CLINICAL FEATURES OF INTESTINAL OBSTRUCTION

Dynamic obstruction

• Pain

• Vomiting

• Distension

• Constipation

• Other manifestations

Pain

• 1st symptom, usually sudden• Colicky nature• Centered on the umbilicus (small bowel) or

lower abdomen (large bowel)• Coincides with increased peristaltic activity• Severe pain indicates presence of

strangulation

Vomiting

• The more distal the obstruction ,the longer the

interval between the onset of symptoms and

the appearance of nausea and vomiting.

• As obstruction progresses the character of

vomitus alters from digested food to faeculent

material.

Distension

• Degree of distension dependent on site

• The more distal the lesion greater is the

distension

Constipation

• Absolute (neither faeces nor flatus is passed) cardinal feature of complete intestinal

obstruction• Relative (only flatus is passed)

Other manifestations

• Dehydration : in small bowel obstruction because of repeated vomiting

• Hypokalaemia • Pyrexia : onset of ischemia intestinal perforation associated inflammation hypothermia indicates septicaemic shock• Abdominal tenderness

Clinical features of strangulation

• Constant pain –pain never completely absent• Tenderness with rigidity –indicates early

laparotomy• Shock –indicates underlying ischaemia

Clinical features of intussusception

• Classical presentation –episodes of screaming and drawing up of legs in previously well male infant

• Vomiting –conspicuous and bile stained

• ‘Redcurrant jelly’ stool

• Lump which hardens on palpation in 60%• Feeling of emptiness in the right iliac fossa

(the sign of dance)• On rectal examination blood stained mucus

may be found on the finger• Unrelieved, progressive dehydration and

abdominal distension, followed by peritonitis secondary to gangrene.

• D/D : a/c gastroenteritis Henoch-Schoenlein purpura Rectal prolapse

Clinical features of volvulus

• Volvulus of the small intestine

• Caecal volvulus: usually a clockwise twist in 25% ,a palpable tympanic swelling in

midline or left side of abdomen

Sigmoid volvulus: large bowel obstruction abdominal distension vomiting absolute constipation