The small bowel measures about 120 cm in length from pylorus to ileocecal valve. The jejunum begins at ligament of Treitz. Jejunum and ileum are suspended by a mobile mesentery covered by a visceral peritoneal lining that extends onto the external surface of

the bowel to form the serosa. Jejunum and ileum receive their blood from the superior mesenteric artery (SMA). Although mesenteric arcades form a rich collateral network, occlusion of a major branch of the SMA may result in segmental intestinal infarction. Venous drain is via the superior mesenteric vein, which then joins the splenic vein behind the neck of the pancreas to form the portal vein. Peyer’s patches are lymphoid aggregates present on the antimesenteric border of distal ileum. Smaller follicles are present through all small bowel.

click here Lymphatic drainage of intestine is abundant. Regional lymph nodes follow the vascular arcades and then drein toward the cysterna chyli. Jejunal and ileal wall consists of serosa, muscolaris, submucosa and, innermost, mucosa [1]. Mechanical small bowel obstruction Acute mechanical obstruction of the intestine is a common surgical emergency and a major cause of admission to emergency surgery departments. Small bowel obstruction occurs when there is an obstacle to the flow of luminal contents caused by an extrinsic or intrinsic encroachment on the lumen [2]. Adynamic ileus presents Ganetespib supplier the same symptoms of mechanical obstruction but the underlying SHP099 problem is disordered motility. One of the keys to management of intestinal obstruction is early diagnosis. Particularly, accurate early recognition of strangulation is crucial because this emergency causes bowel ischemia, necrosis and perforation. In neonates most common causes are atresia, midgut volvulus

and meconium ileus, in infants groin hernia, intussusception and Meckel’s diverticulum, whereas in young adults and adults adhesions and groin Lepirudin hernia [1]. In small bowel obstruction the normal mechanisms of intestinal absorption are compromised, so an excess of fluid loss occurs. Initially vomiting, bowel wall edema and transudation into the peritoneal cavity are present, whereas in the later stages venous pressure increases with consequent bleeding into the lumen and aggravation of hypovolemia [2]. Diagnosis is usually clinical. Main symptoms are abdominal pain, absence of flatus or stool, nausea or vomiting, dehydration, and abdominal distension if the obstruction is not in proximal jejunum [1]. Moreover the kind of pain suggests the level of the small bowel obstruction. Proximal obstruction tend to present with more frequent cramps whereas distal obstructions cause less severe cramps with longer duration between episodes. Laboratory tests show an elevated hematocrit because of intravascular volume loss.