OCCLUSION DU GRLE OCCLUSION DU COLON Dfinition Le syndrome occlusif correspond une interruption du transit dans lintestin

entre langle duodnojjunal et lanus Signes cliniques Douleurs abdominales Vomissements rpts Arrt des matires et des gaz Mtorisme (distension abdominale)

ASP Distension abdominale avec des niveaux hydroariques

Occlusion du grle Etiologies mcaniques tiologie fonctionnelle Occlusion du grle

Etiologies mcaniques: Obstruction endoluminale (1) Corps trangers, calcul biliaires qui obstruent le passage dans la lumire.

Lsions intrinsques (5,6,7) De nature inflammatoires (maladie de Crohn), tumorale, ou encore invagination (introduction dune portion dintestin dans la portion qui suit)

Lsions extrinsques (2,3,4) La bride : adhrences post opratoires Volvulus (4) torsion dune anse du grle sur lui-mme Hernie inguinale

Transit du grle normal invagination Occlusion du grle (2) Physiopathologie: Occlusion simple

Obstacle > dilatation en amont > secrtions lectrolytes et deau > se propage > vomissements > dshydratation au niveau de la stase > prolifration microbienne Strangulation Ischmie vasculaire immdiate, infection du rapide, risque de ncrose > gangrne > perforation

Occlusion du grle (3): clinique Occlusion du grle (4): clinique Occlusions basses Vomissements plutt tardifs / fcalomes

Occlusions hautes Vomissements prcoces Occlusions simples Douleur va durer quelques secondes (pendant les contractions intestinales qui

tentent de forcer le passage) La palpation sent une contraction discontinue Fivre tardive (voire pas de fivre) Signes de dshydratation idem Occlusion par strangulation

Hyperesthsie, dfense en regard de la partie de lintestin qui commence se ncroser. Fivre a + de 38 rapidement Signes de dshydratation, hyperleucocytose. Intestin ncros

Diagnostic Cicatrice abdominale ASP+++ Permet a lui seul de faire le diagnostic (voir diapo suivante) TDM Localiser le siege exact de lobstacle

Occlusion du grle Traitement Aspiration gastrique par sonde Intervention chirurgicale sous laparoscopie

Occlusion du grle (5) tiologie fonctionnelle: = ilus du grle ou pseudo-obstruction aigue Ilus du grle

Dfinition Causes Physiopathologie Signes cliniques ASP Traitement

Ilus du grle Dfinition Distension paralytique de lintestin. (pas de cause mcanique de blocage) Ilus du grle (1): tiologies Ilus post-opratoire

Pritonite Appendicite Cholcystite aigue Pancratite Traumatisme vertbral Hmatome rtro pritonal Infarctus du myocarde

Iatrogne Maladie gnrale Ilus du grle (2) Physiopathologie Pas dexplication vidente

Ilus du grle (3): clinique Anorexie Nauses Vomissements Distension abdominale Arrt des matires et des gaz Pas de symptmes de lutte

Ilus du grle (4) ASP Ilus du grle (5) traitement Aspiration gastrique Rhydratation Correction des troubles lectrolytiques

Traitement tiologique Occlusion du colon Soit occlusion mcanique du colon Occlusion simple Occlusion par strangulation

Soit occlusion fonctionnelle = ilus du colon Occlusion du colon: clinique Arrt des matires et des gaz prcoce Douleur moins vive au dbut Distension abdominale+++ Vomissements rares et tardifs

Occlusion mcanique simple tiologie : cancer du colon+++ (souvent a gauche) Diagnostic: ASP

Lavement Baryt TDM et/ou coloscopie Complication majeure Perforation (pritonite / pneumopritoine) Traitement Chirurgie

Cancer du colon , angle gauche Occlusion par strangulation tiologie : volvulus du sigmode+++

Risque dischmie Clinique Douleur fosse iliaque G pas trs importante Arrt immdiat des matires et des gaz

ASP LB Traitement Complication necrose, douleur trs vive, fievre, defense abdo par la palpation, tachycardie > uregnece

chirurgicale >>> sigmoidectomie. radiographie volvulus LB: aspect en bec

doiseau Occlusion fonctionnelle ou colectasie aigue sans obstacle ou syndrome dOgilvie Arrt du pristaltisme du colon Causes Clinique

ASP LB et coloscopie

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