INTESTINAL OBSTRUCTION

Open (simple)
Closed (strangulation)

To get type right is more important than

to be certain of the cause

Strangulation has a mortality up to 45%

in the first 24 hours
PHISIOLOGICAL DISTURBANCE-GENERAL

1. Acute EVD (Extracelullar Volume Deficiency)

2. Vomiting and Distension
3. Strangulation can cause
- Metabolic acidosis due to reduced perfusion
- Hypovolemia
4. Sepsis → distension of the gastrointestinal tract
becomes more permeable to endotoxins
→ devolepment of gangrene in
strangulation
PHISIOLOGICAL DISTURBANCE - LOCAL

1. Contraction of the bowel against the

obstruction

2. In time, contraction fails and bowel becomes

a dynamic → absence of bowel sounds
→ absence of peristaltic
CLINICAL FEATURES

1. Pain

2. Borborygmus

3. Vomiting

4. Constipation
PAIN
High obstruction (jejunum or high ileum)
→ colic appears within 3-5 min

Low obstruction (terminal ileum or large bowel)

→ colic appears within 6-10 min

BORBORYGMUS
“tinkling” or “clicking” sounds

VOMITING
Severe prognosis: feculent vomit (should not be confused with
fecal vomiting due to gastro colic fistula.

CONSTIPATION
Failure to pass intestinal gas or feces
SIMPLE OR STRANGULATING OCCLUSION?

1. Sudden onset

2. Shock (tachycardia, hypotension)

3. Pain (occurs in both cases)

4. Rectal digital examination

5. Fever (more often in strangulation)

6. Abdominal or pelvic swelling

RADIOLOGICAL DIAGNOSIS

Erect film diagnose the presence of obstruction by

showing multiple fluid levels – “Steps ladder pattern”

→ Obstruction of the small bowel is revealed by straight

loops that are disposed centrally or all across the
abdomen

→ Large bowel obstruction indicates by a periphery

distribution
MEDICAL TREATMENT

Nasogastric tube decompression (may be the very

issue in incomplete obstruction – 75% of cases)

Restoring of water and electrolyte balance in order to

reduce the loss with at least 50%
→Saline solution (6-9 drops/sec - 1,5 L/h) until
reinstallation of diuresis
→KCl 30-40 mEq/L in glucose 5%

Metabolic acidosis requires alkaline solution sodium

bicarbonate 14%
SURGICAL TREATMENT
How do we deal with the distension?

Small bowel
Monks - Monyhan procedure: stripping the bowel proximally
into the stomach and then out through a large naso-gastric tube
(Baker, Faucher tube)

The principal purpose of N-G decompression is to permit easier

closure of the abdomen

Large bowel
Since its content is mainly gaseous needle puncture may be used
to deflate the bowel
The surgeon must resist the temptation
to pull the abdominal wall together with
sutures under high tension