Intestinal obstruction - types, symptoms, causes, treatment, operations, rehabilitation

Intestinal obstruction is a complete or partial disruption of the movement of contents through the intestines and is a disease of mechanical origin.

What is intestinal obstruction?

Most often, obstruction of the small intestine is associated with the formation of adhesions and hernias.
The main cause of colon obstruction is colon cancer.

Intestinal obstruction of all types is characterized by the main pathological signs:

• intestinal dilatation,
• loss of fluid and electrolytes,
• dyspnea,
• tachycardia.

Poor circulation in the intestinal wall significantly complicates intestinal obstruction. The result is bleeding. In this regard, the success of treatment depends entirely on the timing of the operation and the volume of blood replacement therapy.

With intestinal obstruction, peristalsis visible to the eye appears. It is accompanied by high-pitched ringing sounds with a metallic tint, often gurgling, reminiscent of the sound of water pouring out of a bottle. Simultaneously with peristaltic waves, abdominal pain occurs or intensifies.

Peristaltic sounds are absent with peritonitis, in the postoperative period and with paralytic obstruction.

Types of intestinal obstruction

All types of intestinal obstruction can be divided into two main groups:

• mechanical , which in turn can be obstructive (blockage of the intestine) and strangulation (impaired blood circulation in the intestine),
• dynamic or physiological.

Mechanical obstruction

The causes of mechanical obstruction may be:

• blockage of the intestinal lumen,
• twisting (volvulus) of the intestine,
• intestinal strangulation.

The earliest symptom of mechanical obstruction is a sharp dilation of the middle sections of the intestine.

Obstructive obstruction (blockage)

In the case of obstruction (blockage) of the intestinal lumen, disruption of the movement of intestinal contents is its main manifestation. There are high (small intestinal) and low (colon) obstructive obstruction.

The main symptoms of any obstruction (blockage) of the intestine:

• pain,
• vomit,
• lack of stool.

Types of pain . Pain is the earliest characteristic sign of intestinal obstruction. Usually it is very strong, cramping. Periodic cramping pain is the result of intestinal expansion and contractions.

If the pain is chronic, this may indicate a gradual narrowing of the intestinal lumen.

Constant severe pain may be a sign of the development of strangulation (compression of blood vessels), perforation, or peritonitis.

Pain from small bowel obstruction is most often localized in the upper or middle abdomen.

Colonic obstruction is manifested by pain in the lower abdomen or in the projection of the colon.

Character of vomiting . Vomiting is another important sign of intestinal obstruction. The time at which vomiting begins depends on which part of the intestine the obstruction occurs in. The lower it is (closer to the rectum), the later vomiting appears. In cases of colonic obstruction, vomiting may be absent or appear late, depending on the normal functioning of the ileocecal valve.

The characteristics of vomit are determined by the localization of obstruction, the degree of cessation of motility, bacterial growth, and putrefactive processes in the intestines. The nature of the vomit is important for preliminary diagnosis.

The lower the pathological process is located, the more often the vomit has a fecal odor.

Lack of stool . A persistent absence of stool and gas is a sign of cessation of bowel function. Depending on the level of obstruction and the amount of contents in the distal part of the intestine, constipation can be partial or complete.

Obstructive small bowel obstruction

Symptoms of high intestinal obstruction manifest themselves in the form of early severe vomiting of gastric contents and bile. Since the rest of the intestine is practically empty, there is no bowel movement.

With obstruction of the small intestine, the absorption of water and electrolytes worsens and at the same time secretion increases. As a result, peristalsis is disrupted and all intestinal functions are disrupted. It accumulates a large amount of fluid coming from the blood. The intestine is stretched, absorption from the stretched segment stops. The contents quickly become infected with microbial flora and become a source of toxins.

If the intraintestinal pressure reaches the level of blood pressure, then the microcirculation of the intestinal wall is disrupted and gangrene of the intestinal wall occurs. Through the wall affected by gangrene, fluid rushes into the abdominal cavity. In order to prevent peritonitis and reduce intoxication, it is very important to quickly remove this fluid from the abdominal cavity.

Obstructive colonic obstruction

Symptoms include progressive constipation, abdominal pain and flatulence, and vomiting that smells like feces or fecal matter.

The cause of this type of obstruction in most cases is carcinoma.

The diagnosis is established based on sigmoidoscopy data.

Strangulating obstruction

Strangulated intestinal obstruction is a combination of obstruction with impaired blood supply in the intestinal loop as a result of intestinal strangulation or volvulus.

The main causes of this type of obstruction are:

• strangulated hernia,
• intussusception,
• adhesions,
• volvulus,
• tumor,
• gallstone.

Mechanical obstruction can be caused by foreign bodies.
It can be caused by food lumps that form after a heavy meal, especially sauerkraut, pasta, or the ingestion of fruit seeds, oranges, etc. Often such a foreign body is gallstones if they reach a size of 2-2.5 cm.

Gallstones are formed during cholelithiasis. This disease develops more often in middle-aged and elderly women if they have had attacks of hepatic colic or exacerbation of cholecystitis in the past. In this case, an attack of obstruction is similar to another biliary colic, which complicates diagnosis. Therefore, in case of such attacks, you should immediately consult a doctor.

Symptoms of strangulation

During strangulation, a significant amount of fluid moves into the abdominal cavity along with blood. As a result, the pulse rate increases as peritonitis or other complications worsen.

With obstructive obstruction, blood pressure and respiratory rate do not change in the early stages, there is no tension in the abdominal muscles and no pain on palpation. When these symptoms appear in combination with fever, tachycardia and leukocytosis, strangulation should be assumed.

Volvulus

In this case, the intestine twists around itself.

