Small bowel obstruction

small bowel obstruction

1. DR / MUFTAH BOUGHRARA MBChB , MS ,MD . SMALL BOWEL OBSTRUCTION

2. Definition . Etiologies . Pathophysiology . Diagnosis . Treatment . 2

3. Mechanical small bowel obstruction is the most frequently encountered surgical disorder of the small bowel . 3

4. Small bowel obstruction classified as : 4

5. Common etiologies : 5

6. Pathophysiology : With the onset of obstruction , gas and fluid accumulate within the intestinal lumen proximal to the site of obstruction. The intestinal activity increase in an effort to overcome the obstruction , accounting for the colicky pain and diarrhea that some experience even in the presence of complete intestinal obstruction , most of the gases that accumulates originates from swallowed air , although some is produced within the intestine ,obstruction stimulates intestinal epithelial water secretion lead to intramural and intraluminal pressure rise……intestinal microvascular perfusion is impaired, leading to ischemia and necrosis, this condition is termed strangulated bowel obstruction . 6

7. Pathophysiology : 7

8. Clinical presentation: Symptoms : Colicky abdominal pain . Nausea. Vomiting . Obstipation . Signs : General examination Abdominal distention Hyperactive BS. DO NOT FORGET PR EXAM BS HERNIA SCARS 8

9. Laboratory finding : Electrolytes inbalance . Leukocytosis . Renal function test . 9

10. Diagnosis : The diagnostic evaluation should focus on the following goals : 1.Distinguishing mechanical obstruction from ileus . 2.Determining the etiology 3.Discriminate partial from complete obstruction. 4.Discriminate simple from strangulating obstruction . 10

11. The diagnosis of SBO is usually confirmed with radiological examination. The abdominal series consists of a radiograph of the abdomen with patient in a supine position , upright position , and radiograph of the chest with patient in an upright position . 11

12. Despite the limitations of abdominal radiograhs remain an important study in patients with suspected small bowel obstruction . CT scan is 80-90% sensitive and 70-90% specific in the detection of small bowel obstruction . 12

13. Management: 13

14. Outcomes : The majority of patients with adhesive small bowel obstruction treated conservatively . Less than 20% readmission over subsequent 5 years . Mortality rate associated with surgery for nonstrangulating small bowel obstruction is less than 5% . 14

15. Prevention : Good surgical technique. Careful handling of tissue. Use of laparoscopic surgery. 15

16. thank you… 16