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What to do with intestinal obstruction?
The symptoms of this disease are very often mistaken for signs of other diseases of the gastrointestinal tract and try to cope with them on their own. It is categorically impossible to do this, since only timely medical assistance can save the patient's life. This disease can be treated only in the hospital of the surgical department.
What it is?
Intestinal obstruction consists in partial or complete cessation of the movement of contents (chyme) through the intestine. It requires urgent medical attention as it is a life-threatening condition.
Causes of occurrence
Predisposing factors for mechanical intestinal obstruction:
- adhesions in the abdominal cavity,
- lengthening of the sigmoid colon in old age,
- congenital dolichosigma
- mobile cecum,
- additional pockets and folds of the peritoneum,
- hernias of the anterior abdominal wall and internal hernias.
The reasons can be benign and malignant tumors of various parts of the intestine, leading to obstructive obstruction. Obturation can also occur due to compression of the intestinal tube by a tumor from the outside, emanating from neighboring organs, as well as narrowing of the intestinal lumen as a result of perifocal, tumor or inflammatory infiltration. With the defeat of three to five lymph nodes of the mesentery of the intestine and tumor genesis of intestinal obstruction, the recovery rate is 99 percent. Exophytic tumors (or polyps) of the small intestine, as well as Meckel's diverticulum, can cause intussusception.
For other types of obstruction, changes in intestinal motility associated with a change in diet are often provoking factors:
- eating a lot of high-calorie foods
- plentiful food intake against the background of prolonged fasting (volvulus of the small intestine is possible);
- the transition from breastfeeding to artificial feeding in children of the first year of life.
Paralytic obstruction most often occurs as a result of trauma (including the operating room), metabolic disorders (hypokalemia), peritonitis.
All acute surgical diseases of the abdominal organs, which can potentially lead to peritonitis, proceed with the symptoms of intestinal paresis. A decrease in the peristaltic activity of the gastrointestinal tract is noted when physical activity is limited (bed rest) and as a result of long-term intractable biliary or renal colic.
Spastic intestinal obstruction is caused by lesions of the brain or spinal cord (metastases of malignant tumors, tabes dorsum, etc.), poisoning with salts of heavy metals (for example, lead), hysteria.
Signs of acute intestinal obstruction
Acute intestinal obstruction is an extremely dangerous condition in which the normal passage of the contents of the gastrointestinal tract is disrupted. Symptoms of acute obstruction are quite similar to partial. However, it proceeds more rapidly, more aggressively and more pronounced.
- severe abdominal pain that occurs regardless of the time of eating;
- nausea;
- severe vomiting (the stronger the level of obstruction, the more pronounced the vomiting);
- bloating;
- lack of waste gases;
- upset stool.
If such a condition occurs, it is necessary to urgently contact an ambulance. Precious wasted time can determine a far from reassuring prognosis for treatment.
Symptoms
If you suspect intestinal obstruction, it is important to know that such a disease has symptoms that develop in 3 periods:
- Early period, first 12 hours (or less). There is bloating and a feeling of heaviness in the abdomen, nausea. Then pain occurs, the nature and intensity of which depend on the cause of the pathology. If the intestine is squeezed from the outside, for example, if adhesive intestinal obstruction is diagnosed, then the pain symptoms are constant, but their intensity changes: from moderate to severe, leading to a state of shock. When the lumen is blocked from the inside, they are paroxysmal, last for several minutes, and then disappear. Vomiting occurs when the passage of food from the stomach to the intestines is impaired.
- Intermediate period, from 12 to 24 hours. The symptoms of intestinal obstruction become severe. Regardless of the cause of the disease, pain is constant, bloating increases, vomiting is frequent and profuse. Dehydration, intestinal edema develops.
- Late period, from 24 hours. Signs of intestinal obstruction in adults and children at this stage indicate the involvement of the whole organism in the pathological process. The respiratory rate increases, due to bacterial intoxication, the temperature rises, the production of urine stops, and abdominal pain intensifies. Development of peritonitis and sepsis is possible.
