Intestinal obstruction in adults. Causes, symptoms and treatment

Intestinal obstruction is a serious pathological process, which is characterized by a disruption in the process of exiting substances from the intestines. This disease most often affects people who are vegetarians. There are dynamic and mechanical intestinal obstruction. If the first symptoms of the disease are detected, you must go to the surgeon. Only he can accurately prescribe treatment. Without timely medical help, the patient may die.

Reasons for formation

Intestinal obstruction can be caused by the following mechanical reasons:

• strangulated hernia;
• formation and blocking of the lumen by adhesions, the development of which occurs after surgery on abdominal cavity;
• intussusception of the intestinal wall, resulting in the retraction of one section of the intestine into another;
• colon cancer or neoplasm on a nearby organ;
• volvulus and nodulation;
• obstruction of the intestinal lumen by fecal or gallstones, worms, foreign bodies;
• inflammatory diseases of the abdominal organs;
• anterior hernia abdominal wall.

Dynamic intestinal obstruction forms immediately after surgery on the abdominal cavity, in case of poisoning or the presence of peritonitis.

What are the signs of the disease?

Symptoms of intestinal obstruction begin with painful sensations in the abdominal area, which are sharp, cramping and increasing in nature. This condition contributes to the formation of nausea and vomiting. After some time, the contents of the intestine are sent to the stomach, as a result of which the vomit acquires an odor characteristic of feces. The patient is concerned about constipation and flatulence. At the initial stage of the disease, intestinal motility is preserved and can be observed through the abdominal wall. A characteristic signal of the formation of intestinal obstruction is an increase in the size of the abdomen and an irregular shape.

During patient diagnosis, it is possible to detect following signs intestinal obstruction:

• increased heart rate;
• a fall blood pressure;
• dry tongue;
• enlarged intestinal loops filled with gas and liquid;
• temperature increase.

How does acute intestinal obstruction manifest?

Acute intestinal obstruction develops suddenly. As a rule, it manifests itself according to the symptoms of intestinal dysfunction. As a result, the patient experiences the following symptoms:

• pain syndrome;
• flatulence and rumbling stomach;
• constipation and diarrhea;
• nausea and vomiting;
• increased peristalsis and shock.

Acute intestinal obstruction can have very diverse symptoms, and they depend on the level of obstruction of the affected organ. The presented symptoms rarely bother a person all at once, so the absence of any of them does not exclude the presence of the presented pathology. Therefore, let's look at them in more detail.

The pain syndrome is pronounced from the very beginning. As a rule, the pain is concentrated in the pit of the stomach, around the navel. Her character is spasmodic.

Vomiting is the most constant sign acute intestinal obstruction. Increased vomiting is observed if the obstruction in the intestines is located high. If there is obstruction of the colon, then this symptom will be absent, but nausea remains. At first, the vomit consists of the contents of the stomach, and then it acquires a yellowish tint, gradually becoming green and greenish-brown.

Constipation is a late manifestation of the disease, since the first time after the development of obstruction, a reflex emptying of the underlying sections occurs. Thus, the illusion of normality is created.

Acute intestinal obstruction is accompanied by large losses of fluid and electrolytes during vomiting, and intoxication with stagnant intestinal contents. With absence effective therapy The patient experiences increased heart rate and decreased blood pressure. Such symptoms of intestinal obstruction indicate the onset of shock.

Manifestations of adhesive obstruction

Adhesive intestinal obstruction, which is assumed by the classification of the disease, is a violation of passage through the intestines, which can be caused by adhesions in the abdominal cavity. The presented pathology is considered the most common. Today there is a tendency to increase its frequency, as a large number of abdominal surgeries are being performed.

Adhesive intestinal obstruction and its classification involves the following forms of the disease:

• obstruction;
• strangulation;
• dynamic intestinal obstruction.

In the first form of the disease, compression of the intestine by adhesions occurs, but its blood supply and innervation are not disrupted.

With strangulation intestinal obstruction, adhesions put pressure on the intestinal mesenteries. The result of this process is necrosis of the affected organ. The classification of strangulation intestinal obstruction involves 3 types: volvulus, nodulation and pinching.

Volvulus is noted in those parts of the organ where the mesentery is present. The main reasons for its formation are scars and adhesions in the abdominal cavity, fasting with further filling of the intestines with rough food.

This form of strangulation intestinal obstruction, such as nodulation, is formed at any level of the small and large intestines where the mesentery is present. The reasons for the formation of a pinch ring are based on pinching sigmoid colon.

Symptoms of paralytic ileus

The presented type of disease manifests itself in the form of a progressive decrease in the tone and peristalsis of the intestinal muscles. This condition can lead to complete paralysis of the affected organ. It can affect all parts of the gastrointestinal tract or be concentrated in one.

Paralytic ileus has the following symptoms:

• uniform bloating;
• pain;
• vomit;
• retention of stool and gases.

The pain syndrome affects the entire abdominal area, has a bursting character and does not radiate. The patient vomits repeatedly, first with gastric and then with intestinal contents. If there is diapedetic bleeding from the wall of the intestine and stomach, acute ulcers of the digestive tract, then the vomit is hemorrhagic in nature. Severe flatulence causes chest breathing. Patients are diagnosed with tachycardia, low blood pressure and dry mouth.

How does the disease manifest in children?

Intestinal obstruction in newborns can occur due to a malformation of the organ:

• lengthening or narrowing of a certain section of the intestine;
• individual location or rotation of the intestinal loop, which helps to delay the movement of intestinal contents. Characteristic manifestations are bloating, gases and constipation.

