INTESTINAL OBSTRUCTION SAHARA

NEUROGENIC paralytic MECHANICAL MECHANICAL : - Simplex - Stranggulata Aetilogy: -In the lumen -In the wall -Outside the wall Site : - High - Low Speed of onset : - Acute - Chronic

What Causes Intestinal Strangulation?

Intestinal strangulation (cutting off of the blood supply to the intestine) usually results from one of three causes.

MECHANICAL OBSTRUCTION
Common causes of obtruction at each age group Neonate -Congenital atresia -Volvulus neonatum -Meconeum ileus -Hirschsprungs disease -Imperforate anus -Stranggulated inguinal hernia -Intussuception -Complication of Meckels diverticulum -Hischsprungs diseases

Infant

 Young adult Middle age

-Adhesions and bands -Strangulated ing.hernia -Adhesesion and band -Strangulated Ing.hernia -Strangulated fem.hernia -Carcinoma colon -Volvulus -Adhesion and bands -Strangulated Ing.hernia -Strangulated fem.hernia -Carcinoma colon -Volvulus -Impacted faeces

Elderly

Incidence
May occur at any age 70 percent small bowel, 30 percent large bowel

Physiologic and Pathologic Derangement

Fluid and electrolyte disturbances -8 10 L of fluid are secreted -Sequestration within the dilated loop-- hypovolumic shock Bacteriology -Rapid colonisation Pathology -High intra luminar pressure- oedematous-- cyanosis intraperitoneal exudation necrosis perforation--peritonitis

Clinical Manifestations
Abdominal pain is colicky -On Auscultation -borborygmi -metalic sound Vomiting - Consists food and gastric chyme- bile faeculent Absolute constipation Abdominal distension -Inspection distended visible peristalsis and colicky pain Sign - the classic quartet->pain,vomiting,constipation,abd dist Scars-- Adhesion or Band Vital Sign---Pulse - SBP RR Temp-- hypovolumic shock ? Palpation--- palpable mass - DRE

Diagnoctic Studies
Laboratory test--->Fecal Occult Blood Test Sigmoidoscopy X ray examination Plain X ray --- Erect and lying down - routinely Follow-through studies after ingestion of radiopague meal --- gastrografin Barium enema X ray

Treatment
NGT Rehydration Foley bag Catheter Antibiotics Informed concent Exploratory laporotomy

Exploratory Laparotomy
Inspected and palpated the Caecum -Distended--- colon obstruction -Collapsed-- small bowel obstruction Distended SBO - Prevent Abd.Comp.syndrom -Retrograde milkingby Jones and Matheson(1968) -canula inserted + pursetring suture ? -Enterostomy Distended LBO- Prevent Abd.Comp.Syndrom -canula inserted + pursestring suture -Caecostomy