How intestinal obstruction manifests itself depends in part on where it is located. So, vomiting in the early period of the disease is characteristic of pathology in the small intestine, especially in its upper parts, and constipation and disruption of gas discharge - in the large intestine. But in the late period, when peritonitis develops, these symptoms develop with any type of obstruction.
Diagnostics
To diagnose intestinal obstruction, a number of laboratory and instrumental studies are required:
- a biochemical blood test can indicate metabolic disorders (violation of the composition of trace elements, a decrease in protein);
- complete blood count - there may be an increase in leukocytes in inflammatory processes;
- colonoscopy (examination of the large intestine using a sensor with a video camera at the end) helps with large bowel obstruction; irrigoscopy is used to examine the small intestine;
- X-ray examination of the intestine is mandatory when making this diagnosis. With the introduction of a radiopaque substance into the intestinal lumen, it is possible to determine the level of development of intestinal obstruction;
- ultrasound is not always informative, since with intestinal obstruction, air accumulates in the abdomen, which interferes with the normal assessment of the data.
In difficult cases, a 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 examine the abdominal organs and make an accurate diagnosis, and in some cases, immediately carry out treatment (volvulus, adhesions).
It is necessary to differentiate intestinal obstruction with:
- acute appendicitis (ultrasound, localization in the right iliac region);
- perforated ulcers of the stomach and 12 duodenal ulcers (conducting FGDS, radiography with a contrast agent);
- renal colic (ultrasound, urography).
To clarify the diagnosis, it is always necessary to carry out additional research methods, since it is impossible to differentiate intestinal obstruction only by symptoms.
Consequences of intestinal obstruction
This disease, if untreated, leads to a host of serious complications. So, turning off a part of the intestine, which is necrotic due to a violation of the blood supply in it, provokes a violation of digestion and absorption of nutrients in it.
A decrease in the protective functions of the mucous membrane leads to an increase in the permeability of the intestinal wall for bacteria and their metabolic products - severe intoxication occurs, and subsequently bacterial complications: peritonitis, sepsis, multiple organ failure. The termination of absorption in the dead intestine also applies to water. Insufficient flow of it into the blood, coupled with frequent vomiting, leads to rapid dehydration of the body.
All these phenomena develop relatively quickly and within a few days lead to an inevitable death if the patient is not promptly delivered to the surgical hospital.
Treatment of intestinal obstruction
Treatment of acute intestinal obstruction begins with conservative measures. Regardless of the cause that caused this condition, hunger and peace are shown to all patients. A nasogastric tube is passed through the nose into the stomach. It is needed to empty the stomach, which helps to stop vomiting. Intravenous administration of solutions and drugs (antispasmodic, analgesic and antiemetic drugs) is started.
Intestinal motility is stimulated by subcutaneous administration of proserin. In case of infringement of a hernia, it is necessary to perform an emergency operation - it is impossible to stop intestinal obstruction in such a situation without surgical intervention. In other cases, if conservative treatment is ineffective, surgical intervention is also necessary.
Before the operation, elastic bandaging of the lower extremities is necessary to prevent thrombus formation in the veins of the legs.
The operation for intestinal obstruction is performed under general anesthesia (endotracheal intubation anesthesia with muscle relaxants). With this pathology, it is necessary to perform a wide midline laparotomy - a midline incision on the anterior abdominal wall. Such an incision is necessary for an adequate examination of the abdominal organs and the search for the disease that caused the intestinal obstruction. Depending on the established reason, an appropriate operational manual is performed.
Nutrition
After treating any form of intestinal obstruction, you must strictly monitor your diet and adhere to a diet.
With intestinal obstruction, foods that contribute to flatulence, constipation are strictly prohibited:
- smoked, salted, spicy, spicy foods;
- soda, coffee, alcohol;
- sweets and chocolate;
- fatty meat, fish;
- cereals that are difficult to digest (millet groats, barley);
- legumes, mushrooms;
- fresh bread and baked goods;
- white cabbage;
- apples;
- kefir, sour cream, cheese, cream, milk.
For the first month after surgery, eat finely grated food. The following products are allowed:
- cooked vegetables that do not cause bloating;
- fruits that do not cause bloating, rubbed, can be baked;
- low-fat cottage cheese, acidophilus;
- cereals (semolina, buckwheat, rice, oatmeal);
- lean meats and fish;
- compotes and jelly from fruits and berries.