In infants, there is a specific type of disease - intussusception. It is characterized by inversion of part of the intestine and insertion into another. As a rule, this pathology is diagnosed in children 5–10 months old. In children one year and older, this disease is rarely detected. The main reasons for the formation of this phenomenon are the immaturity of the peristalsis mechanism and the mobility of the colon.

Abrupt disruptions in the diet in children can provoke disturbances in peristalsis. early age, initiation of complementary feeding and infection. The following symptoms are characteristic of intussusception:

• frequent attacks of abdominal pain;
• vomit;
• instead of feces bloody issues with mucus from the anus;
• the children are very restless and cry constantly;
• the end of the attacks occurs as suddenly as their beginning.

Infants may be diagnosed with dynamic intestinal obstruction in the form of spasms or paralysis. The reasons for this pathology are immaturity digestive system against the background of operations, intestinal infections, pneumonia.

Stages of the disease

A disease such as intestinal obstruction develops in three stages:

1. Initial – its duration is 2–12 hours, accompanied by pain in the abdomen, flatulence and increased peristalsis.
2. Intermediate – lasts 12–36 hours. The pain syndrome decreases, a period begins imaginary well-being, meanwhile, signs of dehydration and intoxication are increasing.
3. Terminal – occurs 2 days after the formation of the disease. The patient's condition worsens significantly, there is an increase in signs of damage to internal organs, dehydration and damage to the nervous system.

Diagnostic methods

The main methods of diagnosing this disease are an X-ray examination of the abdominal organs and a blood test. Ultrasound may be used as an addition.

In the case of an objective examination, the patient’s tongue should be dry, covered with a white coating, and uneven bloating.

Therapy

When a patient has been diagnosed or suspected of intestinal obstruction, he requires urgent hospitalization in surgery department. If there is a rapidly occurring, progressive, catastrophic dehydration, then urgent treatment of intestinal obstruction is necessary. Such therapeutic measures should be carried out, whenever possible, while the patient is being transported. Until he is examined by a doctor, he is prohibited from giving laxatives, painkillers, enemas, or gastric lavage.

In the hospital in absence severe symptoms mechanical obstruction, intestinal obstruction is treated, which includes a number of measures:

1. Suctioning the contents of the stomach and intestines through a thin probe inserted through the nose.
2. In case of increased peristalsis, antispasmodics are prescribed.

If there is mechanical obstruction and conservative therapy does not give the desired result, then you need to execute emergency surgery. It includes:

• dissection of adhesions;
• unwinding of the torsion;
• deintussusception;
• resection of the intestine with its necrosis;
• overlay intestinal fistula for the purpose of releasing intestinal contents during colon neoplasms.

The postoperative period includes all the same measures that are aimed at normalizing water-salt and protein metabolism. For these purposes they use intravenous administration saline solutions, blood substitutes. Anti-inflammatory treatment and stimulation of the motor-evacuation function of the gastrointestinal tract are also carried out.

Intestinal obstruction is a very insidious disease, which, if timely treatment is not carried out, will lead to death. Very often, the only method of therapy is surgery, after which the patient must perform a series of measures aimed at restoring the body.

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Intestinal obstruction is a complex of symptoms characterized by congestion gastrointestinal tract chyme ( semi-digested food masses).

Causes of intestinal obstruction

All causes of this syndrome are divided into two categories: mechanical and functional.

Mechanical reasons:

• Violation of the structure of the peritoneum, internal organs of the abdominal cavity
• Congenital bands of peritoneum
• Violation of formation intestines
• Volvulus of one of the intestinal sections
• Reduced intestinal lumen due to neoplasm, endometriosis, vascular diseases
• Neoplasms
• Inflammation
• Entry of foreign elements into the intestines
• Intestinal obstruction
• Hematoma ( more dangerous when taking drugs that prevent blood clotting and hemophilia)
• Meconium
• Feces, gallstones, bezoars
• Accumulation of worms

Factors contributing to the development of mechanical obstruction:

• mobile cecum
• presence of peritoneal pockets
• abdominal adhesions
• increase in the length of the sigmoid colon ( typical for older people).

Functional reasons:

• Spasms
• Paralytic phenomena
• Pseudo-obstruction of the intestine
• Hirschsprung's disease.

Factors contributing to the development of functional type obstruction:

• A sharp increase in the share of fresh fruits and vegetables in season
• Overeating after a long fast
• Transfer of infants under one year of age to adapted milk formulas.

Adhesive intestinal obstruction

A fairly common form of the disease, observed in a third of cases of obstruction. This form of intestinal obstruction develops when adhesions form in the abdominal cavity, compressing the intestines ( obstructive form), and also if the intestinal mesentery is compressed by adhesions ( strangulation form).
The presence of adhesions often leads to volvulus. This type of obstruction often returns frequently: as soon as the amount of food consumed exceeds the norm, the patient begins to feel pain. The intestinal walls are stretched, the muscles stop contracting fully, and the chyme does not move forward.

Treatment is usually conservative, but sometimes it is necessary to resort to surgery.

Partial intestinal obstruction

According to the nature of the movement of food masses, obstruction is divided into complete and partial.

Small intestinal obstruction

Causes:

• Entry of foreign objects into the intestines
• Intestinal torsion, hernia, volvulus
• Malignant neoplasm ( lymphosarcoma, adenocarcinoma).

Symptoms:

• Food aversion
• Anxiety
• Epigastric pain
• Vomit
• Dehydration.

What to do?
Visit a doctor and find out the cause of the ailment.

Colon obstruction

Causes:

• Organic diseases of the large intestine
• Spasms, atony, coprostasis.

Symptoms:

• No defecation occurs
• Acute paroxysmal pain
• Food aversion
• Flatulence

What to do?

• Take a laxative
• Give an enema
• Attend a doctor's consultation.