The reason for this may be the anatomical features of the mesentery, chronic constipation, and consumption of large quantities of rough food. This disease occurs more often in men than in women.

Symptoms begin to appear sharply:

• sudden abdominal pain
• rapid increase in bloating,
• vomiting is uncharacteristic
• There may be a small amount of blood in the stool.

In the case of small intestinal volvulus, gangrene quickly sets in, so early diagnosis and emergency surgery are of great importance.

If the sigmoid colon is torsioned, an attempt is made to straighten it using a colonoscope.
If this can be done, then rapid improvement occurs. If this cannot be done, then immediate surgery is needed.

Intussusception

Intussusception is the insertion of one section of the intestine into another.

Most intussusceptions (85-89%) occur in infants aged 4 to 10 months. Boys get sick more often.

The following types are distinguished:

1. Small intestinal intussusception . Invasion of the small intestine into the small intestine (20-25% of all cases).
2. Small-colic intussusception . Invasion of the small intestine into the cecum (50-65%), and in children – 85%.
3. Colon-colic intussusception . Invasion of the colon into the colon (10%).

In most adults, the cause of intussusception is a benign or malignant intestinal tumor.

In children, intussusception occurs during the transition from breastfeeding to mixed feeding, but the specific cause remains unknown.

Symptoms of acute intussusception

In acute intussusception, three main symptoms appear:

• sudden severe pain of a cramping nature,
• bloody discharge from the rectum with the development of collapse,
• a tumor-like formation of a spherical or sausage shape, determined by palpation of the abdomen.

Chronic intussusception

Chronic intussusception is rare but can develop at any age. When part of the intestine is introduced, the lumen is not completely blocked and food continues to move through the narrow opening.

Obstruction manifests itself in attacks that can end on their own.

Treatment of chronic intussusception

In adults, treatment is surgical.

In children under 5 years of age, you can try to eliminate intussusception with a barium enema. If this fails, then surgical treatment is necessary.

Dynamic (functional) intestinal obstruction

Dynamic intestinal obstruction develops as a result of paralysis or sharp spasm of the muscular lining of the intestinal wall. Depending on this, paralytic (adynamic), spastic obstruction and motor dysfunction with an unidentified cause (intestinal pseudo-obstruction) are distinguished.

Dynamic intestinal obstruction develops reflexively with severe pain of various origins, stress, and metabolic disorders.

It is characterized by an enlarged abdomen, absence of peristaltic sounds and abdominal pain. Treatment depends on the cause of the obstruction.

There are many reasons for the development of dynamic obstruction.

Causes of paralytic obstruction

• Peritoneal injuries
• peritonitis,
• acute pancreatitis, early,
• pneumonia,
• diabetes,
• infections,
• myocardial infarction,
• spinal injuries and diseases,
• hepatic and renal colic.

Paralytic obstruction can develop as a result of severe abdominal pain of any origin.
The main sign is an enlarged abdomen and the absence of peristaltic sounds. Bloating can be severe, the abdomen is symmetrical. On palpation, the abdominal wall is soft and painless.

Elimination of obstruction can be facilitated by electrical stimulation of the intestine with special devices.

Spastic intestinal obstruction

Spastic obstruction occurs due to strong, prolonged spasm of the intestines. This type of obstruction is much less common than paralytic obstruction.

Causes of spastic obstruction:

• hysteria,
• nicotine overdose,
• worms,
• food allergy.

Treatment in this case consists of eliminating the spasm and the cause of the spasm.

Intestinal pseudo-obstruction

Intestinal pseudo-obstruction is an obstruction associated with impaired intestinal motility, the causes of which have not been established.

There are hereditary pseudo-obstruction and its secondary forms.

Secondary pseudo-obstruction develops in various diseases that can damage the muscles of not only the intestines, but also the internal organs.

Diagnostics

During the interview, the doctor needs to obtain information about previous diseases and operations, the presence of blood in the stool, previous diagnoses (Crohn's disease, tuberculosis), as well as the use of medications that can affect intestinal motility.

The most important symptoms during examination are bloating, the intensity of peristaltic sounds and the degree of dehydration of the patient. Hernias and adhesions of the abdominal cavity account for 50% of the causes of all cases of intestinal obstruction.

The main diagnostic method is x-ray examination.

A general X-ray of the abdominal cavity allows you to:

• confirm obstruction
• establish its localization in the small and large intestine,
• distinguish mechanical obstruction from paralytic obstruction.

To clarify the diagnosis, in some cases, an X-ray examination with a contrast enema (irrigoscopy) is performed.

• digital examination of the rectum,
• sigmoidoscopy,
• colonoscopy.

Before performing a colonoscopy, preparation is carried out - 3 regular enemas of 1.5 liters each are given, with an interval of 30 minutes.

Treatment

Acute intestinal obstruction is an emergency disease; strangulation obstruction indicates an even more urgent situation. In these cases, surgical treatment is necessary.

Treatment goals:

• correction of water and electrolyte abnormalities
• elimination of obstruction
• constant suction of contents from the intestine and prevention of its overstretching.

The main goal is the prompt elimination of intestinal obstruction. An exception may be adhesive obstruction and partial obstruction in Crohn's disease. In these cases, it can be restored using intranasal intubation with a special probe.

Forecast

Thanks to early diagnosis, improvement of complex therapy and timely operations, mortality has decreased in recent decades. The success of treatment is influenced by factors such as:

• patient's age,
• causes,
• localization of obstruction,
• complications.

Attention!

Intestinal obstruction is a very ominous sign. The patient’s life depends on the speed of diagnosis and surgical treatment. At the first signs, you should immediately consult a doctor.