intestinal obstruction dr. mazen kurdi assiss. prof. pediatric surgery

INTESTINAL OBSTRUCTION

DR. Mazen Kurdi Assiss. Prof. pediatric surgery

INTESTINAL OBSTRUCTION History:

Age: e g :• Neonate: Meconium ileus. Hirschprung’s disease. Malrotation. Intestinal atresia.• 2 - 24 months : Intususception (>24 M) Hirschprung’s disease.• Children : Hernia

Clinical features :• Pain.• Vomiting.• Distention.• Constipation.

Features vary according to :• Site of obstruction .• Age of Presentation.• Underlying pathology.• The presence or absence of intestinal

ischemia.

Other manifestations:• Dehydration.• Hypokalemia.• Pyrexia.• Abdominal distention.

Definitions:• Ileus : Mechanical or functional intes.

Obstruction (Adynamic or paralytic).• Mechanical obstruction :complete or partial

blockage of the intes. Lumen.• Simple obstruction: one obstructing point.• Closed loop obstruction :both the afferent and

the efferent loops are obstructed.• Strangulation : where the blood supply to the

affected part of the intestine is impaired more likely to sustained increased intraluminal pressur.

Intestinal obstruction

Dynamic Adynamic

ExtrensicAbsent peristalsiseg. paralytic ileus

Present peristalsiseg.

mesenteric v. occ.Pseudoobstruction

Intraluminal obst.

Mural

Mechanical Intestinal obstruction Small intestine Large intestine

Exterensic:•Adhesions•Hernias

AdhesionsHernias

•Congenital:

Malrotation with ladds band

Volvulous: sigmoid 60-80% coecal 20-40%

Malrotation

Malrotation

Malrotation

Mechanical intestinal obstruction

•Annular pancreas (duodenal obstruction).

Annular pancreas

Duodenal obstruction

Mechanical intestinal obstruction

Sup. mesenteric a. syndrome (compression of 3rd part of duodenum ).

Ischemic bowel

Mechanical intestinal obstruction

Mural: •Small bowel atresia.

• Imperforated anus.

Multiple atresia

Mechanical intestinal obstruction

•Stenosis.

•Webs (diaphragm).

Duodenal web

Duodenal web

Duodenal web

Mechanical intestinal obstruction

Inflamatory :•Regional enteritis.(Crohn’s desease.)•Radiational enteritis, stricture.

Neoplastic :Small bowel neoplasms.

•Ulcerative collitis.•Diverticulitis.•Radiational enteritis.

Mechanical intestinal obstruction

Intra luminal obstruction:

•F.B. (Barium , worms)

•Gallstone ileus (more common in elderly).

•F.B. (Constipation , Barium , worms)

F.B in the G.I.T

F.B in the G.I.T

Mechanical intestinal obstruction

•Meconium ileus.

•Meconium ileus.

Intussusception Intussusception

Intussusception

Medical causes of small & Large bowel obstruction

Medications

Response to localized

Inflammatory process

Diffuse peritonitis

Retroperitoneal process

Neuropathic disorders

Post. Operativeileus

Metabolic

cases

Medical causes of small & Large bowel obstruction

Metabolic:1. Hypokalemia.2. Hypomagnesemia.3. Hyponatremia.4. Ketoacidosis.5. Uremia.6. Porphyria.7. Heavy metal poisoning.

Medications:1. Narcotics.2. Antipsychotics.3. Anticholinergics.4. Ganglionic blockers.5. Agents used to treat Parkinson’s

disease.

For optimal treatment to be instituted, five questions must be answered:• Is the diagnosis intestinal obstruction?. Is

the obstruction is mechanical? .• What is the level of obstruction?.• Is there evidence of bowel wall ischemia or

perforation?.• How sever is the associated systemic

disorders?.

Retroperitoneal process:1. Retroperitoneal hematoma.2. Pancreatitis.3. Spinal or pelvic fracture.

Neuropathic disorders:1. Diabetes.2. Multiple sclerosis.3. Scleroderma.4. Lupus erythrematosis.5. Hirschsprung’s disease.

Post. Operative ileus following intra-abdominal surgery:

AS the motility usually returns for the: small bowel within 24 – 48 hrs. gastric within 48 hrs. colonic within 3-5 days.

SHOKRAN