<unk>  is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion.  It can occur at any level distal to the duodenum of the small intestine and is a medical emergency. Although many cases are not treated surgically, it is a surgical problem.<unk>  has been described as far back as 1550 b.c. in ancient Egypt, however, the earliest record of the first successful treatment of small<unk>  was in 350 b.c. by Praxagorus.<unk>   may be classified by 5 different classification methods including; open and closed, incomplete and complete, extrinsic, intrinsic and intraluminal, true and pseudo-obstruction, and finally, small<unk> wel and large<unk> wel. In this chapter, the extrinsic, intrinsic and intraluminal classification method will be used. It is thought that<unk>  may occur functionally as a result of abnormal anatomy or impairment of the autonomic nervous system or mechanically, which may occur acutely or chronically. An obstruction that occurs functionally or mechanically can be classified as extrinsic, intrinsic or intraluminal including tumors, strictures and foreign<unk> dies. Excessive<unk> wel distention can lead to ischemia, necrosis and perforation. A functional obstruction may be due to a number of genetic defects including trisomy 21 and the RET proto-oncogene mutation. Associated conditions include post-operative adhesions, complicated hernias, gastrointestinal cancers and endometriosis. Gross pathology may demonstrate adhesions, narrow lumens and volvulus. Microscopic pathology may show evidence of fibrosis, necrosis and ischemia. The incidence of<unk>  in the US is 1.47 per 100,000 per year. Colorectal cancer and Crohn's disease are often complicated by<unk> . The mortality rate is about 4% on average with the mortality rate reaching as high as 60% in the presence of<unk> wel ischemia or when surgery is delayed.<unk>  incidence has a median age of approximately 64 years. The incidence in newborns is about 1 in 2000 live births and 1 in 5000 in children above the age of 2. There is no racial predilection in cases of<unk> . Men and women have an equal incidence of<unk> . The highest incidence of<unk>  is found in the continent of Africa. If left untreated, 85% of patients with complete<unk>  may progress to develop ischemia, necrosis, and gangrene. Common complications of<unk>  include<unk> wel ischemia,<unk> wel perforation, gangrene and sepsis. Prognosis is generally excellent for non-ischemic<unk> , and the mortality rate of patients with<unk>  is approximately 4%. In contrast, prognosis for ischemic<unk>  is approximately 60%. There is no single diagnostic study of choice for the diagnosis of<unk> , but<unk>  can be diagnosed based on plain x-ray and CT scan. An x-ray is performed when obstruction is suspected with clinical findings of nausea, vomiting, abdominal pain, abdominal distension and constipation. The results of plain x-ray that confirm of<unk>  include dilated<unk> wel loops with air-fluid level, distal collapsed<unk> wel, gasless abdomen or alternatively, "string of pearls" sign. The results of CT that confirm of<unk>  include dilated<unk> wel loops with air-fluid level and distal collapsed<unk> wel. Initially, an x-ray is usually performed before surgical intervention. If urgent intervention is not needed and the diagnosis is equivocal, then a CT may be carried out. The mainstay of treatment for<unk>  is surgical. Surgery is specifically indicated for complicated<unk> . Complications include: complete obstruction, closed-loop obstruction,<unk> wel ischemia, necrosis, and perforation.
Bowel obstruction
Intestinal ischemia
Mesenteric ischemia
Splenic infarction
Spontaneous bacterial peritonitis
Gallstone ileus
Secondary peritonitis
Distal intestinal obstruction syndrome