surgical management of intestinal obstruction shinjan patra medical college kolkata
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Shinjan PatraTRANSCRIPT
Surgical Management of Intestinal Obstruction
Shinjan PatraRoll no-88
When will we do surgery???
• No resolution even after 24-48 hours of conservative treatment in partial obstruction.
• Complete obstruction of bowel
• Strangulated & closed-loop obstruction.
• Principle- laparotomy is to be done.
• Timing-after optimization of the patient for surgery after routine investigations.
• Anesthesia- General/Epidural
• Incision-according to the site of obstruction(mostly median)
Actual steps of Surgery
• At first most importantly the caecum is identified
collapsed distended (small gut obstruction) (large gut obstruction)
Site of obstruction is identified-junction betweencollapsed & distended part
Nature of the obstruction is identified & removed
Viability of the gut is assesed
Gut is viable it is not viable
Gut is put inside the Resection & AnastomosisAbdomen.• Abdomen closed in layers using Non-absorbable sutures.
Comparison between Viable & Non-viable Gut
Features of viable gut• Pinkish• Luster-present• Peristaltic movement-
present• When pricked by a needle-
bleeding from the surface• Pulsation-present in
mesenteric vessels
Features of non-viable gut• Blackish• Absent
• Absent
• There Is no bleeding• No pulsation
If still we are doubtful-
• Warm saline soaked mop over the doubtful area & 100% O2 is administered
• If colour becomes normal with peristalsis,then it is viable.
Other means of checking Viability
1. Doppler study
2. Fluorescence study
Other Approaches
• Second look operation -in multiple segment obstructions
• Laparoscopic approach
Special consideration
• Procedure to prevent recurrences- 1.repair of the hernia 2.lysis of the offending adhesions.
• Bypass surgery
• Colostomy/ileostomy without anastomosis.
• Deferment of resection & anastomosis.
Post-surgical Complications• Recurrences
• Burst abdomen
• Pelvic abscess
• Subphrenic abscess
• Biliary or faecal fistula
• Incisional hernia.
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