Focus: Ileus and Carcinoma of the Colon
I. Introduction
Acute intestinal obstruction is a surgical emergency that causes sudden cessation of intestinal content passage due to a mechanical or functional block. This leads to fluid accumulation, bacterial overgrowth, gas retention, ischemia, and can quickly become fatal if untreated.
II. Classification of Ileus (Intestinal Obstruction) - This is the disruption of the normal propulsive ability of the GI tract
III. Causes of Mechanical Ileus
IV. Pathophysiology (Mechanical Ileus)
Obstruction → accumulation of gas, fluid → ↑ intraluminal pressure
Venous congestion → ischemia of bowel wall
Bacterial overgrowth → translocation, risk of sepsis
Perforation if untreated → peritonitis
V. Symptoms of Obstruction
VI. Diagnosis
A. Clinical:
Abdominal examination: distension, tympany, peristaltic waves, tenderness
Digital rectal exam: may reveal tumor or empty rectum
B. Imaging:
VII. Management of Ileus
1. Conservative (initial management in all cases):
NPO
NG tube decompression
IV fluids + electrolyte correction
Monitoring vitals, urine output
Broad-spectrum antibiotics (especially if strangulation suspected)
2. Surgical:
Indications:
No improvement after 24–48 hrs
Signs of strangulation or perforation
Suspected malignancy or volvulus