Symptoms of intestinal obstruction

• Cramping pain appears suddenly, the duration of one episode is about 10 minutes. May not pass ( if the intestinal muscles are exhausted, if the pain is of strangulation etiology). Most often, after 2–3 days the pain disappears, but this does not indicate recovery, but a complete “switching off” of intestinal motor function.
• Does not remove gases and feces.
• The abdomen is “distorted” and swollen.
• Vomiting can be repeated. Appears faster if the congestion is high.

In addition to the signs described above, there are also a large number specific symptoms, which only a specialist can detect. For example, when listening to the abdominal cavity, a doctor may hear characteristic gurgling sounds or their complete absence, and feel specific intestinal swellings.

Diagnosis of intestinal obstruction

Diagnostic methods used for intestinal obstruction:

• Examination, auscultation and palpation of the patient's abdomen
• Patient interview
• X-ray of the abdomen ( sometimes using barium contrast agent)
• Irrigoscopy ( with obstruction of the colon)
• Ultrasound examination

Treatment of intestinal obstruction

In case of acute mechanical intestinal obstruction, treatment is carried out only in the hospital.
If the patient develops peritonitis, surgery is prescribed. Otherwise use conservative methods treatments: enemas, gastric tube, drugs that relieve pain, droppers to remove toxins from the blood.

If the patient begins to excrete gases and feces, pain is relieved, an x-ray with a contrast agent is prescribed, showing positive changes.
If improvement does not occur within 12 hours, surgery is prescribed.

Surgery for intestinal obstruction

During the operation the following actions are carried out:
1. The obstacle preventing the advancement of chyme is removed. If the small intestine is operated on, a resection is usually performed, completely restoring patency. In some cases, a series of two or three interventions has to be done.
2. All segments of intestine with dead tissue must be completely removed. IN in this case It is better to remove a little extra than to leave the affected areas of the intestine.
3. Before intervention, the patient is prepared with antibiotics wide range action, which is poured into a vein half an hour before the intervention.

In some diseases, for example, Crohn's disease in the acute stage or peritoneal carcinomatosis, patency is restored by installing a special type of probe ( to unload the intestines), as well as the use of medications.
In children with intussusception ( a special form of obstruction characteristic of young children) Barium enemas are also effective.

Intestinal obstruction in newborns

It's very hard and dangerous condition for a newborn.
Causes:

• Mechanical ( congenital and acquired)
• Neurohumoral.

Congenital intestinal obstruction in children can make itself felt immediately after the baby is born or a little later. Disorders of intestinal development begin in the first month of intrauterine development.

Developmental defects leading to intestinal obstruction in newborns:
1. Isolated midgut volvulus
2. Clamping duodenum cecum
3. Ledd's syndrome.

Obstruction may also be due to meconium impaction ( original feces) for cystic fibrosis.
Congenital obstruction can occur in acute, chronic or recurrent form.

Symptoms:
1. Vomiting from the first day of life with an admixture of bile, after eating
2. Major weight loss due to fluids ( up to 300 grams per day)
3. Bloating in the upper part of the abdomen
4. At first the baby is quite calm, but gradually becomes more and more capricious, kicks his legs, and does not eat.
5. The skin takes on a grayish tint.

Diet for intestinal obstruction

The most important condition for maintaining the patient’s well-being is a well-formulated diet. If the patient often suffers from constipation, foods that improve intestinal motility should be introduced into the diet ( foods rich in plant fibers). In the same case, if this does not help, you should try using mild laxatives ( e.g. Epsom salts, senna leaf). You should eat at the same time every day. You should not allow too long intervals between meals. Just like you should not eat too much food at one time.

Products recommended for regular consumption for obstruction: beets, seaweed, vegetable oils, carrot.
It is advisable to exclude from the diet foods that provoke active gas formation ( cabbage,

Intestinal obstruction occurs more often in adults and older people. If symptoms of this disease appear, you should not ignore them and self-medicate. Medical intervention is necessary to determine the causes and determine treatment.

Intestinal obstruction is a process in which digested food does not move through the intestines. An obstruction occurs that causes feces to accumulate in the body. Such accumulation is dangerous due to the appearance of new microorganisms. During their life they produce harmful substances, which enter the organs through the blood and poison them.

How to distinguish constipation from intestinal obstruction?

When a person is constipated, a number of symptoms occur:

When the body cannot get rid of feces, a blockage has formed somewhere. This is why constipation is a symptom of obstruction.

Intestinal obstruction (symptoms in adults may vary depending on the type of illness) occurs with the first symptoms as in constipation, with the addition of new ones:

• Severe abdominal pain. They are accompanied by painful cramps in the abdomen. They arise abruptly, and there is no clear understanding of the location of the pain.
• Partial swelling. There is a clear swelling of a certain part of the abdomen where the obstruction has formed.
• Nausea and vomiting. This happens due to poisoning of the body. Long-term intoxication of the body can worsen the patient’s condition and contribute to death.

Constipation indicates the presence of partial obstruction. The main difference is that constipation is a more tolerant form of obstruction that can be treated with medication.

