Intestinal Obstruction Symptoms and Treatment of Intestinal Obstruction

Intestinal Obstruction

Intestinal obstruction may be mechanical or non mechanical

  • Mechanical obstruction may be adhesions, hernias, diverticulitis, carcinoma, regional enteritis, gall stone obstruction, intussusception.
  • Non-mechanical may be neuromuscular distur­bances leading to ileus.
  • Obstruction may occur in small intestine or large in­testine.
  • Small intestine obstructions are due to adhesions and hernias.
  • Large intestine or colonic obstruction is due to car­cinoma, diverticulitis, volvulus.
  • Pseudo-obstruction is a motility disorder without mechanical obstruction.
  • Adynamic ileus (atonic or paralytic ileus) is the most common cause of obstruction.
  • It is due to peritoneal injury with hydrochloric acid, colonic contents, pancreatic enzymes, blood and urine.
  • Retroperitoneal causes of adynamic ileus are ret­roperitoneal hematoma, ureteral calculus, pyelone­phritis.
  • Dynamic ileus or spastic ileus is uncommon ant!- is due to heavy metal poisoning, uremia, porphyria, in­testinal ulcerations.

Intestinal Obstruction

Intestinal Obstruction Symptoms and Treatment of Intestinal Obstruction


Pathophysiology

  • Obstruction gives rise to increased intra luminal pres­sure.
  • Accumulation of gas and fluid occurs in the obstructed segment.
  • There is impairment of blood supply. Bacterial invasion occurs.
  • Peritonitis may occur.
  • Ventilation becomes restricted due to elevation of dia­phragm and distention of abdomen.
  • There may be atelectasis of lung (collapse of lung). Venous return is hampered.
  • There is loss of fluid and electrolytes.
  • There is hypokalemia, and dehydration because of vomitings.
  • There is hemoconcentration, hypovolaemia, renal fail­ure.
  • All this can lead to shock and death.

Symptoms of Intestinal Obstruction

  • · Mid-abdominal pain
  • · Paraoxysmal pain, cramps, colics
  • · Audible borborygmi
  • · In strangulation, pain is localized
  • · There is vomiting of bile and mucus
  • · Low ileal obstruction gives rise to feculent vomitus, very foul smelling
  • · Hiccups or singultus
  • · Obstipation (gas)
  • · Diarrhea due to partial obstruction
  • · Blood in the stool in intussusception
  • · Altered bowel habit
  • · Constipation.

Physical findings

  • · Abdominal distension, more in colonic obstruction ‘
  • · Tenderness, rigidity
  • · Fever more than 100°F
  • · Shock in strangulation
  • · Rigidity, tenderness, fever in peritonitis
  • · Hernias
  • · Palpable mass
  • · Loud high-pitched borborygmi.

Lab findings

  • · Leucocytosis
  • · Increased serum amylase.

X-ray

  • Shows distended and gas filled loops of small intes­tine in step-ladder pattern with air fluid levels and no colonic gas shadows.
  • In strangulation, coffee-bean shaped mass seen. In adynamic ileus, colonic distension seen.

Sigmoidoscopy

  • It shows volvulus and other diseases.

Barium study

  • Barium study may be done by mouth for obstruction in small intestine. Oral barium should never be given in colonic obstruction.

Treatment of Intestinal Obstruction

  • In obstruction, always operative treatment is the best choice.
  • For strangulation – urgent surgery. Conservative management in incomplete ob­struction and in complete obstruction, along with surgery.
  • IV fluids, IV potassium, nasogastric tube for suc­tion, antibiotics, and sometimes neostigmine in colonic ileus.
  • The degree of volume depletion and metabolic derangement
  • The severity, cause, extent and location of the obstruction
  • Whether nonoperative management can be considered
  • The need for and timing of operative intervention