As with any bowel disease, with CD it is shown to eat often and in small portions. This reduces the load on the gastrointestinal tract, doses the secretion of gastric juices and bile acids, and facilitates the work of the small and large intestines. Avoid eating food that is too hot or too cold. Also, do not eat rough foods that are difficult to digest. Minimize your salt intake. Drink plenty of water.
Forecast and prevention
A favorable prognosis in the treatment of intestinal obstruction depends on the timeliness of medical care. It is impossible to delay the visit to the doctor, otherwise, with the development of severe complications, the risk of death is high. An unfavorable outcome can be observed with late diagnosis, in debilitated and elderly patients, in the presence of inoperable malignant tumors. If adhesions occur in the abdominal cavity, relapses of intestinal obstruction are possible.
Preventive measures to prevent intestinal obstruction include the timely detection and removal of intestinal tumors, treatment of helminthic invasions, prevention of adhesions and abdominal injuries, and proper nutrition.
Intestinal obstruction is a violation of the normal movement of food through the gastrointestinal tract. It develops as a result of obstruction of the intestinal lumen, its spasm or paralysis. This is a very dangerous disease, since in most cases emergency surgery is required. It is important to know the main signs of intestinal obstruction in children and adults in order to be able to recognize them and consult a doctor in a timely manner.
Varieties of intestinal obstruction
Signs of intestinal obstruction directly depend on its type. By the mechanism of development, mechanical and dynamic forms of the disease are distinguished.
Mechanical intestinal obstruction occurs when the intestine is blocked at any level. The causes of occlusion from the inside can be foreign bodies, helminths, stones from the gallbladder, scars and tumors of the intestinal wall, outside - tumors and cysts.
All these options relate to obstructive mechanical obstruction. With volvulus, nodulation and entrapment of the intestine, the mesentery is compressed, and strangulation obstruction develops. An intussusception is observed with intussusception of the intestine - wedging of one part of the intestine into another. In the case of compression of the intestine by adhesions, adhesion mechanical obstruction is distinguished.
Dynamic intestinal obstruction develops when the motor function of the intestine is impaired. This can be observed with excessive relaxation (paralytic type) or overexertion (spastic type).
In the course of the course, intestinal obstruction is acute and chronic. By the level of obturation - high (in the small intestine) and low (in the large intestine). Full and partial - depending on the degree of overlap of the intestinal lumen. By origin - congenital or acquired obstruction. The congenital variant occurs mainly in children due to malformations of the gastrointestinal tract.
Signs of intestinal obstruction
The main symptoms of this disease are:
- stool and gas retention;
- increased gas production and bloating;
- nausea and vomiting.
Pain is the first and constant sign of this disease. It appears suddenly, regardless of meals. Has a cramping, unbearable character. The frequency of pain is due to intestinal peristalsis, with each wave it intensifies. At the same time, the patient's face is distorted, symptoms of shock may appear - pallor, cold sweat, heart palpitations.
By the end of the first day, the pain may decrease or stop altogether. This is an unfavorable sign, since pain relief in this case means intestinal necrosis and necrosis. For 2-3 days of imaginary well-being, peritonitis will develop, and the chances of saving the patient will be minimal even during the operation.
Since with obstruction of the intestine, the movement of feces along it stops, there is a delay in stool and gases. They accumulate in the intestine, stretching its walls and increasing pain. In this case, bloating of the abdomen occurs, and its asymmetry can be observed. In some cases, an inflated intestine and its peristalsis are visually visible through the anterior abdominal wall.
Vomiting is a common symptom of intestinal obstruction. Its frequency and nature are determined by the type of disease. In the early days, vomiting occurs due to a violation of the movement of contents through the gastrointestinal tract. From the intestines, the contents can be thrown into the stomach. Then the vomit has the color and smell of feces. In the following days, nausea and vomiting are signs of intoxication of the body.
Signs of mechanical intestinal obstruction
Mechanical intestinal obstruction occurs in about 90% of all cases. The clinical picture is strongly influenced by the level of obstruction.