Types of intestinal obstruction

View	Characteristic	Classification
Acute	Impaired release of digested food from the stomach to the anus. This is a collective term that combines a number of intestinal diseases in a complicated form. Requires mandatory medical intervention, if left untreated, death is possible.
Partial	Occurs when the passage of feces through the intestines is disrupted; this process is chronic. The reasons for its occurrence may be related to: neoplasm, postoperative period or adhesive disease.	The disease occurs in a periodic manner. At the time of exacerbation, the following appears: increased accumulation of gases, stool disturbances, painful sensations, nausea.
Paralytic	There is a deterioration in the functioning of the intestinal muscles and a decrease in tone, and complete paralysis is also possible. This situation does not arise on its own; it appears due to a number of serious diseases.	The disease occurs in several directions: Complete paralysis. Partial. Occurs in one area, in rare cases in several areas at once.
Obstructive	Poor output of intestinal contents that does not involve the mesentery. Compression occurs in the intestinal tube due to factors acquired during life.	Blockage occurs due to the impact of a foreign body. It forms both inside the intestine (fecal or gallstones, tumors) and outside (cyst, tumor). Partial Complete
Mechanical	A closure of the intestinal tube is created in a separate area, blocking the exit of intestinal contents.	Strangulation. A certain area is involved in this process, where blood circulation is disrupted due to a volvulus or intestinal knot. This leads to a sharp deterioration in the patient’s condition, and gangrene develops within a few hours. An obstruction (blockage) is formed due to an obstruction, the section of the intestine above it suffers secondarily from poor blood flow caused by strong stretching due to feces. This process can cause death of intestinal tissue within a few days. Congestion occurs in a variety of ways various reasons, For example: malignant tumors, gallstone or foreign body. A mixed appearance occurs when one part of the intestine enters another, and the intestinal mesentery is involved in this process.

Causes

Intestinal obstruction can occur for various reasons.

For ease of initial diagnosis, they are divided into groups:

• The list is large, it includes all diseases that provoke changes in the surface of the intestinal tube, resulting in internal obstruction.

It includes diseases such as:

• Diseases of the second group can cause poor blood flow in the intestinal tissues.

This group includes, for example:

1. intestinal volvulus;
2. intestinal hernia (internal, external);
3. entry of one part of the intestine into another (intussusception).

• The third group includes diseases that cause disruption of the nerves in the intestinal tissues.

These include:

1. stroke;
2. injury;
3. hyperocalea.

• The fourth group includes pathologies caused by external influences on the intestines, due to which it is compressed.

For example:

The list of causes of intestinal obstruction includes the 10 most common diseases:

1. intestinal tumors;
2. abdominal diseases;
3. hypokalemia;
4. stroke;
5. surgical operations in the abdominal area;
6. fecal and gallstones;
7. the appearance of hernias (external, internal);
8. non-standard intestinal development;
9. mesenteric diseases;
10. the formation of cysts in and near the intestines.

Symptoms of intestinal obstruction in adults

Intestinal obstruction (symptoms in adults proceed mainly according to one development pattern) has its own special symptoms.

Initially, the first main symptoms appear:

After a day without treatment, complications appear, the list is added with new symptoms:

• strong contraction of the intestines (peristalsis);
• bloating due to accumulated gases and feces in the intestines. The belly becomes more solid form, different from the previous form;
• strong rumbling and noise appears;
• dehydration appears;
• dry mouth.

If for any reason treatment was not started after the appearance of all symptoms, then after 3 days the patient’s condition worsens significantly:

• accumulated masses poison the body and cause intoxication;
• fever appears;
• a state of shock may occur.

It is important to remember that the sooner the doctor begins treatment, the greater the chance of a positive outcome. And also some symptoms differ in their expression from other diseases, thanks to this you can suspect it as early as possible presence of intestinal obstruction:

Stages

Stage	Characteristic	Symptoms	Stage duration
Initial (ileus scream)	Manifested by pronounced abdominal pain	Abdominal pain with cramps; Reduced pressure; Pale skin; Frequent heartbeat; Abundant number of breaths.	Until 12 – 16 hours
Intoxication	Poor circulation and the appearance of severe intoxication in the body	Nausea and vomiting; Flatulence; Abnormal stool; Abdominal pain becomes constant.	Does not exceed 36 hours
Peritonitis	Associated with the process of severe inflammation and poisoning of the body.	Organ function deteriorates; The stomach becomes hard; Bloating; Low pressure; Decreased heart rate; Vomiting feces.	From 36 hours onwards

First aid for intestinal obstruction

Intestinal obstruction in 60% of cases requires surgical intervention. Therefore, an adult should immediately seek help.

It is necessary to monitor the patient’s symptoms and also carry out the following manipulations:

Diagnostics

When a patient is admitted to the hospital with suspected obstruction, the initial examination and diagnosis is carried out by a surgeon. He decides whether it is an operational case or not.

To examine the patient, the following procedures are performed:

1. Collection of information about the patient (history).

2. Initial examination.

It includes a visual examination and examination of the abdomen:

• Feeling the abdomen with your fingers (palpation) - the doctor examines the abdomen and finds the exact location of the source of pain.
• Tapping on the abdomen (percussion) - thanks to tapping on the abdomen, the doctor determines the necessary information by sounds.
• Listening to the abdomen (auscultation) - noises in the patient’s abdomen are determined.

3. The patient's temperature, pressure, pulse are checked, and the oral cavity is examined.

4. After the procedures, the surgeon prescribes an X-ray examination using one or more ways:

5. Ultrasound examination. Allows you to view the condition of the abdominal cavity in real time.

6. Collection of blood for tests. The patient is examined for general and biochemical indicators; venous blood is required for examination.

Can intestinal obstruction be treated without surgery?

About 35 – 40% of cases are cured with medication. After examining the patient, bowel cleansing is prescribed.

This can be done in several ways, depending on where the problem is:

• If the source of the congestion is in the upper part of the intestine, then tubes are installed through the nose to the gastrointestinal tract.
• If the outbreak is in the lower part (large intestine), then an enema is given, with the help of which the intestinal contents are emptied using warm water introduced by a special probe.

These manipulations primarily help relieve the load on the intestines and remove the cause of its poisoning from the body. Next, drug treatment is introduced.

When a patient sees a doctor, treatment decisions are made quickly. If the chosen plan does not bring results within a few hours, then surgery is prescribed.

