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Closed loop obstruction is a type of mechanical intestinal obstruction where a segment of bowel is obstructed at two points along its course, creating a “closed loop” with no proximal or distal outlet. It carries a high risk of strangulation, ischemia, and perforation.

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Etiopathogenesis

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Mechanism: Entrapment of a bowel loop between two obstructing points (e.g., adhesions, hernia or volvulus).

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Pathophysiology:

• Trapped segment accumulates gas and fluid.
• Intraluminal pressure rises rapidly → venous congestion → arterial compromise → ischemia → gangrene → perforation.
• Risk of rapid progression compared to simple obstruction.

Common Causes

• Adhesions (most common, esp. post-surgical).
• Hernias (inguinal, femoral, internal).
• Volvulus (sigmoid, cecal, midgut).
• Congenital bands.
• Intussusception (rare cause in closed-loop form).

Clinical Features

• Severe, colicky abdominal pain.
• Abdominal distension (localized or diffuse).
• Persistent vomiting (bilious/feculent).
• Obstipation.