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The concept of intestinal obstruction: the passage of intestinal contents caused by any cause is collectively referred to as intestinal obstruction
.
Classification of bowel obstruction (causes of obstruction):
Classification of bowel obstruction (causes of obstruction):Mechanical (most common) :
Mechanical (most common)Simplicity: only intestinal patency disorder, no blood flow disorder
No blood supply disorderStrangulated: both smooth intestinal disorder, but also with blood supply disorders
Have blood flow disordersMotivation:
Motivation:Paralytic:
Spasticity:
Blood transport:
Blood transport:Mesenteric artery thrombosis or embolism-blood circulation disorder + intestinal muscle dysfunction
thrombusClassification of bowel obstruction (location of obstruction):
Classification of bowel obstruction (location of obstruction):High obstruction: upper jejunum
High obstruction:Low obstruction: lower jejunum-colon
Low obstruction:Intestinal obstruction classification (degree of obstruction)
Intestinal obstruction classification (degree of obstruction)Complete intestinal obstruction: The intestinal tube is completely blocked, causing the intestinal contents to pass through
Complete intestinal obstruction:Incomplete intestinal obstruction: The intestine has not been completely blocked, there is still some food, water,
Incomplete intestinal obstruction:Gas passing
Clinical manifestations of intestinal obstruction
Clinical manifestations of intestinal obstructionAbdominal pain, bloating, nausea, vomiting, stopping gas, defecation
Signs: abdominal swelling, tenderness
Auscultation: Bowel sounds are enhanced, there is a sound of gas and water
Notice! ! !
Notice! ! ! Notice! ! !The higher the obstruction, the earlier and more frequent vomiting will appear!
The higher the obstruction, the earlier and more frequent vomiting will appear!The characteristics of vomit in high intestinal obstruction : vomiting appears early and frequent, and the vomit is stomach and twelve
High intestinal obstructionThe contents of the intestines
.
The characteristics of vomit in low intestinal obstruction : vomiting is delayed and less, and the vomit is fecal-like
.
The characteristics of strangulated bowel obstruction vomit: the vomit is brown or bloody
.
The characteristics of pyloric obstruction vomit: vomit is a sour food
.
Normal air-liquid level common in the abdomen
Normal air-liquid level common in the abdomenFundus of stomach
Duodenal bulb (bulb-like)
End ileum and colon
Intestinal tube diameter
Intestinal tube diameterNormal small intestine diameter <2.
5cm
Colon diameter is about 4~5cm
The maximum diameter of the cecum is about 5~7cm
Imaging manifestations of bowel obstruction
Imaging manifestations of bowel obstructionThe purpose of X-ray examination:
①Whether there is intestinal obstruction
②If you have intestinal obstruction, you should understand the location of the obstruction
③Analyze the cause of obstruction (more difficult)
Standing inspection, it can be seen that there are steps and different lengths of gas-liquid planes
.
Intestinal gas accumulation, fluid accumulation and intestinal dilatation above obstruction
Step-like, different length gas-liquid plane
Examination in the supine position shows the distribution of flatulence intestinal loops , with the small intestine in the center and the colon occupying the periphery of the abdomen
.
.
When the high jejunum is obstructed, a lot of gas and liquid appear in the stomach
.
Low intestinal obstruction, the liquid level is more
.
In complete obstruction, there is no gas or only a small amount of gas in the colon
.
High complete small intestine obstruction (1)
High complete small intestine obstruction (1)Standing position: Gas accumulates in the left upper abdominal intestine, and multiple gas-liquid planes are visible
.
Recumbent position: Intestinal folds are approximately spring-like-jejunum
.
There was no obvious gas accumulation in the small intestine and colon below the obstructed segment in the standing and lying position films
.
The green arrow is the ureteral stent-double J tube
.
High complete small intestine obstruction (2)
High complete small intestine obstruction (2)The patient came after a major gastrectomy because of abdominal pain
.
Vertical and lying abdominal radiographs showed that there was no obvious gas accumulation in the intestines
.
It is considered that high obstruction of the small intestine, discharge of gas and contents below the obstructed section, and fluid retention in the intestine above the obstructed section
After oral administration of diatrizoate meglumine, the remnant stomach, free duodenum, and upper jejunum were visualized, the contrast agent was completely filled, and the upper jejunum was significantly dilated
.
CT showed that there was a foreign body incarcerated at the obstruction site
.
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Small bowel obstruction (1)
Small bowel obstruction (1)
Small bowel obstruction (1)
Small bowel obstruction (1)In the jejunum and ileum above the obstructed segment, multiple hairs of different lengths, step-like gas-liquid planes, and obvious lumen dilation can be seen
.
The gas accumulation in the small intestine and colon below the obstructive segment is not obvious
.
The obstructive segment should be in the upper ileum
.
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Small bowel obstruction (two)
Small bowel obstruction (two)
Small bowel obstruction (two)
Small bowel obstruction (two)Gas accumulation in the terminal ileum, slightly dilated, and multiple short gas-liquid planes can be seen
.
The obstruction of this site should take into account the possibility of appendicitis
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Small bowel incomplete obstruction
Small bowel incomplete obstruction
Small bowel incomplete obstruction
Small bowel incomplete obstructionAfter oral administration of diatrizoate meglumine, the contrast agent can reach the rectum, but the small intestinal lumen in the mid-abdomen is significantly dilated, and multiple stepped gas-liquid planes can be seen
.
Diagnosed as small bowel incomplete obstruction
diagnosis
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Colon obstruction
Colon obstruction
Colon obstruction
Colon obstructionThe colonic intestines were significantly dilated, and multiple gas-liquid planes were seen in the intestines in the ascending and descending colon regions
The local mesenteric in the abdominal cavity is twisted, causing local torsion of the sigmoid colon to the outside of the liver, and obvious stenosis and obstruction, and obvious expansion and gas accumulation in the distal colon
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