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INTESTINAL OBSTRUCTION

INTESTINAL OBSTRUCTION. DR. Mazen Kurdi Assiss. Prof. pediatric surgery. INTESTINAL OBSTRUCTION. History: Age: e g : Neonate: Meconium ileus. Hirschprung’s disease. Malrotation.

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INTESTINAL OBSTRUCTION

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  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

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

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

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

  6. 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.

  7. Mechanical Intestinal obstruction

  8. Malrotation

  9. Malrotation

  10. Malrotation

  11. Mechanical intestinal obstruction

  12. Annular pancreas

  13. Duodenal obstruction

  14. Mechanical intestinal obstruction

  15. Ischemic bowel

  16. Mechanical intestinal obstruction

  17. Multiple atresia

  18. Mechanical intestinal obstruction

  19. Duodenal web

  20. Duodenal web

  21. Duodenal web

  22. Mechanical intestinal obstruction

  23. Mechanical intestinal obstruction

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

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

  26. Mechanical intestinal obstruction

  27. Intussusception

  28. Medical causes of small & Large bowel obstruction

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

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

  31. 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?.

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

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

  34. 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.

  35. SHOKRAN

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