With the development of the process in the small intestine, the symptoms appear and grow rapidly. Pains of a cramping nature appear sharply in the central part of the abdomen (around the navel). They are joined by nausea and vomiting. The higher the obstruction, the more pronounced the vomiting is - indomitable, abundant, repeated.
With complete obstruction, stool retention occurs, with partial obstruction, there may be diarrhea. Characterized by increased peristaltic sounds in the abdomen, which become louder on the wave of pain. With the development of necrosis or infarction of the intestinal wall, sounds in the abdomen, on the contrary, are absent. This is an unfavorable sign.
Obstruction in the large intestine takes longer to develop, and its symptoms are less pronounced. First, constipation occurs, gradually giving way to a complete absence of stool and bloating. Then the pain joins and slowly intensifies. Soreness can be localized or spread throughout the abdomen. Vomiting is not always the case, more often once.
With volvulus, the onset and development of the disease is acute, with severe cramping pains. The process is progressing rapidly and requires urgent care.
In the clinical course of mechanical intestinal obstruction, several stages are distinguished:
The rate of development of symptoms depends on the specific type of mechanical intestinal obstruction. In severe cases, peritonitis develops on the second day. Therefore, for any severe abdominal pain, you need to see a doctor without taking painkillers in order to prevent blurring of the clinical picture.
Signs of dynamic intestinal obstruction
Dynamic bowel obstruction is rare - about 10% of cases. With this type of disease, a failure occurs in the motor function of the intestine. The peculiarity of this option is that there are no obstacles to the passage of feces in the intestine, but there is a temporary cessation of contractile movements.
The paralytic appearance most often occurs after injuries and surgical interventions in the abdominal cavity as a reflex protective reaction to irritation of the nerve endings of the peritoneum. In the development of this variant of intestinal obstruction, 3 periods are distinguished:
A spastic form of intestinal obstruction is relatively rare (with poisoning with poisons, heavy metals, with porphyria, uremia, etc.). In this case, a spasm of the muscles of the intestinal walls occurs, and peristalsis temporarily stops.
This condition can last from several minutes to several hours. The pain is sharp, so strong that it is sometimes unbearable. They do not have a clear localization, they spread throughout the abdomen. Stool retention is not always the case and is transient. The general condition of the patient is satisfactory. This type of intestinal obstruction has a favorable prognosis and is treated conservatively.
Chronic intestinal obstruction
Acute intestinal obstruction is predominantly found. 
The chronic form is rare. The causes are most often hernias, adhesions growing in the lumen of the intestine or outside the tumor.
In this case, there is a delay in the passage of stools and gases, severe pains of a spastic nature, there may be nausea and vomiting. After some time (from several hours to 1-2 days), all symptoms disappear on their own or as a result of conservative treatment. In the first days after this, diarrhea and bloody stools often occur.
Partial intestinal obstruction
The presence of defecation and passing gas does not always indicate the absence of intestinal obstruction. With partial obstruction of the intestine, a scanty amount of stool comes out, often with blood impurities. It is accompanied by pains of varying intensity and localization. The abdomen is soft but painful. Such a clinical picture may be a sign of a chronic form of the disease. In the acute variant, complete obstruction of the intestine gradually develops, the corresponding symptoms appear.
Sharp abdominal pain is a dangerous symptom. They may indicate various diseases of the abdominal organs, including such dangerous ones as intestinal obstruction. The favorable outcome in this case directly depends on the type of disease and the timely visit to the doctor.
With the dynamic option, the prognosis is most often good, and the treatment is conservative. With mechanical intestinal obstruction, surgery is almost always required. The probability of the patient's recovery depends on this. Therefore, it is very important, when signs of intestinal obstruction appear, do not hesitate, but immediately consult a doctor.
Content
Bowel problems are very common today. One of them is intestinal obstruction - a serious condition, in the acute stage of which the intervention of surgeons is necessary. The earliest harbinger of an illness is pain: it starts suddenly, at any time, for no apparent reason. Less often, the pain increases little by little, and after a certain period of time it becomes intense.
