Intestinal obstruction

Types and causes

Symptoms of intestinal obstruction

Diagnostics

Treatment of intestinal obstruction

Complications

Prevention

Intestinal obstruction is called a condition in which the passage of food masses through the intestines is disturbed. This may be a complete or partial violation of the promotion of intestinal contents.

The most at risk of developing intestinal obstruction, the following groups:

  • elderly people;
  • Persons who underwent surgery on the intestines and stomach.

Types and causes

Intestinal obstruction is divided into the following types:

  • dynamic,
  • mechanical,
  • vascular.

The type is determined by the cause of this pathological condition.

Causes of dynamic obstruction:

  • persistent muscle spasm of the intestine, which can occur with painful irritation of the intestine with worms, with acute pancreatitis, with traumatic injuries by foreign bodies;
  • intestinal muscular paralysis, which develops during surgical interventions, poisoning by morphine – containing preparations, salts of heavy metals, as a result of food infections.

In case of mechanical obstruction, there is necessarily an obstacle:

  • fecal stones, biliary tract stones, foreign body, compression of the intestinal lumen outside tumor formations and cystic formations of other organs, intestinal tumors growing into the lumen;
  • twists of intestinal loops as a result of intestinal infringement in the gates of abdominal hernia, adhesions and cicatricial processes, a node from intestinal loops.

Vascular obstruction always contributes to impaired blood supply (thrombosis, embolism) mesenteric blood vessels.

Symptoms of intestinal obstruction

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Intestinal obstruction is an acute condition, that is, all the symptoms of the disease develop quickly, within a few hours.

There are several characteristic signs of the disease:

  • pain in the abdomen;
  • stool retention;
  • vomiting;
  • violation of the discharge of gases.

Intestinal obstruction always begins with the appearance of abdominal pain. The cramped nature of the pain is due to the presence of peristaltic contractions of the intestine, which contribute to the promotion of food masses.

In the presence of torsion of the intestine, the pain is immediately intense, intolerable, constant. If there is another type of intestinal obstruction, the pain may be cramping and increase gradually in its intensity. The patient has a forced position – he presses his legs to the stomach.

Pain can be so pronounced that the patient comes pain shock.

Vomiting develops early if the patient has an obstruction in the upper intestine (small intestine), while the patient has multiple, but does not bring relief.

When obstruction in the lower intestine, it appears only with the development of general intoxication of the body, after 12-24 hours.

Violation of stool discharge and gas is especially characteristic of the lower intestinal obstruction. The patient has abdominal distension, rumbling.

If the patient is not helped, after about a day, the patient develops a general intoxication of the body, which is characterized by:

  • fever;
  • increased respiratory movements;
  • peritonitis (defeat of the peritoneum);
  • septic process (spread of infection throughout the body);
  • violation of urination;
  • severe dehydration.

As a result of general intoxication, if untreated, the patient may die.

Abdominal pain, diarrhea, constipation, flatulence, bloating …

Diagnostics

For the diagnosis of intestinal obstruction, a number of laboratory and instrumental studies are required:

  • complete blood count – there may be an increase in leukocytes during inflammatory processes;
  • biochemical analysis of blood may indicate metabolic disorders (violation of the composition of trace elements, reduced protein);
  • X-ray examination of the intestine is necessary when making this diagnosis. With the introduction of radiopaque substance into the intestinal lumen, it is possible to determine the level of development of intestinal obstruction;
  • colonoscopy   (examination of the large intestine with a sensor with a video camera at the end) helps with colonic obstruction, is used to study the small intestine –  irrigoscopy;
  • ultrasound is not always informative, since intestinal obstruction causes accumulation of air in the abdomen, which interferes with the normal assessment of data;

In difficult cases, laparoscopic examination of the abdominal cavity is performed, in which a sensor with a video camera is inserted into the abdominal cavity through a small puncture. This procedure allows you to explore the organs of the abdominal cavity and make an accurate diagnosis, and in some cases immediately carry out and treatment (inversion of the intestines, adhesions).

Differentiate intestinal obstruction is necessary with:

  • acute appendicitis (ultrasound, localization in the right iliac region);
  • perforated ulcers of the stomach and duodenum (carrying EGD, radiography with a contrast agent);
  • renal colic (Ultrasound, urography).

To clarify the diagnosis, it is always necessary to conduct additional research methods, since it is impossible to differentiate intestinal obstruction only by symptoms.

Treatment of intestinal obstruction

If an intestinal obstruction is suspected, the patient must be urgently hospitalized to the surgical department.

Important! Self-medication with anesthetics and antispasmodic drugs is not allowed.

In the early hours after the onset of the disease, in the absence of serious complications, conservative therapy is carried out.

For conservative treatment are used:

  • evacuation of gastric and intestinal contents by sensing;
  • with spasms –   antispasmodic therapy ( drotaverine, platifillin ); with paralysis – motility-stimulating drugs ( prozerin );
  • intravenous injection of salt solutions for the normalization of metabolic processes;
  • siphon enemas;
  • therapeutic colonoscopy, in which intestinal volvulus, gallstones can be eliminated.

Most often, the patient undergoes surgery, the purpose of which is to remove obstruction, remove nonviable intestinal tissues.

The following interventions are performed:

  • unwinding bowel loops;
  • adhesions dissection;
  • resection (removal) of part of the intestine followed by stitching the ends of the intestine;
  • if it is impossible to eliminate the cause of obstruction, the colostomy is applied (excretion of feces to the outside);
  • with hernias, plastic surgery is performed.

The duration and outcome of treatment is directly dependent on the cause of the intestinal obstruction, the period of initiation of treatment.

Complications

In case of delayed hospitalization, the following dangerous conditions may develop:

  • pain shock;
  • sepsis;
  • peritonitis.

Prevention

To preventive measures include:

  • timely diagnosis and treatment of tumor processes in the intestine and adjacent organs;
  • treatment of helminthic invasions;
  • prevention of adhesive processes after surgery;
  • balanced diet;
  • maintaining a healthy lifestyle.

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