Treatment of intestinal obstruction at home

Only cases of partial obstruction are treated at home.

The treatment process is divided into several stages:

Drugs

Drugs that help in the conservative treatment of intestinal obstruction:

1. Restoring the normal amount of fluid in the body:

• Methuselah.
• Quintasol.

2. Relieving spasms and cramping pain in the intestines:

3. To improve regional blood circulation:

• Rehydration.
• Reopoliglyukin.
• Pentoxifylline.

4. Replenishment of protein levels in the body:

• A mixture of amino acids.
• Albumen.
• Protein hydrolyzate.

5. Restoring intestinal motor function:

• Neostigmine.
• Distigmine bromide.
• Sorbitol.

6. Relieving body intoxication and reducing risk of developing purulent-septic complications:

• Hemodez.
• Mannitol.
• Disol.

Diet

After the operation, the patient is excluded from eating and drinking for 12 hours. Afterwards, using a dropper, a nutrient solution is administered for 1 to 2 days.

After this time, if the patient is still unable to eat on his own, then an umbrella is inserted through the mouth for nutrition.

After removal of foreign tubes, food is only allowed fermented milk products, baby food from jars. If you have an obstruction, you need to eat in small portions, but often. Depending on the condition, light, unsalted, liquid foods are gradually added to the diet.

If the transition proceeds without complications, then the patient is prescribed a diet close to No. 4. It is designed to prevent food accumulation in the intestines. You need to steam, boil or bake without oil.

The diet is allowed to include:

All foods that can lead to the formation of problems in a new way are excluded from the diet:

• Flour products.
• Fatty food.
• Salting.
• Smoked products.
• Canned food (fish, meat and legumes).
• Raw vegetables.
• Heavy porridges (barley, barley, millet).
• Products with coarse fiber (cabbage, radishes).
• Drink: milk, coffee, sparkling water.

Intestinal obstruction (symptoms in adults and signs of its development are reduced if you follow the prescribed diet) can be cured. The diet is designed to reduce the load on the intestines, eliminating heavy products and reducing the amount of their use.

Physical exercise

After the operation physical exercise are introduced on day 2. To begin with, the set of exercises is designed for a lying position. When the patient sits down on his own, the exercises move to stage 2.

A set of exercises aimed at combating the appearance of intestinal obstruction and recovery of postoperative intervention:

1. Lying position.

2. Sitting position.

• Bend your arms at the elbows, press your hands to your shoulders. In this position, the elbows rise to the side; do the exercise 6–8 times.
• Place your hands on the bed and move your legs, imitating walking, duration 2 – 3 minutes.
• Without lifting your heels from the bed, pull your toes towards you, then lower them away from you. The exercise is done 10 times.

When the patient begins to get out of bed, the load is increased by walking. Initially, you can walk around the ward, then the corridor, then move on to walking along the street.

Folk remedies

Usage folk ways should be discussed with your doctor.

The most popular remedies for intestinal obstruction:

How to treat intestinal obstruction at home

Since intestinal obstruction is one of the serious diseases, it cannot be treated at home. Any actions blur the picture and make it difficult to determine the correct diagnosis.

• Taking painkillers may make it difficult precise definition source of pain.
• Take a laxative.

Inexperienced intervention may distort the exact causes of obstruction. If you suspect it, you must call an ambulance and go to the hospital for examination and determine a treatment regimen.

When is surgery necessary?

If the patient suffers from mechanical intestinal obstruction, then mandatory surgical intervention.

The main reasons for its appearance:

Surgical treatment of intestinal obstruction

The main objective of the operation is to eliminate the cause of obstruction, remove the main obstacle and reduce the risk postoperative complications. The main actions of the surgeon begin with preparing him for the operation and undergoing the preoperative washing procedure.

1. The patient is given anesthesia with muscle relaxants.

2. An incision is made in the abdomen to provide full access to the intestinal area.

3. The entire intestine is examined, since in some cases the congestion occurs in more than one place.

4. If the operation is urgent and it was not possible to free the intestines in advance, this is done at the time of the operation using an incision in the intestine or through a feeding tube.

5. After freeing the intestine, the surgeon begins to eliminate the cause itself.

The procedure can be carried out in several ways, depending on the type of problem:

6. Checking the condition of the intestines. If the operation is performed correctly, the intestinal tissues are pink and all vessels allow blood to pass well. If any doubt arises, the error must be corrected immediately.

7. Colon lavage.

8. Final removal of purulent intestinal contents.

9. Stitching the incision.

Intestinal obstruction (symptoms in adults may reoccur after surgery) occurs due to poor diet or inactive lifestyle. To reduce the risk of recurrent obstruction, you must carefully follow your doctor's recommendations after surgery.

Postoperative period

Intestinal surgery is considered major, and the recovery process is ongoing long time. The patient is sent to the ward intensive care and is under constant control.

A number of procedures must be carried out daily:

• The intestines are washed through the inserted probe, which remains after the operation. With its help, accumulated liquids and gases are removed. This reduces the risk of re-intoxication.
• Introducing fluids into the body to prevent dehydration.
• Feeding occurs through tubes.
• Droppers with antibacterial agents.
• Physiotherapy.
• Dressing the wound.
• Anesthesia.

If no complications arise, then after 4–5 days the patient is removed the tube and allowed to eat on his own. The diet includes only liquid food.

Complications

The outcome after surgery directly depends on the patient’s condition upon admission. If the patient is admitted in a serious condition with obvious intoxication of the body, the risk of death increases to 40%, this is due to extensive intoxication of all organs.

The remaining 60% receive high risks development of postoperative complications, such as:

And also in rare cases, it is possible for all operated patients to develop such complications as:

• bleeding;
• spread of adhesive disease;
• the appearance of fistulas;
• seam tears.

