SMALL BOWEL OBSTRUCTION

(Review of Small-Bowel
Obstruction: The Diagnosis and
When to Worry)

CHLARASINTA BENYAMIN
1308012044
Background
Intestinal obstruction is the partial or total blockage of the
intestines can cause clinical emergency
Small-bowel obstruction (SBO) is a substantial cause of
morbidity and mortality
Abdominal radiography is usually the initial imaging modality
in patients suspected of having SBO because it is widely
available, is inexpensive, and has an accuracy of 5086%.
Multidetector CT has been proven to be the single best
imaging tool for evaluating patients suspected of having SBO
CT: - sensitivity and specificity of 95%;
-highly accurate in detecting the complications of SBO.
Clasification
1. Complete or high-grade obstruction no fluid or gas
passes beyond the site of obstruction
2. Incomplete or partial obstruction some fluid or gas
pass beyond the obstruction
3. Strangulated obstruction blood flow is compromised,
which may lead to intestinal ischemia, necrosis, and
perforation
4. Closed-loop obstruction occurs when a segment of
bowel is obstructed at two points along its course,
resulting in progressive accumulation of fluid in gas
within the isolated loop, placing it at risk for volvulus and
subsequent ischemia
Gambar
Clinical Finding of SBO

Anamneses and PE:

Crampy abdominal pain, distention, vomiting, and
high-pitched or absent bowel sounds.
Laboratory findings:
leukocytosis or an elevated serum amylase and lactic
acid levels suggest a complication
 Etiology

Adhesion major cause

Hernia
Malignancy
Crohn disease
Intussusception
Volvulus
Other cause
Gallstone
Foreign body
Trauma
 Ileus ? Abd 3 posisi.
AP Supine
Prone atau lateral
Erect atau LLD

+ Chest -
erect atau supine
 Posisi apa untuk menilai apa ?
Posisi AP Supine : Erect atau LLD:
Penyebaran udara usus, Udara bebas
Kalsifikasi Air-fluid level
Massa soft tissue Chest - erect or supine
Prone atau lateral : Udara bebas
Udara di rektum/sigmoid subdiafragma
Udara di kolon asendens Basal pneumonia
dan desendens Efusi pleura
The hallmark of SBO: dilated
small bowel proximal to the
site of obstruction with
decompressed distal bowel
Management

nasogastric tube decompression

surgical repair complete obstriction, NGT
decompression failed, coexistent of complication.
TERIMA KASIH