acute Strangulated Intestinal Obstruction -Bhadra.pptx

Strangulated intestinal obstruction is a relatively common type of acute abdomen and requires urgent surgical treatment. The causes of strangulated intestinal obstruction are many including primary volvulus, hernias, adhesions, bands, and intussusceptions.

1. SMOLENSK STATE MEDICAL UNIVERSITY Topic-Acute Strangulated Intestinal Obstruction Submitted by- Penothil Bhadra Sudheer Dev 504

2. INTRODUCTION Intestinal obstruction occurs when the passage of intestinal contents through the lumen is impaired. Intestinal obstruction is an interruption in the normal flow of intestinal contents along the intestinal tract. The block may occur in the small or large intestine, may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply. Obstruction most frequently occurs in the young and the old.

3. The small bowel is most commonly affected, with the ileum as the most common site of obstruction. Large bowel obstruction accounts for only 15% of cases of bowel obstruction and the sigmoid colon is the most common site of obstruction. Types of Intestinal Obstruction: Mechanical obstruction Paralytic (adynamic, neurogenic) ileus Strangulation obstruction

4. Acute Strangulated Intestinal Obstruction It compromises blood supply, leading to gangrene of the intestinal wall , Caused by prolonged mechanical obstruction . Physiology:Increased peristalsis, distention by fluid and gas, and increased bacterial growth proximal to obstruction. The intestine empties distally. Increased secretions into the intestine are associated with diminution in the bowel's absorptive capacity. The accumulation of gases, secretions, and oral intake above the obstruction causes increasing intraluminal pressure. Venous pressure in the affected area increases, and circulatory stasis and edema result. Bowel necrosis may occur because of anoxia and compression of the terminal branches of the mesenteric artery. Bacteria and toxins pass across the intestinal membranes into the abdominal cavity, thereby leading to peritonitis.

5. CLINICAL MANIFESTATIONS Abdominal distention. Abdominal fullness, gas. Abdominal pain and cramping. Breath odor. Constipation. Diarrhea. Vomiting. Fever peritoneal irritation increased WBC count toxicity, shock may develop with all types of intestinal obstruction.

6. RISK FACTORS Abdominal or pelvic surgery, which often causes adhesions. Crohn's disease. Cancer within your abdomen

7. DIAGNOSTICS Physical exam : Fecal material aspiration from NG tube Abdominal and chest X-rays: May show presence and location of small or large intestinal distention, gas or fluid. Bird beak lesion in colonic volvulus. Foreign body visualization.

8. Laboratory Tests: May show decreased sodium, potassium, and chloride levels due to vomiting. Elevated WBC counts due to inflammation; marked increase with necrosis, strangulation, or peritonitis. Serum amylase may be elevated from irritation of the pancreas by the bowel loop. Flexible sigmoidoscopy or colonoscopy may identify the source of the obstruction such as tumor or stricture.

9. SURGICAL TREATMENT Closed bowel procedures: lysis of adhesions, reduction of volvulus, intussusception, or incarcerated hernia Enterotomy for removal of foreign bodies. Resection of bowel for obstructing lesions, or strangulated bowel with end-to-end anastomosis Intestinal bypass around obstruction Temporary ostomy may be indicated.

10. COMPLICATIONS Dehydration due to loss of water, sodium, and chloride. Peritonitis. Shock due to loss of electrolytes and dehydration. Death due to shock.

11. REFERENCE Slideplayer https://slideplayer.com/slide/5673035/

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