DISTENDED LARGE BOWEL WITH AIR/FLUID


LEVELS SURROUNDING THE ABDOMEN LIKE A
PICTURE FRAME
LIMITED BARIUM ENEMA MAY SHOW APPLE
CORE LESION
INSTANT ENEMA TO EXCLUDE PSEUDOOBSTRUCTION
BY CHILDREN HYDROSTATIC PRESSURE OF A
CONTRAST ENEMA MAY REDUCE THE
INTUSSUSCEPTION
GASTROGRAFIN IS WATER SOLUBLE CONTRAST

ENDOSCOPY
SIGMOIDOSCOPY
COLONOSCOPY
TO EXCLUDE PSEUDO-OBSTRUCTION
STENTING

TREATMENT

INTRAVENOUS FLUIDS
CORRECT ELECTROLYTE IMBALANCE
NIL ORALLY
NASOGASTRIC ASPIRATION
CATHETERIZIED

SOME CASES OF SIMPLE OBSTRUCTION,


e.g. DUE TO ADHESIONS, WILL SETTLE ON
THIS REGIMEN

SURGERY
STRANGULATING OBSTRUCTION. E.g. A
TENDER IRREDUCIBLE HERNIA REQUIRE
URGENT SURGERY
IF A CONSERVATIVE DRIP AND SUCK
REGIMEN HAS BEEN UNDERTAKEN FOR
OBSTRUCTION, SURGERY IS INDICATED
FOR SIGN OF INCIPIENT
STRANGULATION (PYREXIA,
TACHYCARDIA, LOCALIZED TENDERNESS)

SURGERY
SURGERY IS ALSO REQUIRED FOR
SIMPLE OBSTRUCTION WHICH FAILS TO
SETTLE, e.g. GALLSTONES ILEUS,
ADHESIONS
AT SURGERY THE AFFECTED BOWEL IS
INSPECTED FOR VIABILITY

SURGERY

INDICATIONS OF NON-VIABILITY
INCLUDE :
- ABSENCE OF PERISTALSIS
- LOSS OF NORMAL SHEEN
- LOSS OF PULSATION IN BOWEL
MESENTERY

SURGERY

COLOUR :
- GREEN OR BLACK BOWEL IS NON
VIABLE AND RESECTION IS REQUIRED
- PLUM-COLOURED BOWEL MAY
RESPOND TO WRAPPING FOR A FEW
MINUTES IN WARM SALINE-SOAKED PACKS.
IF COLOUR RETURNS AND IT WILL TRANSMIT
A PERISTALTIC WAVE, IT IS VIABLE

SURGERY
GALLSTONE, REMOVAL OF STONE BY
MILKING THROUGH ILEOCAECAL VALVE
OR REMOVAL BY ENTEROTOMY
ADHESIOLYSIS
RESECTION (TUMOURS, GANGRENE)
RETROGRAD REDUCTION OF
INTUSSUCEPTION
DECOMPRESSION (OPEN, CLOSE)

SURGERY OF THE LARGE BOWEL


OBSTRUCTION
A CAECUM 10 cm OR GREATER IN
DIAMETER ON RADIOGRAPH NEEDS
URGENT SURGERY, ESPECIALLY IF
TENDER TO PALPATION
RIGHT-SIDED LESIONS ARE TREATED BY
RIGHT HEMICOLECTOMY
LEFT-SIDED LESIONS ARE TREATED BY
LEFT HEMICOLECTOMY WITH COVERING
COLOSTOMY/ ILEOSTOMY

LARGE BOWEL OBSTRUCTION


LOW LEFT-SIDED LESIONS ARE TREATED
- BY RESECTION OF THE TUMOUR WITH
HARTMANNS PROCEDURE (CLOSURE OF THE
RECTAL STUMP AND COLOSTOMY)
- ON TABLE LAVAGE OF THE COLON AND
PRIMARY ANASTOMOSIS, COVERING
COLOSTOMY/ ILEOSTOMY
RESECTION SIGMOID APEX TUMOUR AND A
PAUL-MISKULICZ DOUBLE-BARREL
ANASTOMOSIS

IN A POORLY PATIENT
DEFUNCTIONING COLOSTOMY OR
CAECOSTOMY MAY BE CARRIED OUT AND
ELECTIVE RESECTION DELAYED UNTIL THE
LATER DATE WHEN THE PATIENT IS FITTER
SIGMOID VOLVULUS MAY BE TREATED BY
RESECTION AND A PAUL-MICKULICZ
PROCEDURE
COLONIC STENTING MAY BE CARRIED OUT IN
THOSE UNFIT FOR SURGERY

PARALYTIC ILEUS
THIS IS THE CESSATION OF GI MOTILITY
AETIOLOGICAL FACTORS :
- FRACTURES OF THE SPINE AND PELVIS
- RETROPERITONEAL HAEMORRHAGE
- VASCULAR : EMBOLUS, THROMBOSIS
- INFLAMMATION, TOXIC (PERITONITIS)
- HYPOKALIAEMIA (METABOLIC)
- DRUGS : GANGLION BLOCKERS, ANTICHOLINERGIC
AGENTS
- ABDOMINAL SURGERY, IMMOBILIZATION

PARALYTIC ILEUS
ATONY OF THE BOWEL MAY BE EXPECTED FOR
24 - 48 HOURS POSTOPERATIVELY
PARALYTIC ILEUS CONTINUING AFTER 48
HOURS MAY HAVE AN UNDERLYING CAUSE
SYMPTOMS AND SIGNS :
- ABDOMINAL DISTENSION
- VOMITING, CONSTIPATION
- TENSE TYMPANITIC ABDOMEN
- ABSENT OF BOWEL SOUNDS

PARALYTIC ILEUS
INVESTIGATIONS
AXR : GASEOUS DISTENSION WITH FLUID
LEVELS THROUGHOUT THE LARGE AND SMALL
BOWEL
TREATMENT
- PASS NG TUBE AND ASPIRATE HOURLY
- ENSURE ADEQUATE HYDRATION
- CORRECT ANY POTASIUM IMBALANCE
- MEDICATIONS : FURSULTHIAMINE

SURGERY
PERITONITIS
MESENTERIC ARTERY ISCHAEMIA/
OCCLUSION

PARALYTIC ILEUS
: USUALLY SETTLES IN 4
DAYS
BOWEL SOUNDS : ABSENT
PAIN
: PAINLESS
AXR
:
GENERAL GASEOUS DILATATION OF
SMALL AND LARGE BOWEL

TIME

OBSTRUCTION
TIME : MAY PERSIST LONGER THAN 3 - 4
DAYS
BOWEL SOUNDS : HIGH-PICTHED AND
TINKLING
PAIN : COLICKY ABDOMINAL PAIN
AXR :
LOCALIZED SMALL BOWEL DISTENSION
WITH ABSENT GAS IN COLON AND
RECTUM

S-ar putea să vă placă și