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FOR MORE MEDICAL PRESENTATIONS AND VIDEOS http://medicalpresentation.blogspot.in/
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AETIOLOGY
CAUSES OF INTESTINAL OBSTRUCTION
Dynamic Intraluminal impaction foreign bodies bezoars gallstones Intramural stricture malignancy
Extramural bands/adhesions hernia Volvulus Intussusception
Adynamic Paralytic ileus Mesenteric vascular
occlusion Pseudo -obstruct
Common causes of obstruction
ADHESION
TUMOR HERNIA
Internal herniaA portion of the SI becomes entrapped in one of the retroperitoneal fossae or in a congenital mesenteric defect
Sites Foramen of Winslow Holes in the mesentery or transverse
mesocolon Defect in the broad ligament Diaphragmatic hernia Duodenal/caecal/appendiceal
retroperitoneal fossae
Obstruction from enteric stricture
Secondary to tuberculosis or crohn’s diseaseTreatment- Resection & anastomosis
Bolus Obstruction
1. Gall stones In the elderly 20 to erosion of a large gallstone through the gallbladder into the duodenum Classically there is impaction about 60 cm proximal to the ileocaecal valve
2. Food Occur after partial or total gastrectomy when
unchewed articles can pass into the small bowel
3. StercolithIn association with jejunal diverticulum or ileal stricture
4. TrichobezoarFirm masses of undigested hair ballsAssociated with an underlying psychiatric abnormality
5. PhytobezoarFirm masses of fruit or vegetable fibres
Predisposing factors High fibre intake Inadequate chewing Previous gastric surgery Hypochlorhydria Loss of the gastric pump mechanism
6. WormsAscaris LumbricoidesIn childrenAn attack frequently follows the initiation of antihelminthic therapy
ADHESIONCommon cause of intestinal obstruction in western countriesAny peritoneal irritation → local fibrin production → adhesions between opposed surfacesCauses Ischemic areas- Sites of anastomoses, trauma
vascular occlusion Foreign material- Talc , starch, gauze, silk Infection- Peritonitis, tuberculosis Inflammatory conditions- Crohn’s disease Radiation enteritis
INTUSSUSCEPTION
One portion of the gut becomes invaginated within an immediately adjacent segmentCommonly in children(5-10 months)90% idiopathicSecondary to intestinal pathology. Eg. Polyp, Meckels diverticulumHyperplasia of the Peyer’s patch in the terminal ileum may be the initiating event
Volvulus
Twisting or axial rotation of a portion of bowel about its mesenteryPrimary or secondary10 – occurs secondary to congenital malrotation of the gut, abnormal mesenteric attachments, congenital bands20 – rotation of a piece of bowel around an acquired adhesion or stoma