الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Small bowel obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine.
Common causes of dynamic obstruction are adhesions, hernias, tumors, foreign bodies, volvulus, intussusception and fecal impaction. Adynamic obstruction caused by paralytic ileus, pseudo-obstruction and acute mesenteric ischaemia.
In simple mechanical obstruction, blockage occurs without vascular compromise. Fluid and gas accumulate above the obstruction. The proximal bowel distends, and the distal segment collapses. The normal secretory and absorptive functions are depressed, and the bowel wall becomes edematous and congested, increasing the risks of dehydration and progression to strangulating obstruction.
Strangulating obstruction is obstruction with compromised blood flow. It is usually associated with hernia, volvulus, and intussusception. Venous obstruction occurs first, followed by arterial occlusion, resulting in rapid ischemia of the bowel wall. The ischemic bowel becomes edematous and infarcts, leading to gangrene and perforation.
Symptoms and Signs are abdominal cramps, vomiting, and absolute constipation. Patients with partial obstruction may develop diarrhea. Severe, steady pain suggests that strangulation.
Sometimes, dilated loops of bowel are palpable. With infarction, the abdomen becomes tender and auscultation reveals a silent abdomen. Shock and oliguria indicate either late simple obstruction or strangulation.
Supine and upright abdominal x-rays should be obtained. On plain x rays, distended small-bowel loops is typical of small-bowel obstruction. Multiple air fluid levels in the bowel can be seen in upright views.
The findings in Computed tomographic (CT) scanning include a discrete transition zone with dilation of bowel proximally, decompression of bowel distally. CT scanning may also provide evidence for the presence of closed-loop obstruction and strangulation.
Barium study include small bowel series (small bowel follow-through) or enteroclysis (intubation infusion of barium). It can be helpful in the detection of low-grade or partial small bowel obstruction.
Patients with intestinal obstruction should be hospitalized. Nasogastric suction, IV fluids and a urinary catheter to monitor fluid output. This conservative therapy has been documented to be successful in 65 to 81% of patients with partial small bowel obstruction, adhesive intestinal obstruction, Intestinal obstruction due to Crohn’s disease and obstruction occurring in the early postoperative period.
Surgical interference is mandatory if there is no improvement after 48 hours of conservative therapy or when symptoms and signs of strangulation or ischaemia devoloped.
Common complications are toxaemia, hypovolemic shock, intestinal perforation and peritonitis.