What is intestinal obstruction
Intestinal obstruction is called the impossibility of the physiological nature of the passage of feces to the anus. The process of natural emptying of the rectum becomes difficult, the passage of gases stops, and fecal obstructions form. Symptoms become more pronounced as the condition worsens. The source of problems is irregular bowel movements: it is correct if a person empties once a day. In case of constipation, signs of obstruction appear, you should consult a doctor.
Obstruction reasons
Intestinal obstruction develops under the influence of various reasons, which are divided into two categories: functional and mechanical. The development of an ailment of a mechanical type is facilitated by such factors as an increase in the length of the sigmoid colon, the presence of pockets of the peritoneum, a mobile cecum, adhesions. Functional obstruction develops against the background of overeating after starvation, a sharp increase in fresh fruits, transfer of newborns to adapted formulas for up to a year.
Mechanical
Mechanical causes of the disease, which noticeably poisons the patient's existence:
- accumulation of worms;
- hematoma;
- disruptions in the formation of the intestine;
- disruptions in the structure of the peritoneum;
- gallstones and fecal stones;
- vascular ailments;
- inflammation;
- neoplasms (cancer or benign);
- oncology;
- intestinal obstruction;
- adhesions;
- hernia;
- volvulus of the intestine;
- cords of the peritoneum of the congenital type;
- the ingress of foreign elements into the intestines;
- decrease in the lumen of the intestine.
Functional
The functional reasons for the development of obstruction are also known. Their list usually depends on the related problems, but a short version looks like this:
- paralytic phenomena;
- cramping;
- disruptions in intestinal motility.
Symptoms and signs of intestinal obstruction
According to doctors, if there is a suspicion of intestinal obstruction, the patient should be taken to the hospital as soon as possible. So the forecast will be favorable. The violation can be corrected without surgery in some cases. Obvious signs of the onset of the disease are considered the impracticability of the discharge of feces and gases. In the case of partial obstruction or obstruction of the upper intestines, there are scanty stools and a slight discharge of gases. Symptoms such as repeated vomiting, abnormal shape, and bloating may occur.
There are also specific symptoms that can only be detected by a specialist, which is why prompt hospitalization of the patient is so important. If you do not start treating the patient on time, the risk of developing dangerous consequences increases, including cardiac disorders, hepatic and renal failure, and death. In the case of squeezing of the vessels, intestinal necrosis develops. Even an operation (if the case is neglected) may not save the patient.
The most dangerous conditions include intestinal obstruction in infants. Therefore, it is important for moms and dads to know the symptoms that should cause concern:
- significant weight loss due to fluid loss,
- vomiting with an admixture of bile, which appears after eating,
- grayish skin tone of the child,
- temperature,
- bloating in the upper abdomen.
A calm infant may refuse to eat, become restless and moody. Then you must immediately call a doctor.
Video: How to get rid of intestinal obstruction at home
The topic of the video below is such a symptom as constipation and what it can threaten. Constipation can indicate many serious illnesses, including obstruction or Hirschsprung's disease.
Photo of intestinal obstruction
Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.
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How to identify and treat intestinal obstruction
Such a common symptom as abdominal pain should always be treated with caution, because it can be a manifestation of a serious surgical pathology, in which the movement of food contents through the digestive tube is disrupted. This condition can lead to serious consequences, so it is important to recognize it in time and seek medical help in a timely manner.
This condition is characterized by a violation (complete or partial) of the movement of contents through the intestine.
This is an acute surgical pathology, which is more common in the male population aged 30-60 years. But women and children with such a diagnosis are not at all uncommon for hospitals and clinics. Among all "acute bellies", this diagnosis is established in 5-9% of cases.
This pathology is classified according to the anatomical principle into the large intestine (if the process affects the end sections of the gastrointestinal tract) and small intestinal (with lesions of the duodenum, jejunum and ileum). By origin - congenital and acquired.
But more informative is the classification, which reveals the mechanism of the onset of the disease, according to which dynamic and mechanical obstruction is distinguished.
The reasons for the development of a mechanical form
This pathology is called obstructive. The term comes from lat. obturatio - blockage.
