Straining of the intestine is one of the acute diseases of the abdominal organs. Symptoms appear suddenly and are usually so severe that the patient does not wait to report to the doctor, and in this case the surgical consultation usually ends with surgery.

Intestinal stiffnessis a mechanicalintestinal obstruction . Intestinal obstruction is a phenomenon in which intestinal peristalsis is inhibited, which stops the passage of food. The cause of obstruction can be divided into mechanical and functional. Strangulation of the intestine is one of the first types of obstruction, and its cause is the closure of the intestinal lumen, accompanied by the constriction of the mesentery.

The mesentery of the intestine is an organ that stabilizes the intestine and other abdominal organs, and which contains, among other things, blood vessels necessary for the proper functioning of the body.

Strangulation obstruction is most often caused by entrapment of the intestine in the hernial gates or peritoneal adhesions, which may arise, for example, as a result of various surgical procedures inside the abdomen, or as a result of inflammatory processes that take place in this area.

An inguinal hernia is the most often stuck, and the most common of internal hernias is a peripunodenal or periocular hernia that "enters" the recesses of the peritoneum. Other causes of bowel obstruction include intussusception (most often the terminal ileum) and torsion. The elderly, who overuse laxatives due to constipation, are particularly prone to torsion of the intestine. Sometimes a strangulation obstruction is the first symptom of a developing cancer process that leads to the formation of adhesions and "sticking" of intestinal loops.

Strangulation of the intestines: pathomechanism

In the event of a strangulation, blood is initially correctly supplied to the intestine through the artery, but it is blocked from flowing out through the vein. Venous blood gradually accumulates in the vessels, fluid leaks into the extravascular space, which causes the intestine to "swell" and, over time, to completely close the hernia gate. Ultimately it leads toischemia and necrosis of a given section of the intestine. Necrosis usually takes about 6-10 hours. Extravasated fluid can rapidly multiply bacteria, which then enter the peritoneal cavity due to the damaged tissue barrier, causing it to become inflamed. Infection can spread, causing sepsis, which is a direct threat to the patient's life.

Symptoms of stiff bowel

Stuffing the intestines is associated with the so-called "sharp abdomen". Common symptoms for this condition are:

  • stomach ache
  • nausea
  • vomiting
  • gas and stool retention.

Abdominal pain is the earliest symptom. Initially, it is paroxysmal, colic in nature, and periodically increases and decreases. When there is a constant, dull pain in the abdomen, it indicates a build-up of the obstruction. Nausea and vomiting are typical of obstruction, and their severity and nature largely depend on its cause. They appear relatively early in haemorrhage and are more severe in severe obstruction. If the obstruction continues, so-called fecal vomiting may occur. Most often, they are not vomiting with fecal content in the strict sense, but with content in which putrefactive processes have already taken place. As the infection continues in the abdomen, a generalized inflammatory reaction of the body develops, fever appears.

On physical examination, the abdomen may be soft at first, and the pain may be diffuse and dull. If peritonitis occurs, peritoneal symptoms and muscular defense will appear. Sometimes the symptom of "bowel formation" can be seen through the abdominal wall as the perist altic wave travels through the distended stretch. Typical for mechanical obstruction is an audible metallic peristalsis, which may disappear completely with time.

Diagnosis of stiff bowel

Strangulation of the intestines should always be considered in the differential diagnosis of acute abdominal conditions. In this case, among others, an X-ray examination of the abdominal cavity is ordered, which will visualize distended intestinal loops with fluid levels (they are formed as a result of the separation of the intestinal contents into gaseous and liquid content). Ultrasound examination can sometimes be helpful in determining the level of obstruction and assessing vascular flow, but it is significantly hampered by the distension of the intestinal loops. Computed tomography of the abdominal cavity is a very good and useful examination in case of bowel strangulation, as it will show the cause and place of the obstruction most accurately. It is sometimes necessary to perform diagnostic laparoscopy orlaparotomy.

Treating a strangulation obstruction

Treatment of intestinal obstruction depends on its cause, but in practice it always ends on the operating table, as it is the only effective method of treating mechanical obstruction. First of all, the patient's condition should be stabilized, mainly by balancing the electrolyte balance and adequate hydration. It is also important to implement appropriate antibiotic therapy. A sharp abdomen is an indication for laparotomy. In some cases, simply reversing the cause of the obstruction is not enough, and it is necessary to remove the dead intestine.

Category:

Gastrology