Intestinal obstruction

Definition

Intestinal obstruction is a blockage in the intestines that prevents food, liquid, and gas from moving through the digestive tract.

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Types

Mainly 2 types of intestinal obstruction

1. Mechanical obstruction

2. Paralytic ileus

1. Mechanical obstruction is caused by a physical blockage in the intestines.

2. Paralytic ileus is caused by a problem with the muscles of the intestines

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Classification

Here are the different types of intestinal obstruction, along with their definitions:

1. Acute intestinal obstruction: A sudden blockage of the intestine that occurs over a short period of time.

2. Chronic intestinal obstruction: A long-term blockage of the intestine that develops gradually over time.

3. Dynamic intestinal obstruction: A blockage of the intestine that is caused by a change in the muscle contractions of the intestine.

4. Adynamic intestinal obstruction: A blockage of the intestine that is caused by a lack of muscle contractions in the intestine.

5. Subacute intestinal obstruction: A blockage of the intestine that occurs over a period of several days to weeks.

6. Simple intestinal obstruction: A blockage of the intestine that does not involve any twisting or narrowing of the intestine.

7. Strangulated intestinal obstruction: A blockage of the intestine that is caused by a twisting or narrowing of the intestine, which cuts off the blood supply to the intestine.

8. Closed loop obstruction: A blockage of the intestine that occurs when two segments of the intestine become twisted around each other, creating a loop that traps food and fluid.

9. Intussusception: A blockage of the intestine that occurs when one segment of the intestine slides into another segment, like a telescope.

These are just some of the different types of intestinal obstruction. The specific type of obstruction that a person experiences will depend on the underlying cause of the blockage.

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Causes

There are many different causes of intestinal obstruction. Some of the most common causes include:

• Adhesions: These are bands of scar tissue that can form after abdominal or pelvic surgery. Adhesions can cause a blockage by narrowing the intestine or by trapping food or fluid.

• Hernia: A hernia is a bulge in the abdominal wall that can allow part of the intestine to protrude through the weakened area. Hernias can cause a blockage if they become large enough to trap food or fluid.

• Cancer: Cancer of the intestine can cause a blockage by narrowing the intestine or by obstructing the flow of food or fluid.

• Inflammatory bowel disease: Conditions such as Crohn's disease and ulcerative colitis can cause inflammation and scarring of the intestine, which can lead to a blockage.

• Foreign bodies: Swallowing a foreign object, such as a coin or a piece of bone, can cause a blockage in the intestine.

• Volvulus: Volvulus is a twisting of the intestine that can cause a blockage. Volvulus is more common in the large intestine than in the small intestine.

• Intussusception: Intussusception is a condition in which one segment of the intestine slides into another segment, like a telescope. Intussusception can cause a blockage in the intestine.

Other less common causes of intestinal obstruction include:

• Medications: Some medications, such as narcotics, can slow down the movement of food through the intestine and increase the risk of a blockage.

• Irritable bowel syndrome: This condition can cause inflammation and spasms of the intestine, which can lead to a blockage.

• Radiation therapy: Radiation therapy to the abdomen can damage the intestine and increase the risk of a blockage.

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Sign and symptoms

• Colicky pain usually centered on umbilical(small bowel) or lower abdomen (large bowel)

• Nausea and vomitting (bile stained)

• Abdominal cramps

• Coffeebean like stool

• Feculent vomitting

• Pyloric watery and acidic vomitting

• Hemetmesis ( blood 🩸 in vomitting)

• Hemeptysis( blood 🩸 in sputum)

• Abdomen distention

• Absolute or Relative Constipation

• Visible peristalsis

• Bloating

• Fatigue /weakness

• Dehydration

• Infrequent urination

• Hypokalemia( ⬇️sed potassium level in blood)

• Pyrexia

• Abdominal tenderness

• Frequent bowel sound

• Peritonitis

• Constant pain

• Absent bowel sounds

• Tenderness with rigidity

• Leukocytosis

• Fever and tachycardia

• Shock

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Diagnosis

1. History collection

2. Physical examination

3. Blood examination

• CBC( Complete blood 🩸 count)

• Serum Urea and Electrolytes

• Serum Amylase level

• Metabolic acidosis

4. Radiological examination

• X-Ray

• Ultrasonography

• Enterolysis ( independent gastric emptying

• CT- Scan

• Endoscopy

• Barrium swallow

• Barrium enema

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Treatment

Nonsurgical Management:

1. Correction of fluid and electrolyte imbalances with normal saline or Ringer's solution with potassium as required.

2. NG suction to decompress bowel.

3. TPN may be necessary to correct protein deficiency from chronic obstruction, paralytic ileus, or infection.

4. Analgesics and sedatives, avoiding opiates due to GI motility inhibition.

5. Antibiotics to prevent or treat infection.

6. Ambulation for patients with paralytic ileus to encourage return of peristalsis.

Surgical management:

CONSERVATIVE MANAGEMENT:

NG-Decompression and Rehydration.

Not prolonged beyond 72 hrs

SURGICAL MANAGEMENT:

• Divide the causative adhesion(s) adheolysis

• Repair serosal tears, areas of doubtful viability.

• Laparoscopic adhesiolysis

• Midline Laprotomy

• Resection with primary anastomosis