Intestinal obstruction serious illness, its symptoms should not be ignored. In 60-65% of cases you have to refuse drug treatment and urgent surgery is prescribed. If the first signs of illness appear in a child or adult, you must immediately call an ambulance.

Article format: Mila Friedan

Video about intestinal obstruction

Elena Malysheva will talk about intestinal obstruction:

It is customary to distinguish between dynamic intestinal obstruction, when the motor function of the intestinal wall is disrupted (i.e., peristalsis is disrupted and the movement of contents through the intestine stops) and mechanical intestinal obstruction (in this case, mechanical blockage of the intestine occurs at some level).

Mechanical obstruction is much more common and can develop due to intestinal blockage, tumor, feces, as well as due to compression or strangulation of the intestine from the outside during adhesions in the abdominal cavity, volvulus or the formation of nodes.

Dynamic intestinal obstruction can develop with diffuse intestinal obstruction of any etiology, with long-term uncontrolled biliary or renal colic, after surgical intervention on the abdominal organs, in case of salt poisoning heavy metals, as well as injuries and tumors of the brain and spinal cord (when the innervation of the intestinal wall is disrupted).

The level at which it occurred is of great importance. intestinal obstruction. The higher the obstacle arises, the harder it flows, the more energetic therapeutic measures she demands.

Symptoms of acute intestinal obstruction

• strong, cramping or constant, occurring suddenly, regardless of food intake, without a specific localization;
• bloating;
• indomitable vomiting (the higher the level of obstruction, the more pronounced);
• retention of stool and gases (with high obstruction, there may be stool first due to bowel movements below the level of the obstruction).

Diagnostics

Acute intestinal obstruction The emergency doctor may suspect it already when examining the patient (the examination includes questioning, palpation, percussion and auscultation of the abdomen, measuring blood pressure, auscultation of the heart and lungs).

Suspicion of obstruction is an absolute indication for hospitalization of the patient.

IN reception department Hospitals primarily perform plain radiographs of the abdomen. If signs of intestinal obstruction are detected, radiography with oral administration of a radiocontrast agent is performed to clarify the localization of the process. A colonoscopy may also be performed ( endoscopic method colon studies) and other additional studies.

What can you do

At the slightest suspicion of the occurrence of this terrible condition, you should call an ambulance. Clinical picture intestinal obstruction develops within a few hours. The timing of admission of such patients to medical institutions largely determine the prognosis and outcome of the disease.

How can a doctor help?

Therapeutic tactics for intestinal obstruction depend on the cause that caused it and the type of obstruction. In most cases, urgent surgery is necessary. However, all types dynamic obstruction subject to conservative treatment, which includes ensuring patency of the gastrointestinal tract using enemas, removing intestinal contents with a nasogastric or nasointestinal tube, correction water and electrolyte disturbances, hemodynamic control, normalization of peristalsis, detoxification and antibacterial therapy.

Intestinal obstruction is a severe pathology consisting in a complete disruption of the passage of contents through the intestines. Symptoms of intestinal obstruction include cramping, vomiting, bloating, and gas retention. The diagnosis is clinical, confirmed by radiography of the abdominal organs. Treatment of intestinal obstruction consists of intensive infusion therapy, nasogastric aspiration and in most cases complete obstruction, surgical intervention.

ICD-10 code

K56 Paralytic ileus and intestinal obstruction without hernia

K56.7 Ileus, unspecified

K56.6 Other and unspecified intestinal obstruction

Causes of intestinal obstruction

Localization	Causes
Colon	Tumors (usually in the splenic angle or sigmoid colon), diverticulosis (usually in the sigmoid colon), sigmoid or cecal volvulus, coprostasis, Hirschsprung's disease
Duodenum
Adults	Cancer of the duodenum or head of the pancreas
Newborns	Atresia, volvulus, cords, annular pancreas
Jejunum and ileum
Adults	Hernia, adhesions (common), tumors, foreign body, Meckel's diverticulum, Crohn's disease (rare), roundworm infestation, volvulus, tumor intussusception (rare)
Newborns	Meconium ileus, volvulus or malrotation, atresia, intussusception

Pathogenesis

In general, the main causes of mechanical obstruction are abdominal adhesions, hernias and tumors. Other causes include diverticulitis, foreign bodies (including gallstones), volvulus (turning of the intestine around the mesentery), intussusception (invasion of one intestine into another) and coprostasis. Certain areas of the intestine are differentially affected.

According to the mechanism of occurrence, intestinal obstruction is divided into two types: dynamic (spastic and paralytic) and mechanical (obstructive - when the intestinal lumen is blocked by a tumor, fecal or gallstones, and strangulation, compression of the vessels, nerves of the intestinal mesentery due to strangulation, volvulus, nodulation). With adhesive disease and intussusception, intestinal obstruction of a mixed type occurs, since with them both obturation and strangulation occur. By degree - full and partial.

With simple mechanical obstruction, obstruction occurs without a vascular component. Liquid and food entering the intestines, digestive secretions and gas accumulate above the obstruction. The proximal segment of the intestine expands, and the distal segment collapses. The secretory and absorption functions of the mucous membrane are reduced, and the intestinal wall becomes swollen and stagnant. Significant intestinal distension is constantly progressing, increasing disturbances of peristalsis and secretion and increasing the risk of dehydration and the development of strangulation obstruction.

Strangulated intestinal obstruction is an obstruction with circulatory impairment; this occurs in almost 25% of patients with small bowel obstruction. It is usually associated with hernias, volvulus and intussusception. Strangulated intestinal obstruction can progress to infarction and gangrene in less than 6 hours. Initially, a violation of venous blood flow develops, followed by a violation of arterial blood flow, leading to rapid ischemia of the intestinal wall. The ischemic bowel becomes swollen and imbibed with blood, leading to gangrene and perforation. With colonic obstruction, strangulation rarely occurs (except for volvulus).

