BY :

1.DICKY ADITYA DWIKA

2.MARADEWI MAKSUM

Bowel obstruction occurs when the normal

propulsion and passage of intestinal contents
does not occur. This obstruction can involve
only the small intestine (small bowel
obstruction), the large intestine (large bowel
obstruction), or via systemic alterations,
involving both the small and large intestine
(generalized ileus).

The "obstruction" can involve a mechanical

obstruction or, in contrast, may be related to
ineffective motility without any physical
obstruction, so-called functional obstruction,
"pseudo-obstruction," or ileus.

This term is used to define intestinal

obstruction caused by a physical blockage
of the intestinal lumen. This blockage may
be intrinsic or extrinsic to the wall of the
intestine or on occasion may occur
secondary to luminal obstruction arising
from the intraluminal contents.

Lesions Extrinsic to the

Intestinal Wall

Lesions Intrinsic to the

Intestinal Wall

ADHESIONS:
Post-operative, Congenital, Postinflammatory

CONGENITAL:
Intestinal atresia, Meckels
diverticulum, duplications

HERNIA:
H. External abdominal wall, H.
Internal, H. Incisional

INFLAMMATORY:
Chrons disease, eosinophilic
granuloma

CONGENITAL:
Annular pancreas, malrotation,
Omphalomesenteric duct remnant

INFECTIONS:
Tuberculosis, actinomycosis,
complicated diverticulitis

NEOPLASTIC:
Carcinomatosis, Extraintestinal
neoplasm

NEOPLASTIC:
Primary or metastatic neoplasms,
appendicitis

INFLAMMATORY:
Intra-abdominal abscess, Starch
peritonitis

MISCELLANEOUS:
Intussusception, endometriosis,
radiation stricture, intramural
hematoma, ischemic stricture

MISCELLANEOUS:
Volvulus, Gossypiboma, Superior
mesentric artery syndrome

INTRALUMINAL/OBTURATOR
OBSTRUCTION:
Gallstone, enterolith, phytobezoar,
parasite infestaion, swallowed foreign
body

When the obstruction is secondary to

factors that cause either paralysis or
dysmotility of intestinal peristalsis that
prevents coordinated aboral transit of
luminal contents, the obstruction is called a
functional or pseudo-obstruction. With
functional obstruction, no physical site of
mechanical obstruction is present.

The most common cause is POSTOPERATIVE ILEUS

It is correlate with the degree of surgical trauma as well

as the type of operation.

Different anatomic segments of the

gastrointestinal tract also recover at
different rates after manipulation and
trauma.
The small bowel recovers within several
hours post-operatively. Stomach within one
day later. Colon about 3-5 days later.

Intra-Abdominal Causes

Extra-Abdominal Causes

INTRAPERITONEAL
PROBLEMS:
peritonitis, intra-abdominal
abscess, post-operative ,
chemical (gastric juice, bile,
blood), Autoimmune (Serositis,
vasculitis) & Intestinal ischemia
(arterial or venous, sickle cell
disease)

METABOLIC ABNORMALITIES:
Electrolyte imbalance, sepsis,
lead poisoning, porphyria,
hyperglicemia, hypothiroidsm,
uremia

RETROPERITONEAL
PROBLEMS:
Urolithiasis, pyelonefphritis,
metastasis, pancreatitis,
retroperitoneal trauma

THORACIC PROBLEMS:
Myocardial infarction, congestive
heart failure, pneumonia, thoracic
trauma
MEDICINES:
opiates, anti-cholinergic, alphaadrenergik agonists,
antihistamines
MISCELLANEOUS:
Spinal cord injury, pelvic fracture,

Luminal obstruction results in prominent

alterations of the normal intestinal
physiology. Despite the many changes
noted, the pathophysiology of bowel
obstruction remains incompletely
understood. Bowel distension, decreased
absorption, intraluminal hypersecretion, and
alterations in motility are found universally,
yet the mechanisms responsible for these
pathophysiologic derangements are not
clear.

Mechanical bowel obstruct

DISTENTION

BOWEL

Early phases of obstruct, accumulates gas from

swallowed air (75% nitrogen).
The next phases, gas arise from the fermentation of
sugars, production of carbon dioxide by interaction of
gastric acid and bicarbonates in pancreatic and biliary
secretions, and diffusion of oxygen and carbon
dioxide from the blood.

Intestinal motility are disruption of the normal

autonomic parasympathetic (vagal) and

sympathetic splanchnic innervation.
Early phase of bowel obstruction,
Intestinal contractile activity increases propel
intraluminal contents past the obstruction

Later phase of bowel obstruction,

The contractile activity diminishes intestinal wall hypoxia
exaggerated intramural inflammation

Distention

of the bowel lumen with a

concomitant results in increased
transmural pressure on capillary
blood flow within the wall of the bowel risk
ischemic.

of

Intestinal wall ischemia is real concern in Large

Bowel Obstruction. The Ascending
Colon luminal diameter is the greatest and
(by Laplace's law) the wall tension (and ischemia)
is also the greatest high risk to ischemia.

Upper small intestine gram-positive facultative

organisms in small concentrations, <106
colonies/mL. More distally, in the distal ileum the
bacterial count increases in concentration to about
108 colonies/mL, the flora primarily coliforms and
anaerobic organisms

in the presence of obstruction, a rapid proliferation

of bacterial organisms occurs consisting
predominantly of fecal-type organisms. reaching a
plateau of 1091010 colonies/mL after 1248 hours of
an established obstruction.

Bacterial toxins have an important role in the

mucosal response to bowel obstruction .

 The

diagnosis of bowel obstruction is

suspected clinically based on the presence
of classic signs and symptoms and then
confirmed by some form of imaging test,
such as abdominal radiography or more
recently by computed tomography. The
etiology can often be pinpointed by careful
history-taking complemented with imaging
studies.