- Infringement, twisting of the intestinal loops behind each other or around its axis, the formation of nodes, which results in a violation of the blood filling of the vessels and blockage of blood flow in the areas of the loops. This is the situation that people say about "volvulus". The medical name for this phenomenon is strangulation intestinal obstruction.
- A combination of obturation and infringement. This is a situation in which one loop is inserted, pressed into another, being both a mechanical obstacle and a source of vascular compression and cessation of normal blood flow.
Reasons for the development of a dynamic form
It is based on functional disorders of the motor activity of the gastrointestinal tract, namely:
- persistent spasm
- paresis
- paralysis
Based on the mechanism of motor disorders, this form is divided into paralytic and spastic.
Defects of muscle tone and peristalsis in the form of paralysis and paresis can be observed both in the entire intestine and in its individual areas. The following conditions are capable of provoking motor-evacuation dysfunction and causing paralytic obstruction:
- trauma, surgery on the abdominal and gastrointestinal tract
- inflammatory processes: appendicitis, peritonitis, ileitis, cholecystitis
- pathological conditions occurring outside the peritoneum: myocardial infarction, spinal and skull injuries, pneumonia
- retroperitoneal hematomas, as well as thrombosis of mesenteric vessels, spleen infarctions
- metabolic diseases (diabetic precoma, cystic fibrosis)
Persistent spasm of the intestinal muscles is possible with:
- ascariasis
- hepatic and renal colic
- diseases of the nervous system (hysteria, neurasthenia)
- intoxications of the body both by products of internal metabolism (with severe renal and hepatic insufficiency) and by substances coming from outside (alcohol, heavy metals)
Adhesive process as an etiological factor
Adhesions are capable of deforming the structure of the organ, tightening, disrupting the anatomical arrangement of intestinal loops.
Some practicing surgeons distinguish separately the adhesions form of disturbance in the conduction of contents through the intestines, thereby emphasizing the role of the causative factor: the presence of adhesions - connective tissue fibers formed as a result of an inflammatory process or organ trauma.
Other authors believe that it is more convenient to consider the adhesive process not as a separate form, but as one of the causes of obstructive and strangulated obstruction, since these structures can cause both circulatory disorders and block the intestinal lumen.
Both opinions are justified and have the right to exist.
Mechanism of damage development
It is clear what is the cause of the dangerous surgical pathology, but what happens inside the intestine when the normal movement of food through it stops?
In general terms, pathogenesis can be represented as follows:
The content in the form of food gruel meets an obstacle on its way, stagnation occurs. The intestinal wall is exposed to excessive stretching, excess digestive juices, bile, pancreatic secretions, gases due to the vital activity of microorganisms and the decay of organic acids accumulate in it.
The altered wall is unable to fully carry out absorption, the pressure in it increases, the intestinal loops increase in volume, swell, change color, turn purple or cyanotic, or is completely absent.
The pathogenesis of the process and its speed depends on the form of obstruction. In the strangulation form, due to a sharp violation of blood circulation, pathological changes in the intestinal wall grow extremely quickly: its vessels are compressed, blood clots form, and death develops - necrosis.
All processes lead to disruption of the functioning of parts of the intestine or its department. Through a non-functioning organ, pathogenic microorganisms, part of the liquid contents, and bacterial toxins can penetrate into the abdominal cavity. Peritonitis develops.
Such changes in the body cannot but affect the patient's well-being. And if at the initial stages the process is local, limited, albeit with a vivid clinical picture. Then, as the disease progresses, peritonitis develops, followed by sepsis (blood poisoning), multiple organ failure.
At the stage of systemic damage to the body without highly qualified medical care, the disease ends in death.
Bowel obstruction symptoms
You can suspect a disease by knowing the main signs and symptoms that are characteristic of it. Most often, patients with a confirmed diagnosis, upon treatment or initial examination, complain of:
1. Stomach pain
The earliest, most frequent and common symptom. They can be characterized as cramping, increasing in intensity, like colic with "light" painless intervals during obstruction, or as unbearable, constant with ischemic disorders.
2. Vomiting
It occurs in more than 75% of cases. It is characteristic that in the event of pathology in the high small intestine sections, vomiting bothers quite often, it is multiple, does not bring relief. Reflex incessant vomiting is very characteristic of the strangulation form.