Perforation can occur in an ischemic area of ​​the intestine (typical of the small intestine) or with significant dilatation. The risk of perforation is very high if the cecum is dilated in diameter >13 cm. Perforation of a tumor or diverticulum may occur at the site of obstruction.

Symptoms of intestinal obstruction

Symptoms are polymorphic, they depend on the type and height of intestinal damage (the higher, the brighter the picture and the faster the change of stages), the stage of the disease.

The main symptom is pain: contractions, quite sharp, constantly increasing, initially in the area of ​​intestinal obstruction, but may not have a constant localization, then throughout the abdomen, becomes constant and dull, and practically disappears in the terminal phase.

Flatulence (bloating) is more pronounced in the obstructive form, although it occurs in all types; it determines the asymmetry of the abdomen upon examination: with the dynamic form of the large intestine - bloating is uniform throughout the entire abdomen, of the small intestine - more often in one area of ​​the abdomen (with a high - in the upper floor, with volvulus - in the middle part, with intussusception - in the right half). Retention of stool and gases may not appear at the onset of the disease, especially with high intestinal obstruction, since stool and gases pass from distal sections intestines, sometimes even independently or during enemas. On the contrary, vomiting is more typical for high intestinal obstruction; it appears faster and more intense. The vomit initially contains gastric contents mixed with bile, then the contents appear, and finally the vomit acquires a fecal odor. The appearance of continuous vomiting, which does not bring relief, is more typical for the obstructive and adhesive form.

Peristalsis depends on the form and stage. In obstructive and mixed forms, hyperperistalsis is initially observed, sometimes audible at a distance and visible to the eye, accompanied by increased pain. When localizing the process in small intestine it occurs early, simultaneously with pain, frequent, short, in the thick - peristalsis becomes intensified later, sometimes on the second day, attacks are rare, long or have a wave-like character. Peristalsis is especially clearly determined during auscultation of the abdomen. Gradually, peristalsis subsides and with the onset of intoxication disappears and is not detected even with auscultation. A sign of the transition of the neuro-reflex stage to intoxication is the appearance of dry tongue, sometimes with a “varnish” bright red tint due to dehydration and chloropenia.

Symptoms of intestinal obstruction appear soon after the onset of the disease: cramping pain in the navel or epigastrium, vomiting and, in case of complete obstruction, bloating. Patients with partial obstruction may experience diarrhea. Strong, constant pain suggests the development of strangulation syndrome. In the absence of strangulation, pain on palpation is not expressed. Characterized by hyperactive, high-frequency peristalsis with periods coinciding with spastic attacks. Sometimes dilated intestinal loops are palpated. With the development of a heart attack, the abdomen becomes painful and upon auscultation, peristaltic sounds are not heard or they are sharply weakened. The development of shock and oliguria is an unfavorable symptom indicating advanced obstructive obstruction or strangulation.

Signs of intestinal obstruction of the large intestine are less pronounced and develop gradually compared to small intestinal obstruction. Characteristic is a gradual retention of stool, leading to complete retention and bloating. Vomiting may occur, but is not common (usually several hours after other symptoms appear). Spasmodic pain in the lower abdomen is a reflex and is caused by the accumulation of feces. On physical examination it is characteristically determined bloated belly with a loud rumbling sound. There is no pain on palpation, and the rectum is usually empty. You can palpate a space-occupying formation in the abdomen corresponding to the area of ​​tumor obstruction. General symptoms are expressed moderately, and the deficiency of fluid and electrolytes is insignificant.

Stages

In dynamics, three stages are distinguished: neuro-reflex, manifested by the syndrome “ acute abdomen"; intoxication, accompanied by a violation of water-electrolyte, acid-base conditions, chloropenia, impaired microcirculation due to blood thickening, mainly in the portal blood flow system; peritonitis.

Forms

Obstructive intestinal obstruction is divided into small intestinal obstruction (including the duodenum) and large intestinal obstruction. Obturation can be partial or complete. Approximately 85% of cases of partial small bowel obstruction resolve with conservative measures, while approximately 85% of cases of complete small bowel obstruction require surgery.

Diagnosis of intestinal obstruction

Obligatory radiography with the patient in the supine and upright position usually allows the diagnosis of obstruction. However, only with laparotomy can strangulation be definitively diagnosed; complete sequential clinical and laboratory examination (eg, complete blood count and biochemical analysis including lactate levels) ensures timely diagnosis.

Specific symptoms play an important role in diagnosis.

• Mathieu-Sklyarov's symptom - palpation, with a slight shaking of the abdominal wall, reveals a noise, a splash of fluid accumulated in a distended loop of intestine - characteristic of obstructive intestinal obstruction.
• Schiemann-Dans sign - characteristic of ileocecal intussusception - upon palpation, the right iliac fossa becomes empty.
• Chugaev's symptom - when lying on the back with the legs pulled up to the stomach, a deep transverse stripe is revealed on the stomach - characteristic of the strangulation form.
• Shlange's sign - upon palpation of the abdomen there is a sharp increase in peristalsis in the initial stage obstructive and mixed forms.
• Auscultation of the abdomen with simultaneous percussion can reveal the following symptoms: Kivulya (metallic sound), Spasokukotsky (the sound of a falling drop), Vilas (the sound of a bursting bubble).

