Just For Sharing : Classification of Acute Intestinal Obstruction

Syllibus Year 4 Phase II (Surgical Diseases)

CLASSIFICATION OF ACUTE INTESTINAL OBSTRUCTION (AIO)

1. STAGES :

I - Impairment of passage

II - Disturbance of microcirculation

III - Peritonitis & necrosis

2. ORIGIN:

I - Congenital (eg: Complete atresia of SI, LI, anus & sclerosis)

II - Acquired (eg: Malignant tumour, trauma, bile stones ileus)

3. MECHANISM:

i. Mechanical

a) Obturation

(eg: Tumour, Foreign body, Gall stone)

b) Strangulation

(eg: Irreducible strangulated hernia, volvulus 0r mesentery twist)

Characteristic: Formation of knots or coils of SI loops with each others.

c) Mix

(eg: Invagination, adhesion)

Characteristic: Invagination (proximal part comes to distal part). This invagination is called as intersusception. Usually in children.

In adult, there are usually adhesion.

Causes of adhesion: Trauma of peritoneum, peritonitis, post-op.

Eg. of post-op that causes adhesion:

- Appendicectomy (adhesion at Right Iliac Region)

- Splenectomy (adhesion of Left Hypochondrium)

ii. Dynamic

a) Spastic (eg: Spinal cord trauma, poisonings)

b) Paralytic

(This is typical AIO. Causes: Complication of urgent abdominal diseases, eg: Peritonitis, Pancreatitis, etc.)

4. LEVEL OF OBSTRUCTION

i. High (SI)

ii. Lower (LI)

5. CLINICAL STATES OF PATIENT

i. Acute (eg: adhesion, strangulation)

ii. Chronic (eg: tumour)

6. CONDITION OF INTESTINES

i. Complete obstruction

ii. Partial obstruction

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CONCLUSIONS:

1. There are 3 types of mechanical AIO:

I - Acute Mechanical Obturation IO

II - Acute Mechanical Strangulation IO

III - Acute Mechanical Mix IO

2. There are 2 types of dynamic AIO:

I - Acute Dynamic Spastic IO

II - Acute Dynamic Paralytic IO (typical)

NB!

STRANGULATION - Needs IMMEDIATE SURGERY!

OBTURATION - You have 4 HOURS to OPERATE!

That's all. Good luck. Tawakkal alaAllah =)