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CLINICAL FEATURES OF INTESTINAL OBSTRUCTION Dynamic obstruction The diagnosis of dynamic intestinal obstruction is based on the classic quartet of pain, distension, vomiting and absolute constipation. Obstruction may be classified clinically into two types: /...

Clinical features of strangulation It is vital to distinguish strangulating from non-strangulating intestinal obstruction because the former is a surgical emer - gency . The diagnosis is clinical but may be aided by CT scanning as long as this does not delay s...

Clinical features of volvulus Volvulus of the small intestine This may be primary or secondary and usually occurs in the lower ileum. It may occur spontaneously in African people, particularly following the consumption of a large volume of Henry Hamilton Bail...

Closed-loop obstruction This occurs when the bowel is obstructed at both the proximal and distal points ( Figure 78.2 ). The distension is principally confined to the closed loop; distension proximal to the obstructed segment is not typically marked. A classic ...

Constipation This may be classified as absolute (i.e. neither faeces nor flatus is passed) or relative (where only flatus is passed). Absolute consti - pation is a cardinal feature of complete intestinal obstruction. Some patients may pass flatus or faeces after ...

Distension In the small bowel the degree of distension is dependent on the site of the obstruction and is greater the more distal the lesion. Visible peristalsis may be present in thin patients ( Figure 78.8 ). This can sometimes be provoked by ‘flickingâ...

IMAGING Erect abdominal films are no longer routinely obtained and the radiological diagnosis is based on a supine abdominal film ( Figure 78.12 ). An erect film may subsequently be requested when further doubt exists. - Figure 78.12 Gas- /f_i lled small bowel lo...

Imaging in intussusception A plain abdominal field usually reveals evidence of small or large bowel obstruction with an absent caecal gas shadow in A barium enema may be used to diagnose the presence of an ileocolic intussusception but does not demonstrate sma...

Imaging in volvulus /uni25CF In caecal volvulus, radiological abnormalities are iden tifiable in nearly all patients but are often non-specific, with caecal dilatation (98–100%), a single air–fluid level (72–88%), small bowel dilatation (42–55%) and absence of ga...

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Investigation Plain abdominal radiography confirms the presence of large bowel distension. All such cases should be investigated by a subsequent single-contrast water-soluble enema study , CT scan or endoscopic assessment to rule out functional disease. Organi...

Learning objectives To understand: The pathophysiology of dynamic and adynamic intestinal • obstruction The cardinal features on history and examination •

Obstruction from enteric strictures Small bowel strictures usually occur secondary to tubercu losis or Crohn’s disease. Malignant strictures associated with lymphoma are uncommon; carcinoma and sarcoma are rare. Presentation is usually subacute or chronic. Sta...

Other manifestations Dehydration Dehydration is seen most commonly in small bowel obstruc tion because of repeated vomiting and fluid sequestration. It results in dry skin and tongue, poor venous filling and sunken eyes with oliguria. The blood urea level and h...

PATHOPHYSIOLOGY Irrespective of aetiology or acuteness of onset, in dynamic (mechanical) obstruction the bowel proximal to the obstruction dilates and the bowel below the obstruction exhibits normal peristalsis and absorption until it becomes empty and colla...

Pain Pain is the first symptom encountered; it occurs suddenly and is usually severe. It is colicky in nature and usually centred on the umbilicus (small bowel) or lower abdomen (large bowel) (see Chapter 63 ). The pain coincides with increased peristaltic acti...

Postoperative intestinal obstruction Di ff erentiation between persistent paralytic ileus and early mechanical obstruction may be di ffi cult in the early postopera - tive period. Mechanical obstruction is more likely if the patient has regained bowel function po...

Pseudo-obstruction This condition describes an obstruction, usually of the colon, that occurs in the absence of a mechanical cause or acute intra-abdominal disease. It is associated with a variety of syndromes in which there is an underlying neuropathy and/o...