Intestinal Obstruction due to Small Bowel Intussusception

One of the commonest operation that a busy practising General Surgeon does as emergency is a Laparotomy for Intestinal Obstruction.

The commonest causes of Intestinal Obstruction are Bowel Cancer,Adhesion from previous surger and Hernia.

There are rarer causes that are seldom seen by surgeons.One of them is the Intussusception of small bowel segment initiated by a polyp or a diverticulum.

A segment of bowel is "telescoped" into the adjacent segment of the more distal colon.

This process will cause blockage of the bowel lumen and hence Intestinal Obstruction.

Due to the sudden occurrence and complete obstruction of this condition,patient will present with the following symptoms;

1.very severe colicky(twisting) abdominal pain,often not relieved by the usual painkillers despite very high doses

2.persistent severe vomiting despite anti-vomiting medications

3.dehydration

Clinical examination may be unremarkable.

Abdominal X-ray confirms the diagnosis of Acute Intestinal obstruction.

The severe symptoms mandate Emergency Surgery.

At Exploratory Laparotomy,the Intussusception is discovered (see pic. above) and manually reduced.

If the bowels are still viable and there are no polyps or diverticulum,the bowels are left alone.But if the bowels are dead or there are polyps or diverticulum deemed to be the initiator of the Intusssusception,then the relevant segment of bowels will be resected.