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AnatomyThejejunalmucosaisrelativelythickwithprominentplicaecirculares;themesentericvesselsformonlyoneortwoarcadeswithlongvasarecta.

Theileumissmallerincircumferenceandhasthinnerwalls;themesentericvesselsformmultiplevasculararcadeswit

hshortvasarecta.Bloodsupplytothejejunoileumanddistalduodenumisentirelyfromthesuperiormesentericartery,whichcoursesanteriortothethirdportionofthed

uodenum.Theceliacarterysuppliestheproximalduodenum.Physiology•Motility:Peristalsisconsistsofintestinalcon

tractionspassingaborallyatarateof1to2cm/seccontractionsinitiatedbythemigratingmyoelectriccomplex(MMC)underthecontrolofbothneuralandhumoralp

athways•ENDOCRINEFUNCTIONObstruction•Etiology:Commoncausesofsmallbowelobstructioninindustrializedcountries:Cl

inicalManifestationsandDiagnosis•Cardinalsymptoms:colickyabdominalpainnauseavomitingabdominaldistentionfailuretopassflat

usandfecesPhysicalExam•distendedabdomen•peristalticwaves•minimalornobowelsounds•Mildabdominaltendernesswith/withoutapalpablem

ass•Examtoruleoutincarceratedhernias•RectalexamRadiologicandLaboratoryExaminations•Plainabdominalradiographs:accuracy≈60%-dilatedloopsofsm

allintestinewithoutevidenceofcolonicdistention-multipleair-fluidlevels,ofteninastepwisepattern-demonstratethecauseoftheobs

truction•CT:formorecomplexcasesPlainabdominalfilmshowscompletebowelobstructioncausedbyalargeradiopaquegalls

tone(arrow)obstructingthedistalileum.CTscanoftheabdomenofapatientwithamechanicalbowelobstructionsecondarytoanabscessintherightlowerquadra

nt(arrow).Multipledilatedandfluid-filledloopsofsmallbowelarenoted.SimpleVsStrangulatingObstruction•“C

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

:passflatusorliquidstools•CompleteSBO:obstipationDifferentiationofProximal/distalSBO•pain:epigastric/periumbilicalarea•vomiting:prominent/later

onset•distention:no/predominateTreatment•Medicalandsurgicalmanagement•Theoverlappingsequence:investigationresuscitationope

ration•Thetimingofoperationdependsonthreefactors:-duration-opportunityofvitalorganfunction-riskofstrangulationMedicalManage

ment•Nasointestinal/nasogastricintubation•Intravenousfluids/bloodplasmaadministration•Broad-spectrumantibioticsadministrationSur

gicalprinciples•ThenatureofproblemdeterminesapproachtomanagementofSBO.•Thecriteriaofdeterminingbowelviability:color,motility,arterial

pulsation•Ifquestionable,releasedandplaced,re-examined