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AnatomyThejejunalmucosaisrelativelythickwithprominentplicaecirculares;themesentericvesselsformonlyoneortwoarcadeswithlong

vasarecta.Theileumissmallerincircumferenceandhasthinnerwalls;themesentericvesselsformmultiplevasculararcadeswithshort

vasarecta.Bloodsupplytothejejunoileumanddistalduodenumisentirelyfromthesuperiormesentericartery,whichcours

esanteriortothethirdportionoftheduodenum.Theceliacarterysuppliestheproximalduodenum.Physiology•Motility:Peristals

isconsistsofintestinalcontractionspassingaborallyatarateof1to2cm/seccontractionsinitiatedbythemigratingmyoelec

triccomplex(MMC)underthecontrolofbothneuralandhumoralpathways•ENDOCRINEFUNCTIONObstruction•Etiology:Commoncausesofsmallbowelobstructioninindustr

ializedcountries:ClinicalManifestationsandDiagnosis•Cardinalsymptoms:colickyabdominalpainnauseavomitingabdominaldistentionfailuretop

assflatusandfecesPhysicalExam•distendedabdomen•peristalticwaves•minimalornobowelsounds•Mildabdominaltendernesswith/withoutapa

lpablemass•Examtoruleoutincarceratedhernias•RectalexamRadiologicandLaboratoryExaminations•Plainabdominalradiographs:accura

cy≈60%-dilatedloopsofsmallintestinewithoutevidenceofcolonicdistention-multipleair-fluidlevels,ofteninast

epwisepattern-demonstratethecauseoftheobstruction•CT:formorecomplexcasesPlainabdominalfilmshowscompletebowelobs

tructioncausedbyalargeradiopaquegallstone(arrow)obstructingthedistalileum.CTscanoftheabdomenofapatientwithamechanicalbowelobstructionseco

ndarytoanabscessintherightlowerquadrant(arrow).Multipledilatedandfluid-filledloopsofsmallbowelarenoted.SimpleVsStrangulatingObstruction•“Class

ic”signsofstrangulation:-tachycardia-fever-Leukocytosis-aconstant,noncrampingabdominalpainDifferentiationofpartialfromcompleteSBO•PartialSBO:passfl

atusorliquidstools•CompleteSBO:obstipationDifferentiationofProximal/distalSBO•pain:epigastric/periumbilicalarea•vomiting:prominent/lateronset•diste

ntion:no/predominateTreatment•Medicalandsurgicalmanagement•Theoverlappingsequence:investigationresuscitationoperation•Thetimingofoperati

ondependsonthreefactors:-duration-opportunityofvitalorganfunction-riskofstrangulationMedicalManagement•Nasointestinal/naso

gastricintubation•Intravenousfluids/bloodplasmaadministration•Broad-spectrumantibioticsadministrationSu

rgicalprinciples•ThenatureofproblemdeterminesapproachtomanagementofSBO.•Thecriteriaofdeterminingbowelvi

ability:color,motility,arterialpulsation•Ifquestionable,releasedandplaced,re-examined