Professional Documents
Culture Documents
By:
Dr. Wasfi M Salayta
Definition
Any condition interferes with normal
propulsion and passage of intestinal contents.
Can involve the small bowel, colon or both
small and colon as in generalized ileus.
Classification
Cause of obstruction : mechanical or
functional ( Ileus ).
Duration of obstruction: acute or chronic.
Extent of obstruction : partial or complete
Type of obstruction : simple or complex
(closed loop and strangulation) .
Mechanical obstruction
There is physical blockage of intestinal lumen which due to:
1. Intramural : congenital-tumor-hematoma-inflammatory
2. Extramural : adhesion-volvulus-hernia abscess-hematoma
3. Lumen obstruction: stone-meconium-foreign body- impaction
(stool-worm-barium)
This mechanical obstruction can be partial ( lumen narrowed
but allow transit some content) or complete ( lumen totally
obstruction) this classify to
A. simple obstruction (no vascular impairment)
B. closed loop ( both ends are obstructed e.g volvulus)
C. strangulation obstruction
Functional obstruction
These obstructions secondary to factors cause either
paralysis or dysmotility of intestinal peristalsis.
Postoperative ileus is the most common form of functional
bowel obstruction.
Postoperative ileus present to some extent after most
intra-abdominal operation
Postoperative ileus correlates with degree of surgical
trauma and type of operation ,so patients operated on for
radiation enteropathy-chronic obstruction or sever
peritonitis has more prolong P.O.I
Different anatomic segments of GIT also recover at
different rates after manipulation and trauma :
1. Small bowel within hours after operation.
2. Stomach may take 24-48 hr .
3. Colon 3-5 days post op.
This should be differentiated from early postoperative
mechanical bowel obstruction:
Occurs within the first 6 weeks post operation
Acute adhesions are responsible cause > 90%
other causes are:
Internal herniation
intra-abdominal abscess
intramural hematoma
anastomatic edema and leak
Difficult to differentiate by clinical presentation and X-ray so contrast
study and CT scan helpful to differentiated between them
Epidemiology
1% of all hospitalization
3% of emergency surgical admissions
More frequent in female patients because of gynecological-obstetric
and pelvic surgical operations are important etiologies for post
operative adhesions
Adhesion is the most common cause of intestinal obstruction
80% of bowel obstruction due to small bowel obstruction and the
most common causes are adhesionhernia---neoplasm while 20%
due to colon obstruction and the most common cause is CR-cancer
60-70% while 30% are diverticular disease and volvulus
Mortality rate range between 3% for simple bowel obstruction to 30%
when there is strangulation or perforation
Recurrent rate vary according to method of treatment if conservative
12% while the operation treatment recurrent rate 8-32%
Path physiology
o Patho-physiology of bowel obstruction incompletely
understood
Bowel distension-decreased absorption-intralumial
hypersecrtion and alteration in motility are found but yet
the mechanisms are responsible not clear.
In opposite to old explaination that pathophysiology of
obstruction decreases in blood flow responsible for these
changes , recently these changes in part related to
increase in blood flow in association with intramural
inflammatory reaction ( strong evidence suggests this
inflammatory reaction plays key role).