Intestinal Obstuction Hua-dan Xue 2008-11-30
Intestinal Obstuction Hua-dan Xue 2008-11-30
Ileus (intestinal obstruction) ◼ Mechanical intestinal obstruction – Simple obstruction：occlusion/constriction of bowel lumen – Strangulated obstruction：impaired blood supply of obstructed segment ◼ Ileus (adynamic/non-obstructive) – Paralytic & spasm – Derangement impairing proper distal propulsion of intestinal contents Cautions to barium exam due to the possibility of obstruction aggravating
Classification location ■ Gastric outlet obstruction: Only one/two air-fluid levels Homogeneous mass displacing transverse colon Duodenal obstruction: Double-bubble sign; Frequently normal due to absence of gas from vomiting
Classification - location ◼ Gastric outlet obstruction: – Only one/two air-fluid levels – Homogeneous mass displacing transverse colon ◼ Duodenal obstruction: – Double-bubble sign; – Frequently normal due to absence of gas from vomiting
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Classification location Jejunal and ileal obstruction: Candy cane:>3 loops+>3cm gas-fluid levels+>3~5 hours onset Disparity in size between obstructed and normal loops Little/no gas stool in colon with complete mechanical obstruction after 12-24 hours Stepladder appearance;string-of-bead; Cave:fluid-distended loops may lead one to overlook obstruction!!!
Classification - location ◼ Jejunal and ileal obstruction: – Candy cane: >3 loops+>3cm gas-fluid levels+>3~5 hours onset – Disparity in size between obstructed and normal loops – Little/no gas + stool in colon with complete mechanical obstruction after 12-24 hours – Stepladder appearance; string-of-bead; Cave: fluid-distended loops may lead one to overlook obstruction!!!
Mechanical obstruction
Mechanical obstruction
Classification location ■Colonic obstruction Dilated colon only Dilated small bowel (incompetent ileo- cecal valve) Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) Cecum most dilated portion (>10cm will be critical)
Classification - location ◼ Colonic obstruction – Dilated colon only – Dilated small bowel (incompetent ileocecal valve) – Gas-fluid levels distal to hepatic flexure (fluid is normal in cecum and ascending colon) – Cecum most dilated portion (>10cm will be critical)
Classification location ■Localized ileus Causes:often associated with adjacent acute inflammatory process (acute pancreatitis,acute appendicitis,etc.) Sentinel loop:loops near the local peritonitis Closed-loop obstruction
Classification – location ◼ Localized ileus – Causes: often associated with adjacent acute inflammatory process (acute pancreatitis, acute appendicitis, etc.) ◼ Sentinel loop: loops near the local peritonitis ◼ Closed-loop obstruction
