Intestinal obstruction means impaired passage of food through the small and large intestines as a result of inhibition of their peristalsis. Intestinal obstruction is often the cause of symptoms such as acute abdominal pain and, if not treated properly, has a high risk of complications and mortality. What are the causes and symptoms of intestinal obstruction? What is the treatment?

Intestinal obstructionin most cases is caused by small intestine adhesions, incarceration of the abdominal hernia and colon cancer. It is worth knowing that the incidence of this disease in adults increases with age. Commonsymptoms of a bowel obstructioninclude abdominal pain, nausea and vomiting, and arrest of wind and stools.

Intestinal obstruction: breakdown

Intestinal obstruction can be divided into:

  • reason:

a) mechanical obstruction (presence of physical factors hindering the passage of food) b) functional obstruction (disturbances in intestinal motility)

  • the course and dynamics of symptom development:

a) acute obstruction (rapidly increasing symptoms, from several hours to several days) b) chronic obstruction (gradually increasing symptoms)

  • Passage Impairment:

a) full b) incomplete

  • location:

a) high (includes the section of the duodenum located peripherally from the greater papilla and jejunum) b) low (applies to the ileum and large intestine)

Intestinal obstruction: causes

a) mechanical intestinal obstruction

Mechanical obstruction is conditioned by the presence of physical factors that lead to impaired passage of food. The causes of mechanical obstruction include:

  • presence of changes in the intestinal lumen (foreign bodies, gallstones, parasites, bezoars)
  • changes in the intestinal wall (congenital atresia, post-inflammatory stenosis in the course of Crohn's disease or tuberculosis, cancer)
  • changes present outside the intestinal wall (adhesions, hernias, torsion, intussusception, congenital intra-abdominal strands, inflammatory tumors and neoplasms)

The most common mechanical obstruction is strangulation and strangulationobstruction with clogging. Strangulation obstruction is caused by an entrapment of a hernia in its gate or by adhesions of the peritoneum and usually involves the small intestine or the sigmoid colon. On the other hand, obstruction from obstruction is most often caused by colon cancer.

b) functional intestinal obstruction

Functional obstruction is caused by atony and loss of normal intestinal peristalsis in the absence of a mechanical cause. This leads to what is known as a paralytic obstruction in the case of the small intestine and its alleged obstruction in the case of the large intestine. The mechanisms of atony development are complex, but local disturbances in the plexus of the intestinal muscle membrane and disturbances between the parasympathetic and sympathetic innervation are important. It is worth knowing that atony can be either generalized or concern only a fragment of the intestine. The most common causes of functional obstruction include:

  • peritonitis
  • renal colic accompanying urolithiasis or urinary tract infection
  • biliary colic
  • presence of metabolic disorders (e.g. ketoacidosis, uremia, hypo- and hyperkalemia, hyponatremia, hypothermia, hypoxia, porphyria)
  • intestinal ischemia, drugs (e.g. anticholinergics, opioids, tricyclic antidepressants)
  • and in rare cases, diseases of the chest organs (heart attack, inflammation of the lower lobe of the lung)

Read also: Small intestine - what is its role?

Intestinal obstruction: symptoms

The characteristic triad of intestinal obstruction symptoms includes:

  • pain in the abdomen
  • nausea
  • vomiting
  • to stop winds and stool

a) mechanical intestinal obstruction

In mechanical intestinal obstruction, colic abdominal pain is usually one of the first symptoms and is characterized by a wave of acute pain followed by relief and reappearance. It is worth knowing that the frequency and intensity of consecutive seizures gradually increases, and if this type of pain subsides, and appears instead constant and dull in the mesogastrium, it may indicate a build-up of obstruction.

When it comes to vomiting, the lower the obstruction is, the less severe it is and the later it appears. In high obstruction they are persistent, abundant and usually with an admixture of bile, while in low obstruction they are foul-smelling.

In the physical examination of the patient, high perist altic tones with a metallic undertone (the so-called purring and splashing) are audible,which are especially aggravated during the period of pain. Interestingly, in the later stage of the disease, due to intestinal fatigue, the intervals between periods of increased peristalsis may be longer.

