补充课文 intestinal obstruction.docVIP

Intestinal Obstruction Intestinal obstruction designates an impairment of movement of intestinal contents in a cephalocaudal direction. The causes can be categorized as mechanical obstruction and paralytic obstruction. Strangulation with necrosis of the bowel may occur and lead to perforation, peritonitis and sepsis. It is a serious complication and may increase the mortality rate of intestinal obstruction to about 25%. Mechanical Obstruction can result from a number of conditions，intrinsic and extrinsic that encroach on the patency of the bowel lumen. Major inciting causes include external hernia (i.e., inguinal, femoral, or umbilical) and postoperative adhesions. Less common causes are strictures, tumors, foreign bodies, intussuception and volvulus. Intussusception involves the telescoping of bowel into the adjacent segment. It is the most common cause of intestinal obstruction in children younger than 2 years of age. The most common form is the intussusception of the terminal ileum into the right colon, but other areas of the bowel may be involved. In most cases, the cause of the disorder is unknown. The condition can also occur in adults when an intra-luminal mass or tumor acts as a traction force and pulls the segment along as it telescopes into the distal segment. Volvulus refers to a complete twisting of the bowel on an axis formed by its mesentery. Volvulus of the colon accounts for 5% to 10% of large bowel obstruction. Mechanical bowel obstruction may be a single obstruction, in which there is no alteration in blood flow, or a strangulation obstruction, in which there is impairment of blood flow and necrosis of bowel tissue. Paralysis, or adynamic, obstruction results from neurogenic or muscular impairment of peristalsis. Paralytic ileus is seen most commonly after abdominal surgery. It also accompanies inflammatory conditions of the abdomen, intestinal ischemia, pelvic fractures and back injuries. It occurs early in the course of peritonitis and can res