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Intestinal Obstruction
PptxGenJS Presentation
Prof. Dr. Zahid Mahmood
Prof. Dr. Zahid Mahmood
1
2026-03-26T05:42:30Z
2026-03-26T05:42:30Z
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INTESTINALOBSTRUCTIONDefinition · Causes · ManagementFinal Year MBBS Surgical LectureBased on Bailey & Love TextbookProf. Dr. Zahid MahmoodExam & Viva Essentials FocusPK
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Clinical ScenarioThink Like a SurgeonIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love2 / 10 📋 Case PresentationA patient presents to the emergency department with severe colicky abdominal pain, progressive abdominal distension, persistent vomiting, and complete inability to pass stool or flatus (absolute constipation). Q1What is the most likely diagnosis? Q2What is the immediate management?→ Suspected Acute Intestinal Obstruction – Requires immediate assessment!PK
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DefinitionWhat is Intestinal Obstruction?Intestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love3 / 10 "Intestinal obstruction is the impaired or absent passage of intestinal contents through the bowel lumen, due to mechanical or functional causes." ⚠️ Fluid & Gas AccumulationLeads to progressive bowel distension proximal to the site of obstruction. 🔴 Life ThreateningUntreated obstruction causes bowel necrosis, perforation, peritonitis and death. ⏱️ Surgical EmergencyPrompt recognition and management are critical to patient survival and outcomes.PK
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ClassificationDynamic vs Adynamic ObstructionIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love4 / 10 DYNAMIC (Mechanical)Physical blockage present in the lumenBowel motility is initially normalAcute or chronic formsIncludes: adhesions, hernia, volvulus,intussusception, malignancy ADYNAMIC (Functional)No physical blockage in the lumenFailure of normal peristalsisParalytic ileus (post-op, peritonitis)Pseudo-obstruction (Ogilvie syndrome)Key Principle: Classification guides clinical management and surgical decision-making.PK
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Causes of Dynamic ObstructionMechanical Causes – Intraluminal · Intramural · ExtramuralIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love5 / 10 INTRALUMINALFaecal impactionBezoars (food/hair balls)Gallstone ileusForeign bodiesMeconium (neonates) INTRAMURALColorectal carcinomaCrohn's disease strictureDiverticular strictureRadiation strictureCongenital atresia EXTRAMURALAdhesions ⭐ MOST COMMONExternal herniaVolvulus (sigmoid/caecal)IntussusceptionPelvic/abdominal mass⭐ Adhesions account for ~60–70% of all mechanical small bowel obstruction in adults.PK
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PathophysiologySequential Events Following ObstructionIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love6 / 10 01Obstruction PointMechanical or functional block halts normal flow of bowel contents. 02Proximal DilationBowel proximal to block distends with gas (70% swallowed air) and fluid. 03Distal CollapseBowel distal to obstruction empties and collapses. 04Increased PeristalsisInitial hyperperistalsis causes colicky pain as bowel tries to overcome block. 05ParalysisEventually bowel becomes paralysed; vomiting worsens; electrolyte imbalance ensues. 06Ischaemia → NecrosisRising intraluminal pressure compromises blood supply → ischaemia, necrosis, perforation.PK
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Clinical FeaturesThe Classic Quartet – Essential for Exams & VivaIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love7 / 10 PainColicky, episodic DistensionProgressive, central VomitingEarly in high obstruction ConstipationAbsolute – no stool/flatus Pain: colicky, central, comes in waves (small bowel obstruction)Level of obstruction affects symptom pattern (high vs low)High obstruction: early, bilious vomiting; less distensionLow obstruction: late vomiting (feculent); marked distension Examination: visible peristalsis, tinkling/high-pitched BSAbdominal tenderness may indicate strangulationFever, tachycardia, peritonism → ischaemia/perforationAlways check ALL hernial orifices and rectal examinationPK
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InvestigationsFrom First-Line to Definitive DiagnosisIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love8 / 10 Abdominal X-Ray (First Line)Dilated bowel loops (>3cm small bowel; >6cm large bowel)Erect film: air-fluid levels (step-ladder pattern)Supine: coffee-bean sign in sigmoid volvulusAbsence of gas in rectum supports complete obstruction CT Abdomen (Gold Standard)Sensitivity ~90–95% for site and causeIdentifies transition point and levelDetects closed-loop, strangulation, free gasIV contrast enhances vascular assessment Other InvestigationsBlood: FBC, U&E, LFT, amylase, lactateGroup & Save; VBG to assess metabolic stateUltrasound: useful in children (intussusception)Contrast enema: define site of large bowel obstruction⚠️ Raised serum lactate suggests bowel ischaemia – immediate surgical consultation required.PK
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Management PrinciplesResuscitate · Decompress · Relieve · MonitorIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love9 / 10 AAssess & ResuscitateIV access; blood tests; ABG/VBGFluid & electrolyte replacement (IVF)Monitor vitals and urine output (IDC)NBM – nil by mouth BBowel DecompressionNasogastric tube (NGT) insertionDrip and suck – IV fluids + NGTReduces vomiting and aspiration riskRelieves abdominal distension CConservative ManagementAdhesive SBO: 80% resolve non-operativelyRegular clinical reassessment (q4–6 hrs)Water-soluble contrast may be therapeuticPain management with analgesics DDefinitive: SurgeryIndicated for strangulation, closed-loopLaparoscopic vs open adhesiolysisBowel resection if ischaemic/necroticHartmann's / colostomy if perforatedPK
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ComplicationsConsequences of Untreated or Delayed ManagementIntestinal Obstruction | Prof. Dr. Zahid Mahmood | Bailey & Love10 / 10 Bowel IschaemiaVenous congestion and arterial compromise → mucosal necrosis. PerforationFull-thickness necrosis leads to perforation and faecal peritonitis. SepsisBacterial translocation through ischaemic bowel wall → bacteraemia. Septic ShockSystemic inflammatory response → multi-organ dysfunction (MODS). Electrolyte ImbalanceVomiting and third-space losses → hyponatraemia, hypokalaemia, metabolic alkalosis. DeathOverall mortality 2–8%; rises sharply with strangulation (≥25%) if delayed.Early recognition and prompt surgical intervention save lives — never delay in suspected strangulation.PK
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