Intestinal Obstruction Flashcards
Causes of mechanical IIeus (Small bowell)
External :
- Intra-abdominal adhesion Bands (90%)
- Adhesion
- PID
- Diverticulitis
- Endometriosis
- Hernia
- Tumor
- Volvulus
- Abscess with mass effect
- Hematoma with mass effect
- pancreatic pseudocyst
Intraluminal :
- Tumors
- Atypical (0.5%):
- Bezoar
- Gallbladder stone
- Foreign body
Intramural :
- Tumors
- Strictures
- Hematoma
- Intussusception
- Regional enteritis
- Aktinic Enteritis
Hallmark of Ileus
- Abdominal distension
- Increased wall tension
- Impaired microcriculation
- Hypoxia of intestinal wall
- Increased endotoxin concentration
Biomechanical concequences of Ileus
Endotoxin - > Amine and Kinin in the blood in the liver those lead to cytokine production (impaired protein production) Interleukins lead to prostaglandin E, Leucoytosis and Fever Septic toxic shock, multiple organ failure
Ileus classification in type
Mechanic vs paralytic
Ileus classification in localisation
High small bowel Low small bowel Small bowel altogether 80% Colon Mixed form
Ileus and vascularisation
Small bowel : mobile, increased risk of blood supply impairment Larg bowel : less mobile, less risk of blood supply impairment
Causes of paralytic ileus
Peritonitis Post operative Hämatoma Vertebral fracture
By gallstone ileus:
- aerobilie is present in
- therapy
- 50% of cases
- Move stone to proximal, incise axial, close transverse. +/- Cholecystectomy / resection of fistula.
Advantages of CT
- Sensitivity
- Specificity
- Localisation
Sensitivity 93%
Specificity 100%
Allows llocalisation of Stop
Diferentiation between Obstruction and strangulation
Ischemia can also be evaluated
Time Gastrographin in Colon
24h =
97% sensibility
96% specificity
Indication for operation
- Peritonitis
- Strangulation
- incarcerated hernia
- Volvulus
- Pneumatosis intestinalis
- High small bowell obstruction
Obstruction caused by wall hematoma
Can be treated conservatively most of the time
Small bowel obstruction without foreoperation and without hernia
Chances of Malignancy is high
Criterias for operation
- Shock
- Sepsis
- Fever
- Worsening condition
- Peritonitis
- Localized origin:
- Hernia
- Tumor
- Band
- Strangulation
- > 500 ml nasogastric output on the third day
- Pain at the fourth day
- Give more time in
- Crohn’s disease (may need 1-2 weeks)
- Wall hematoma (2-4 weeks)
Laparoscopic operation in ileus
- if distension allows it
- for single bands
- Success in 74% to 95%
- Conversion rate of 30 to 50%
