Abdominal X-ray 11/23/2017 5:34:00 AM

Small Intestine:
 Presence of valvulae continnetes (transverse entire width of
bowel)
 Located centrally
 Loop size <3cm (in dilation no more than 5-7cm)

Large intestine:
 Presence of haustra (partial cross the bowel loop)
 Located peripherally (ascending + descending are in
retroperitoneum)
 Loop size >6cm (in dilation >10cm)
 Contain fecal matter

Bowel Obstruction can be functional (absent peristalsis) or mechanical

(high pitched, tinkling).
 Functional ileus: Surgery, intra-abd infection, pancreatitis,
trauma (spinal,head), metabolis (hyponat, hypokal, hypoxia,
hypothermia, DKA), Meds (Anesthesia, TCA)
 Mechanical obstruction:
o Luminal – gallstone, foreign body, bezoars)
o Mucosal/Bowel wall – Inflam (IBD, necrotizing
enterocolitis, malignancy, stricture, congenital atresia
o Extrinsic (adhesions – common, volvulus,
intussusception)

Diagnosis of Mechanical LB obstruction over Functional LB obstruction:

 Abrupt change in caliber of LB
 Lack of gas in distal bowel (due to collapse of bowel distal to
obstruction)
 Preceding history of weight loss + PR bleeding

Commonest causes of Large Bowel (LB) Obstruction:
 Adenocarcinoma
 Sigmoid volvulus
 Inflammatory and ischemic strictures (Diverticular disease,
Necrotising enterocolitis, Bowel ischemia, IBD)
o Tested using Barium enema
o Benign stricture – smooth contours
 o Malignant stricture – irregular contour
 Marked constipation and extrinsic bowel compression by tumor.

Treatment of Obstructive colorectal malignancy:

 Laparotomy + Hartmann’s Procedure in the case of malignant
distal LBO complicated by perforation & fecal peritonitis.
o Emergency operation
 Laparoscopic Colonic resection with primary anastomosis
 Stent Placement temporarily with fluoroscopy + elective surgery

Volvulus – Sigmoid, Caecum, Stomach, Duodenum

Sigmoid Volvulus = most common
 Arises from left lower quadrant
 Extend toward epigastrium  liver overlap sign + Northern
exposure sign
 Devoid of haustra
 Ass with large bowel obstruction
 Coffee bean or N shaped sign
 Barium enema or Water soluble enema shows bird’s beak shape.

Cecal Volvulus
 Arises from right lower quadrant
 Extends towards left upper quadrant
 Haustra present usually
 Ass with small bowel obstruction
 Barium enema – non dilated distal colon with caecal obstruction
11/23/2017 5:34:00 AM
11/23/2017 5:34:00 AM