Obstructive Mechanic

8/13/2019 Obstructive Mechanic

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OBSTRUKSI MEKANIKPembimbing : dr.Munthadar,Sp.B,Sp,BA

dr. Dian Adi Saputra, Sp B(K)

BA

Department Ilmu Bedah Divisi Bedah Anak

Fakultas Kedokteran Universitas Syiah Kuala

BLUD Rumah Sakit Umum Zainal Abidin

Banda Aceh

Oleh:Veliqa Nadhila

Nurul syakila


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INTRODUCTIONObstruction is the most common

disorder afflicting the small bowel.

the majority (75%) of small bowel

obstructions are attributed tointraabdominal adhesions from prior

operations.

At 10 years, recurrent obstruction

from adhesions is estimated to

occur 15 to 50% of the time. Amongs

patients with adhesive obstruction,

anywhere from 25 to 66% are

reported to require an operation

In the first three or so decades of

the 20th century, mortality from

small bowel obstruction was ashigh as 60%. Factors shown to

potentiate mortality risk include

older age and presence of

comorbiditiesDuron JJ,tezenas du Montcel S, Berger A et al: Prevalence and

risk factors of mortality and morbidity after operation for adhesive

postoperative small bowel obstruction. Am J Surg 2008;195:72673


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II. DEFINITION

MECHANICAL OBSTRUCTIONA mechanical bowel obstruction is a partial orcomplete blockage in the intestine, which is

also called the bowel. Blockages can occur at

any point along the small or large bowel.

They are more common in the small bowel.

When the bowel is blocked, food and liquid

cannot pass through. Over time, food, liquid,and gas build up in the area above the

blockage.


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Risk Factors

Risk factors for a bowel

obstruction include anything that is

likely to cause scar tissue or ablockage, such as:

-History of ulcers

-Previous gastrointestinal or

gynecologic surgery

-Diverticulitis

-Crohnsdisease-Hirschsprungsdisease

(in infants and children)

-Cancer of the gastrointestinal

tract

ETIOLOGY

Most small bowel blockages are due to

adhesions. An adhesion is a band of scar

tissue that causes the bowel to attach to

the abdominal wall or other organs. Most

largebowel obstructions are caused bytumors.

Specific causes of bowel obstructions

include:

-Hernia

-Tumors

-Bowel inflammation or swelling-Foreign matter in the intestines

-Gallstones

-Impacted feces

-Volvulus (twisting of the intestine)

-Intussusception

(telescoping of the intestine into itself)

-Scar tissue from a previous abdominal or

pelvic surgery, particularly gynecologic or

gastrointestinal operation Beers MH, Berkow R. The Merck Manual of

Diagnosis and Therapy. 17th ed. Whitehouse Station

NJ: Simon and Schuster; 1999.


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SymptomsSymptoms of a bowel obstruction include:

-Abdominal pain

-Abdominal distention-Abdominal cramps

-Nausea

-Vomiting

-Diarrhea

-Severe constipation; inability to pass gas or stool

-Bloating-Fever

-Rapid pulse

-Foul breath odor

Complications from an untreated obstruction can include strangulation, which is

cutting off of the blood supply to part of the intestine.

Beers MH, Berkow R. The Merck Manual of

Diagnosis and Therapy. 17th ed. Whitehouse

Station, NJ: Simon and Schuster; 1999.


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Diagnosis-Auscultation : absent bowel sound,

high pitched or tingling

-Blood tests

-Urine tests

-Abdominal x-rays, such as:

-Barium enema-Endoscopy

-CT scan of the abdomen

Terminology

-Simple obstruction (low grade)

bowel obstruction with an intact blood supply

-Strangulating obstruction (high grade,

complete)

bowel obstruction with resultant ischemia
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ABDOMINAL PLAIN FILM

3S rule:

- Lumen >3 cm

- Folds >3mm

- >3 air fluid levels


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ABDOMEN CT SCAN

Sign of obstruction

-Lumen >3 cm

-Transition point

Transition point

-Normal caliber post stenotic bowel


9/13Eur. Radiol. (2006) 16:967-971


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DIFFERENTIAL DIAGNOSE


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TREATMENT

Possible treatments include the following:

a. Nasogastric tube

This involves the passage of a narrow tube through yournose and down into the stomach to suction out fluids that have become

trapped above the blockage.

b. IV fluidsVomiting and diarrhea can cause dehydrationand imbalances in

your body fluids; if you are dehydrated, you will be given fluids and

electrolytes.

c. Medications

antibiotics or pain medication through an IV or through thenasogastric tube.

d. Removal of fecal impactionIf fecal matter is causing the obstruction.

e. EndoscopyA thin, lighted tube is inserted through the rectum and into the

large intestine to straighten out the intestines.

f. Surgery

Depending on the cause of the obstruction, you may need surgery.Surgery can:

Remove scar tissue, tumors, gallstones, foreign matter, and other causes of the

blockages

Repair hernias
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THANK YOU!!

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Obstructive Mechanic