Special types of intestinal obstruction Obstructed hernia Intussusception

Special types of intestinal obstruction

• Obstructed hernia • Intussusception • Volvulus • Paralytic ileus • Neonatal intestinal obstruction

Intussusception • Definition: Intussusception is invagination (telescoping) of an intestinal segment ( intussusceptum) into the lumen of an adjacent one ( intussusceptiens) It is composed of - inner and returning tube(intussusceptum) - outer tube (intussusceptiens)

Types of intussusception • Ileo-ileal • Ileo-cecal • Ileo-colic • Colico-colic

2 ry intussusception Due to intestinal Mass (? ? Lymphoma)

Clinical presentation • • Classic triad Intermittent abdominal colicky pain with cring Bilious vomiting Passing mucus and blood per rectum # red current jelly stool ( if absent don’t exclude)

Clinical presentation • Symptoms: - Well nourished infant - Age: 6 -24 months - attacks of sever colicky pain with interval of apparent well being during which the infant asks for feeding (early) - with attacks of pain there is lethargy, apathy - vomiting (bilious) - Passing of red current jelly stool (ask about it )

Clinical presentation • Signs : - signs of dehydration ……. . - emptiness in rt iliac fossa ( sign de Dance) - distension ---- absent in early cases …. . If present it may be significant of perforation or gangrene - sausage shaped mass may be felt - DRE … bloody mucus some times the head of intussusception

Investigations # Lab: CBC……. may show anemia, leukocytosis Na& K …. electrolyte imbalance Urea & creatinin …. . May be impaired due to dehydration # Radiological: Abdominal U/S……. . Contrast enema ……… Claw sign

Treatment • Resuscitation • Non surgical treatment • Surgical treatment

Volvulus • Definition: It is twisting of a bowel loop around its mesenteric axis • Volvulus produces both - intestinal obstruction - closed loop obstruction - occlusion of the main vessels at the base of involved mesentery ( strangulation) - increased risk of gangrene and perforation (why ? ? )

• Predisposing factors

Clinical presentation

Investigation

Treatment

Intestinal ischaemia

Acute intestinal

Chronic intestinal ischaemia