Surgical Management of Intestinal Obstruction

ppt presentation on surgical management of intestinal obstruction

1. -HARSHA YADAV CT MANAGEMENT OF INTESTINAL OBSTRUCTION

2. ACUTE INTESTINAL OBSTRUCTION It involves- Supportive Management. Surgical Management. SUPPORTIVE MANAGEMENT: Nasogastric Decompression. Fluid and Electrolyte replacement.

3. NASOGASTRIC INTUBATION

4. ACUTE INTESTINAL OBSTRUCTION SURGICAL MANAGEMENT: PRINCIPLES: Management of segment at site of obstruction. Management of distended proximal bowel. Management of underlying cause of obstruction.

5. SURGICAL DECOMPRESSION: STEPS: Nasogastric Intubation and suction. Anaesthesia. Incision. Handling of the Gut. Decompression of obstruction by Savage Decompressor within purse-string sutures OR Resection and Anastomosis . Assess the viability of the bowel. Prevention of Reperfusion Injury. Closing of the Abdomen.

6. PURSE-STRING SUTURES VIABLE BOWEL NON VIABLE BOWEL

7. TREATMENT OF ADHESIONS: CONSERVATIVE MANAGEMENT: NG-Decompression and Rehydration. Not prolonged beyond 72 hrs. SURGICAL MANAGEMENT: Divide the causative adhesion(s). Repair serosal tears, areas of doubtful viability. Laparoscopic adhesiolysis in expert Surgeon’s hands.

8. TREATMENT OF INTUSSUSCEPTION: CONSERVATIVE MANAGEMENT: NG drainage, resuscitation with IV-fluids, antibiotics. NON OPERATIVE MANAGEMENT: Air OR Barium enema performed if there are no signs of Peritonitis, Perforation. OPERATIVE MANAGEMENT: Reducible Intussusception . Irreducible Intussusception - resection with primary anastomosis .

9. LARGE BOWEL OBSTRUCTION: Ususal cause is Carcinaoma , Diverticular diseases, IBD. But however should be differentiated with pseudo obstruction. Depends on the extent of the lesion. Depends on whether lesion is removable or irremovable. situation of lesion: CEACUM COLON

10. VOLVULUS: CAECAL VOLVULUS: Reduced if viable. Caecopexy . Caecostomy . SIGMOID VOLVULUS: Young- elective sigmoid colectomy . Elderly- fixation to PAW if viable. Paul- Mikulicz operation.

11. ADYNAMIC OBSTRUCTION: PARALYTIC ILEUS: Failure of transmission of peristaltic waves secondary to neuromuscular failure. CAUSES: Post-operative, Infection, Reflex Ileus , Metabolic. MANAGEMENT: NG-suction, Fluid replacement, Use prokinetics ( Domperidone /Erythromycin) in resistant case Laparotomy - if inactivity persists >7days, only after confirmation of abdominal sepsis/mechanical obstruction.

12. ADYNAMIC OBSTRUCTION: PSEUDO-OBSTRUCTION: Obstruction in absence of mechanical cause or acute intra-abdominal disease. ASSOCIATIONS: Metabolic, Severe Trauma, Shock, Retroperitoneal irritation, Drugs. Radiographs show colon obstruction and distension. If no obstruction, confirm by colonoscopy & Barium ennema . MANAGEMENT: Treat the identifiable cause. IV- Neostigmine 1mg. (make patient sit on commode) Repeat with second dose after few minutes if first dose is ineffective. Colonoscopic decompression. Surgery is associated with high mortality and morbidity.

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