When examining the rectum, and this is mandatory in all cases of abdominal pathology, one can identify a tumor, the presence of fluid in the pelvis, the Obukhov hospital symptom (the ampulla of the rectum is dilated, the anus is gaping - characteristic of an obstructive or strangulation form), Gold's symptom (palpation determination of a distended loops of the small intestine). When performing enemas, you can identify the Tsege-Manteuffel symptom - with intestinal obstruction of the sigmoid colon, it is not possible to introduce more than 500 ml of water into the rectum; Babuk's symptom - characteristic of intussusception - during the initial enema there is no blood in the washing waters; after five minutes of palpation of the abdomen during a repeated siphon enema, the washing waters look like “meat slop”.

If intestinal obstruction is suspected, be sure to check the condition of all hernial orifices to exclude strangulation. The second mandatory study, even before enemas, is plain radiography abdominal cavity. Pathognomonic for intestinal obstruction are: Kloiber's cups, arches, transverse striations of the small intestine swollen with gases (better revealed in a supine position in the form of a Casey symptom - a type of circular ribbing resembling a “herring skeleton”). In unclear cases, a contrast X-ray examination of the intestine is performed (the patient is given 100 ml of barium suspension) with repeated studies of the contrast passage every 2 hours. Signs are: retention of contrast in the stomach or small intestine for more than 4 hours. In case of incomplete intestinal obstruction, the passage of contrast is traced until it is removed to the depot above the site of the obstruction - this sometimes takes up to two days. In case of intestinal obstruction of the large intestine, it is advisable to perform a colonoscopy. If dynamic intestinal obstruction occurs, it is necessary to identify the cause that caused the spasm or paresis: appendicitis, pancreatitis, mesenteritis, thrombosis or embolism of mesenteric vessels and other acute abdominal pathology.

On conventional radiography, the appearance of a series of distended small bowel loops resembling a ladder is characteristic of small bowel obstruction, but this pattern can also be observed in obstruction of the right flank of the colon. Horizontal fluid levels in the intestinal loops can be detected with the patient in an upright position. Similar, but less pronounced radiological signs can be observed with paralytic intestinal obstruction (intestinal paresis without obstruction); differential diagnosis intestinal obstruction may be difficult. Distended bowel loops and fluid levels may be absent with high obstruction jejunum or with strangulation obstruction of a closed type (which can be observed with volvulus). The intestine altered by the infarction can create the effect of a space-occupying lesion on the radiograph. Gas in the intestinal wall (pneumatosis coli) indicates gangrene.

In cases of colonic intestinal obstruction, abdominal radiography reveals dilatation of the colon proximal to the obstruction. With cecal volvulus, a large gas bubble may be detected occupying the middle of the abdominal cavity or the left upper quadrant of the abdomen. When torsion of the cecum and sigmoid colon, using a radiopaque enema, you can visualize the deformed obstruction zone in the form of an area of ​​torsion like a “bird’s beak”; this procedure can sometimes actually resolve sigma volvulus. If a contrast enema is not feasible, colonoscopy may be used to decompress the sigmoid colon for volvulus, but this procedure is rarely effective for cecal volvulus.

Treatment of intestinal obstruction

Patients with suspected intestinal obstructive obstruction should be hospitalized. Treatment of intestinal obstruction should be carried out simultaneously with diagnosis. The surgeon should always be involved in this process.

Metabolic therapy is mandatory and similar for both small and large bowel obstruction: nasogastric aspiration, intravenous fluid transfusion (0.9% saline or lactated Ringer's solution to restore intravascular volume) and bladder catheterization to control diuresis. Electrolyte transfusions should be monitored laboratory research, although in cases of repeated vomiting, serum Na and K are likely to be reduced. If intestinal ischemia or infarction is suspected, antibiotics should be prescribed (eg, 3rd generation cephalosporin, such as cefotetan 2 g IV).

Specific events

For duodenal obstruction in adults, resection or, if the affected area cannot be removed, palliative gastrojejunostomy is performed.

In case of complete obstruction of the small intestine, early laparotomy is preferable, although in the case of dehydration and oliguria, the operation can be delayed by 2 or 3 hours to correct the water-electrolyte balance and diuresis. Areas of specific intestinal damage must be removed.

If the cause of the obstruction was a gallstone, cholecystectomy may be performed at the same time or later. Surgical procedures must be performed to prevent recurrence of obstruction, including hernia repair, removal foreign bodies and elimination of adhesions. In some patients with signs of early postoperative obstruction or recurrent obstruction caused by adhesions, in the absence of abdominal symptoms, simple intestinal intubation with a long intestinal tube may be attempted instead of surgery (many consider the standard nasogastric intubation as the most effective).

Disseminated cancerous lesion of the abdominal cavity, occlusive small intestine, is main reason mortality in adult patients with malignant gastrointestinal diseases. Bypass anastomoses, surgical or endoscopic stenting may improve the disease in the short term.

Cancers that obstruct the colon are most often subject to simultaneous resection with a primary anastomosis. Other options include unloading ileostomy and distal anastomosis. Sometimes unloading colostomy with delayed resection is necessary.

If the obstruction is caused by diverticulosis, perforation often occurs. Removal of the affected area can be quite difficult, but is indicated in cases of perforation and general peritonitis. Bowel resection and colostomy are performed without anastomosis.

Coprostasis usually develops in the rectum and can be resolved by digital examination and enemas. However, the formation of single- or multi-component fecal stones (ie, with barium or antacids) causing complete obstruction (usually in the sigmoid colon) requires laparotomy.

Treatment of cecal volvulus consists of resection of the involved area and formation of an anastomosis or fixation of the cecum in its normal position with cecostomy in weakened patients. When sigmoid volvulus occurs, the loop can often be decompressed using an endoscope or a long rectal tube, and resection and anastomosis can be performed over a period of several days. Without resection, intestinal obstruction almost inevitably recurs.