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Definition
Is a partial or complete blockage of the bowel
(small or large intestine) that prevent the feces and
gas from passing distally
Frequency
Among patients who are admitted to the hospital for
severe abdominal pain, 20% have an intestinal
obstruction
INTESTINAL OBSTRUCTION
Frequency
Bowel obstruction can affect individuals of any age
Etiology
There are two types of intestinal obstructions:
mechanical and
non-mechanical, called paralytic ileus
► Intussusception
Is an invagination of the bowel lumen, with
invaginated portion (the intussusceptum) passing
distally into the ensheathing outer portion (the
intussuscipiens) by peristalsis
Illustration
• Intussusception
INTESTINAL OBSTRUCTION
Etiology
Mechanical Obstruction
► Intussusception
Unrelieved intussusception can occlude the
blood supply of the intussusceptum
► External hernias
Are the second most common cause of mechanical
small intestinal obstruction
Illustration
Small bowel obstruction by
adhesion
INTESTINAL OBSTRUCTION
Etiology
Mechanical Obstruction
► Internal hernia due:
to congenital abnormalities of the
mesentery or
to surgical defects in the mesentery
cause bowel obstruction
Etiology
Mechanical Obstruction
► A volvulus
The most common causes of intestinal obstruction in
adults are adhesions, usually from previous
operations:
hernias and
neoplasms
Nausea
Vomiting, which is associated more with
proximal obstructions
Diarrhea (an early finding)
INTESTINAL OBSTRUCTION
Clinical
Small bowel
History
Constipation
(a late finding) as evidenced by the absence of flatus or
bowel movements
Small bowel
Physical Examination:
Small bowel
Check for symptoms commonly believed to be
more diagnostic of intestinal ischemia, including
the following:
Fever (temperature >100°F)
Tachycardia (>100 beats/min)
Peritoneal signs
INTESTINAL OBSTRUCTION
Differential Diagnosis
Small bowel
Appendicitis, Acute
Cholangitis
Cholecystitis and Biliary Colic
Cholelithiasis
Constipation
Diverticular Disease
Foreign Bodies, Gastrointestinal
Gastroenteritis
Inflammatory Bowel Disease
Differential Diagnosis
Small bowel
Obstruction, Large Bowel
Ovarian Torsion
Pancreatitis
Pediatrics, Appendicitis
Pediatrics, Gastroenteritis
Pediatrics, Intussusception
Pelvic Inflammatory Disease
Urinary Tract Infection
Lab Study
Small bowel
1) Essential laboratory tests
Serum chemistries: Results are usually
normal or mildly elevated
BUN level:
If the BUN level is increased, this may
indicate decreased volume state (e.g.,
dehydration)
►Remember
The diagnostic failure rates of as much as
30% have been reported
Small bowel
Imaging Studies
1) Plain radiography
Dilated small-bowel loops with air fluid
levels indicate SBO
Small bowel
Imaging Studies
2) Enteroclysis ( bowel enema)
*Enteroclysis is valuable in detecting the presence of
obstruction and
* in differentiating partial from complete blockages
4) Ultrasonography
Ultrasonography is less costly and less invasive
than CT scanning