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AnatomyThejejunalmucosaisrelativelythickwithprominentplicaecirculares;themesentericvesselsformonlyoneortwoarcadeswithlongvasarec

ta.Theileumissmallerincircumferenceandhasthinnerwalls;themesentericvesselsformmultiplevasculararcadeswithshortvasarecta.Bloodsupplytothejejunoi

leumanddistalduodenumisentirelyfromthesuperiormesentericartery,whichcoursesanteriortothethirdportionoftheduodenum.Theceliacart

erysuppliestheproximalduodenum.Physiology•Motility:Peristalsisconsistsofintestinalcontractionspassingaborallyatarateof1to

2cm/seccontractionsinitiatedbythemigratingmyoelectriccomplex(MMC)underthecontrolofbothneuralandhumoralpathways•ENDOCRINEFUNCTIONObstruction•Etiology:

Commoncausesofsmallbowelobstructioninindustrializedcountries:ClinicalManifestationsandDiagnosis•Cardinalsymptoms:colickyabdominalpai

nnauseavomitingabdominaldistentionfailuretopassflatusandfecesPhysicalExam•distendedabdomen•peristalticwave

s•minimalornobowelsounds•Mildabdominaltendernesswith/withoutapalpablemass•Examtoruleoutincarceratedhernias•RectalexamRadiologicandLaborato

ryExaminations•Plainabdominalradiographs:accuracy≈60%-dilatedloopsofsmallintestinewithoutevidenceofcolonicdistenti

on-multipleair-fluidlevels,ofteninastepwisepattern-demonstratethecauseoftheobstruction•CT:formorecomplexcasesPlainabdominalfilmshowsc

ompletebowelobstructioncausedbyalargeradiopaquegallstone(arrow)obstructingthedistalileum.CTscanoftheabdomenofapatientwithamechanicalbowelobstruc

tionsecondarytoanabscessintherightlowerquadrant(arrow).Multipledilatedandfluid-filledloopsofsmallbowelarenoted.SimpleVsStrangulatingO

bstruction•“Classic”signsofstrangulation:-tachycardia-fever-Leukocytosis-aconstant,noncrampingabdominalpainDifferentiationofpar

tialfromcompleteSBO•PartialSBO:passflatusorliquidstools•CompleteSBO:obstipationDifferentiationofProximal/dis

talSBO•pain:epigastric/periumbilicalarea•vomiting:prominent/lateronset•distention:no/predominateTreatment•Medicalandsurgicalmanagement•Theo

verlappingsequence:investigationresuscitationoperation•Thetimingofoperationdependsonthreefactors:-duration-opportuni

tyofvitalorganfunction-riskofstrangulationMedicalManagement•Nasointestinal/nasogastricintubation•Intravenousfluids/bloodplasmaadministration

•Broad-spectrumantibioticsadministrationSurgicalprinciples•Thenatureofproblemdeterminesapproachtomanagemento

fSBO.•Thecriteriaofdeterminingbowelviability:color,motility,arterialpulsation•Ifquestionable,releasedandplaced,re-examined