ISSN 2398-2950      

Intestine: strangulated obstruction / hernia

ffelis

Introduction

  • Formed when a piece of bowel passes through a congenital or acquired defect in the abdominal wall, perineal musculature, mesentery or diaphragm.
  • Cause: acute or may occur after hernia has been present for a long time.
  • Signs: vomiting Vomiting, abdominal pain, anorexia, fever and depression.
  • Strangulation should always be considered in cases of suspected bowel obstruction where the clinical signs are more severe than those associated with a simple mechanical obstruction.
  • Diagnosis: radiography.
  • Treatment: surgical exposure of the hernial sac contents, breakdown of any adhesions and reduction of the bowel, and possibly resection and anastomosis.
  • Prognosis: guarded.

Pathogenesis

Pathophysiology

  • Luminal blockage as such is not always present but the blood supply to a segment of bowel is severely compromized.
  • An intact arterial supply allows the intramural sequestration of blood and eventually bowel wall edema.
  • The bowel will distend and become filled with gas and fluid proximal to the strangulation. The fluid in a strangulated obstruction will contain a significant amount of blood.
  • If the strangulation continues, the bowel wall will become non-viable and necrotic, allowing the transmural migration of toxins and bacteria. Fluid and blood loss combined with the peritoneal absorption of these bacteria and toxic substances will eventually lead to hypovolemia and endotoxic shock and death if left untreated.

Timecourse

  • Acute.

Diagnosis

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Treatment

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Further Reading

Publications

Refereed papers

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