1. INTESTINAL OBSTRUCTION DR. Mazen Kurdi Assiss. Prof. pediatric surgery

2. INTESTINAL OBSTRUCTION • History: • Age: e g : • Neonate: Meconium ileus. Hirschprung’s disease. Malrotation. Intestinal atresia. • 2 - 24 months : Intususception (>24 M) Hirschprung’s disease. • Children : Hernia

4. Clinical features : • Pain. • Vomiting. • Distention. • Constipation.

5. Features vary according to : • Site of obstruction . • Age of Presentation. • Underlying pathology. • The presence or absence of intestinal ischemia.

6. Other manifestations: • Dehydration. • Hypokalemia. • Pyrexia. • Abdominal distention.

7. Definitions: • Ileus : Mechanical or functional intes. Obstruction (Adynamic or paralytic). • Mechanical obstruction :complete or partial blockage of the intes. Lumen. • Simple obstruction: one obstructing point. • Closed loop obstruction :both the afferent and the efferent loops are obstructed. • Strangulation : where the blood supply to the affected part of the intestine is impaired more likely to sustained increased intraluminal pressur.

11. Mechanical Intestinal obstruction

12. Malrotation

13. Malrotation

14. Malrotation

15. Mechanical intestinal obstruction

16. Annular pancreas

17. Duodenal obstruction

18. Mechanical intestinal obstruction

19. Ischemic bowel

20. Mechanical intestinal obstruction

21. Multiple atresia

22. Mechanical intestinal obstruction

23. Duodenal web

24. Duodenal web

25. Duodenal web

26. Mechanical intestinal obstruction

27. Mechanical intestinal obstruction

28. F.B in the G.I.T

29. F.B in the G.I.T

30. Mechanical intestinal obstruction

32. Intussusception

33. Medical causes of small & Large bowel obstruction

34. Medical causes of small & Large bowel obstruction • Metabolic: • Hypokalemia. • Hypomagnesemia. • Hyponatremia. • Ketoacidosis. • Uremia. • Porphyria. • Heavy metal poisoning.

35. Medications: • Narcotics. • Antipsychotics. • Anticholinergics. • Ganglionic blockers. • Agents used to treat Parkinson’s disease.

36. For optimal treatment to be instituted, five questions must be answered: • Is the diagnosis intestinal obstruction?. Is the obstruction is mechanical? . • What is the level of obstruction?. • Is there evidence of bowel wall ischemia or perforation?. • How sever is the associated systemic disorders?.

37. Retroperitoneal process: • Retroperitoneal hematoma. • Pancreatitis. • Spinal or pelvic fracture.

38. Neuropathic disorders: • Diabetes. • Multiple sclerosis. • Scleroderma. • Lupus erythrematosis. • Hirschsprung’s disease.

39. Post. Operative ileus following intra-abdominal surgery: AS the motility usually returns for the: small bowel within 24 – 48 hrs. gastric within 48 hrs. colonic within 3-5 days.

40. SHOKRAN