Bowel obstruction

1. Bowel obstruction

2. By definition is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion.

3. Extrinsic lesions Adhesions 50-70% Hernia:internal orexternal 25% Volvulus 5% Masses Bowel wall lesions Neoplasm 5% Inflammatory Vascular insufficiency Intramural hemorrhage Stricture ,atresia Luminal occlusion Swallowed (bezoar, gallstone, ascaris) Intussusception Tumor Small bowel obstruction

4. Small bowel obstruction • Plain film • >3 bowel loops • >3 cm 3-5 hr • Air-fluid level • Disparity in size between obstructed loops and contiguous loops beyond site of obstruction. • Little/no gas in colon 12-24hr • CT • Small bowel dilatation>2.5 cm • Small bowel feces • Transition zone

6. Small bowel obstruction • CT • Circumferential thickening of bowel wall, target sign. • Beaklike narrowing at the site of obstruction • Unusual course of mesenteric vessels • Specific enhancement patterns of the bowel wall • Mesenteric haziness • Engorgement of mesenteric vessels • Mesenteric fluid • Pneumatosis intestinalis • Portomesenteric venous gas

7. SBO

8. SBO

9. SBO- post operative

10. SBO- m/p adhesions

12. SBO H.

14. SBO-strangulation a 55-year-old woman presenting with features of intestinal obstruction shows dilated loops of the small bowel associated with thickened edematous valvulae conniventes and a strangulated left inguinal hernia (arrow).

15. SBO- CLOSED LOOP OBS.

16. Small bowel obstruction • Closed loop obstruction _U or C shaped dilated loops • Increasing intraluminal fluid • “Beak sign” • “Whirl sign”- twisting bowel and mesentery

17. SBO- closed loop obstructionThere is bowel wall thickening and mesenteric edema indicating ischemia

18. SBO-mass A CT scan of a 36-year-old woman. The axial contrast-enhanced CT scan through the midabdomen shows an extrinsic mass compressing a loop of small bowel.

19. SBO- intussusception

21. SBO GSE

22. Electrolytes- hypokalemia Ischemic event Medications (anticholinergic, antidepressants) Neuromuscular disorder (DM, porphyria, lead posisoning, hypothyroidism, amyloidosis, scleroderma, vagotomy etc.) Chest disease (LL pneumonia, pleuritis, MI, pericarditis, CHF) Retroperitoneal disease (hematoma, abscess). Post operative Visceral pain Intraabdominal inflammation Paralytic ileus

23. Paralytic ileus • Large + small bowel distention • Delayed but free passage of contrast material

24. ileus

25. post operative

26. SBO- Meckel’s diverticulum

28. Colonic obstruction • Extrinsic • Mass impression- endometriosis, abscess, tumor • Volvulus • Hernia • adhesions • Bowel wall lesions • Tumor (carcinoma) • Inflammtory • Infectious • Wall hematoma • Luminal obstruction • Fecal impaction • Intussusception

29. Colonic obstruction • Plain film • Dilated colon +/- small bowel dilatation • Gas fluid levels • 75%- the cecum is the most dilated portion. >10 cm high probability for perforation.

30. Colonic obstruction- hernia

32. Colonic obstruction- volvulus

33. Caecal v.

34. Colonic obstruction- volvulus

37. Acute colonic pseudoobstruction- Ogilvie syndrome • Metabolic imbalance • Drugs • Retropertoneal trauma • Abdominal/ cardiothoracic surgery • Age >60y • Massively dilated colon (Rt. hemicolon) • Normal haustral marking • Absence of obstructing lesion.

38. Colonic pseudoobstruction

39. Acute fulminant colitis Neurogenic loss of motor tone Extensive colonic dilatation Systemic toxicity Profuse bloody diarrhea Mortality- 20% Etiology: UC, CD, IC Toxic megacolon

40. Toxic megacolon • Colonic ileus with marked dilatation of transverse colon • Air fluid levels • Loss of normal colonic haustra • Pneumatosis coli +/- pneumoperitoneum • Irregular mucosal surface

42. Toxic megacolon

44. Colonic obstruction- sigmoid carcinoma

46. Colonic obstruction- Descending colon carcinoma

48. Thanks