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Early Postoperative Small Bowel Obstruction

Early Postoperative Small Bowel Obstruction. EtiologyMechanical obstructionParalytic ileus. Mechanical Obstruction. Obstruction of the intestinal lumen - intussusception, gallstonesLesions intrinsic to the bowel - strictures, congenital, neoplasmLesions extrinsic to the bowel - adhesions, herni

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Early Postoperative Small Bowel Obstruction

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    1. Early Postoperative Small Bowel Obstruction ?????

    2. Early Postoperative Small Bowel Obstruction Etiology Mechanical obstruction Paralytic ileus

    3. Mechanical Obstruction Obstruction of the intestinal lumen - intussusception, gallstones Lesions intrinsic to the bowel - strictures, congenital, neoplasm Lesions extrinsic to the bowel - adhesions, hernias, volvulus, neoplasm

    4. Paralytic Ileus A common disorder after abdominal operations Non-mechanical obstruction Paralysis Etiology - ischemia, peritonitis, unknown

    5. Does the patient have bowel obstruction? Abdominal pain Vomiting Obstipation Abdominal distension Failure to pass flatus

    6. Where is it? Proximal (high) obstruction - profuse vomiting, - seldom feculent, - variable pain, usually described as abdominal discomfort not cramping pain

    7. Where is it? mid or distal small bowel obstruction - typical cramping pain - in paroxysms at 4- to 5-minute - cresendo – decresendo pattern - poorly localized abdominal pain - more distal, more feculent vomiting

    8. Has strangulation occurred? Peritonitis? Pain pattern change - from crampy pain ? continuous severe abdominal pain

    9. PE findings Fever, dehydration, peritonitis, localized tenderness, muscle guarding ? strangulation Auscultation? periods of high-pitched, tinkling increasing bowel sounds separated by relatively quiet periods Rectal exam? blood?

    10. Plain X-ray Paralytic ileus and Mechanical obstruction ? cannot be differentiated definitely

    11. CT Sensitive to diagnosis obstruction and localization Clinical Radiology 56: 350-359, 2001 Radiographics 21: 613-624, 2001

    12. CT : Extrinsic Causes Adhesion

    13. CT : Extrinsic Causes Closed loop - U shaped loop

    14. CT : Extrinsic Causes Stragulation – bowel wall thickening, traget sign

    15. CT : Extrinsic Causes Hernia – bowel wall thickening

    16. CT : Intrinsic Causes Intussusception – target sign

    17. CT : Intrinsic Causes Gallstones – gallstone with marked bowel wall thickening

    18. CT : Intrinsic Causes Paralytic ileus – no specific findings

    19. When to Operation? Duration of obstruction Risk of strangulation Vital organ functions Absence of fever, leukocytosis, tachycardia, localized tenderness? Non-operative method maybe save

    20. How Long should we wait? Repeat laparotomy : 14 days after NG decompression Surgical Endoscopy. 16(1):115-6, 2002 Jan. Paralytic ileus : >3 days Mechanical obstruction : ? days

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