Surgical Management of Intestinal Obstruction

-HARSHA YADAV CT

MANAGEMENT OF INTESTINAL

OBSTRUCTION

ACUTE INTESTINAL OBSTRUCTION

It involves-

Supportive Management.

Surgical Management.

SUPPORTIVE

MANAGEMENT:

Nasogastric

Decompression.

Fluid and Electrolyte

replacement.

NASOGASTRIC INTUBATION

ACUTE INTESTINAL OBSTRUCTION

SURGICAL MANAGEMENT:

PRINCIPLES:

Management of segment at site of obstruction.

Management of distended proximal bowel.

Management of underlying cause of obstruction.

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.

PURSE-STRING

SUTURES

VIABLE BOWEL NON VIABLE BOWEL

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.

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.

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

VOLVULUS:

CAECAL VOLVULUS:

Reduced if viable.

Caecopexy.

Caecostomy.

SIGMOID

VOLVULUS:

Young- elective

sigmoid colectomy.

Elderly-

fixation to PAW if viable.

Paul-Mikulicz operation.

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.

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.

Thank you...