Additionally, in slim people, the so-called bowel formation, i.e. the tightening of distended intestinal loops in the phase of increased peristalsis. It is worth remembering that the rapidly deteriorating general condition of the patient may be a symptom of intestinal necrosis.

b) functional intestinal obstruction

In case of functional obstruction, the abdominal pain that occurs is severe and constant, and its location may indicate the location of the cause. The physical examination of the patient shows inaudible intestinal peristalsis - silence in the abdominal cavity. Only occasionally individual "knocking" noises are possible. In addition, symptoms of peritonitis may be present, such as muscle defense, pain when trying to cough, positive Blumberg symptom (severe and violent pain when you relieve pressure on the abdominal wall) and often an increase in body temperature.

Read also: What are the symptoms of short bowel syndrome?

Intestinal obstruction: diagnosis

The diagnosis of obstruction is based on a thorough examination of the patient and the use of additional tests, such as:

  • imaging tests - abdominal X-ray, abdominal CT scan and abdominal ultrasound. They are very important because they allow to confirm the clinical diagnosis and determine the type of obstruction
  • endoscopic examination
  • morphology
  • peripheral blood chemistry

a) mechanical intestinal obstruction

In mechanical obstruction, the abdominal X-ray - performed standing up or in severely ill patients lying down - may show fluid levels in the distended bowel loops - it is related to a slower flow of intestinal contents, which causes separation of the liquid and gaseous fractions. Short fluid levels, a high diaphragm position, and a collapse of the large intestine are characteristic of mechanical obstruction of the small intestine. On the other hand, in mechanical obstruction of the large intestine, there is distension in the sections of the colon above the obstruction with the typical bulging of the walls and the formation of folds. In addition, the fluid levels in the colon are less numerous but longer than those in the small intestine. Abdominal CT scan can pinpoint the underlying cause and level of the obstruction, as can colon endoscopy. In the blood count, as dehydration worsens, hematocrit and red blood cell count increase, and if intestinal necrosis occurs, leukocyte count increases.In addition, mechanical obstruction may be evidenced by water and electrolyte disturbances, renal failure and acidosis.

b) functional intestinal obstruction

In functional intestinal obstruction, ultrasound of the abdominal cavity may reveal free fluid in the peritoneal cavity, deposits in the bile ducts and urinary tract, as well as changes in the gallbladder and pancreas. On the other hand, an abdominal X-ray may show air in the free peritoneal cavity, which indicates a perforation of the gastrointestinal tract.

Blood counts show an increase in leukocytes and percentage of neutrophils as a result of peritonitis. In addition, there is an increase in hematocrit and an increase in the number of erythrocytes as a result of progressive dehydration. In special situations, when the cause of the obstruction cannot be determined, laparoscopy is performed.

Intestinal obstruction: treatment

Suspicion of obstruction, both mechanical and functional, always requires a surgeon's consultation. In the case of mechanical obstruction, it is extremely important to diagnose and treat it quickly to avoid the risk of strangulation. It is worth remembering that treatment depends on the cause. For example, if the cause of the intestinal obstruction is a colon tumor, it should be excised and then anastomosed. If the cause is a trapped hernia, it is drained and then plastic surgery is performed. On the other hand, adhesions intersect. It is important that the patient is properly prepared for the surgery - the resulting hypovolemia and electrolyte disturbances should be corrected, an intravenous antibiotic should be administered and the gastric contents must be aspirated.

Failure to treat it may lead to dehydration, hypotension, shock, multi-organ failure, and ultimately death.

In functional intestinal obstruction, treatment is directed to the underlying disease causing the symptoms (e.g. acute pancreatitis, peritonitis). Conservative management is recommended in the case of a metabolic cause and in some cases of renal and biliary colic - then analgesic treatment is applied. In other situations, it is advisable to open the abdominal cavity and appropriate surgical procedures. Before the procedure, it is also necessary to treat shock and to prevent kidney failure.

Probe

Category:

Gastrology