Disturbances in the passage of food in the lower intestinal tract rarely cause this symptom. If vomiting does happen, then in the later stages of the disease, in advanced cases, it has an unpleasant odor of feces due to the decomposition of the contents of the vomit.
3. Absence of stool, violation of gas discharge
These symptoms appear when the lumen of the organ is completely blocked, with partial obstruction, and they may be absent in the early stages.
Stool may be partially present during emptying of the departments below the site of the obstacle, but if the focus of pathology is located in the sigmoid colon and distal, then the patient cannot recover "in a big way" at all.
4. Bloating
A characteristic feature that allows you to make an assumption about the level of violations of patency. If the changes affect the high intestinal regions, bloating is uncommon, since almost all loops are in a collapsed state.
If the passage is disturbed in the lower small intestine, it is symmetrical.
Colonic pathology is characterized by asymmetry: the right half of the abdomen can be enlarged, corresponding to the lesion of the right colon, or the left, where the opposite sections are located.
Sometimes, with obvious obstruction, peristaltic waves and swelling of the loops can be visually observed. Paralytic processes are characterized by a symmetrical accumulation of gases without distortions of the abdomen in any part of it.
5. Peristaltic noises
Rumbling, gurgling, transfusion - these signs are actively manifested in the early stages of the disease, and indicate a violation of motor skills and the work of the gastrointestinal tract.
In the later stages, with the development of necrosis and peritonitis, all the noises subside. This is a prognostically unfavorable sign, "deathly silence" indicates irreversible changes in the organ.
Stages of the disease
There are three successive stages of obstruction, each of which corresponds to certain manifestations.
Knowing the features of the clinical picture step by step, the doctor can quickly navigate, determine exactly how much the patient needs medical care, suggest in the clinic how long the disease lasts and what state the intestines are in.
Stage 1 - early
Lasts up to 12 hours. The main complaint of patients is pain. With a mechanical obstruction in the gastrointestinal tract - cramping, with light gaps, with circulatory disorders - unbearable, extremely pronounced (sometimes of such intensity that it can provoke a painful shock)
Stage 2 - intermediate
12 to 24 hours. The clinic is joined by vomiting, bloating. Repeated profuse vomiting leads to dehydration, thirst.
After drinking the liquid, the patient feels a deterioration in well-being: an increase in pain or vomiting again. The condition progressively worsens from moderate to severe.
The patient is agitated, takes a forced position or cannot find a position that would alleviate his condition, rushes about on the bed. The pulse is frequent, weak filling, tachycardia, the skin is pale, cold.
When examined by a surgeon, specific symptoms are revealed: the noise of a splash, a falling drop, Valya, Kivul, which will reliably indicate to the surgeon that there is an obstruction.
Stage 3 - late
At this stage, the patient's condition is assessed as extremely serious, corresponds to the clinic of peritonitis.
There is an increase in body temperature, pulse, respiratory rate, in the analyzes - signs of bright inflammation.
Bowel sounds are absent. The body refuses to work, decompensation, multiple organ failure sets in.
Without treatment, the patient at this stage has no chance of surviving.
How to diagnose pathology
In the recognition of pathology, the qualification of the surgeon plays an important role, his ability to conduct an examination correctly, palpate the abdomen, collect anamnesis, quickly navigate and decide on the tactics of managing the patient.
This diagnosis does not tolerate slowness and does not allow for a long time to hesitate and wait. As soon as possible, if an obstruction is suspected, the patient should undergo the following diagnostic tests:
- X-ray examination of the abdomen in an upright position and a horizontal position on the left side. X-ray can be performed with barium suspension contrast.
The diagnosis will be confirmed by visualized accumulations of gas in the small intestine (normally there is only gas in the colon), "inverted bowls" - gas above the liquid level, "organ pipes" - swollen loops with gas and liquid. This is how radiologists describe confirmed intestinal obstruction.
- colonoscopy
- irrigoscopy
These methods are used to clarify the pathology in the final sections of the gastrointestinal tract, they will reveal the mechanical cause of the closure of the lumen, more accurately determine the localization of the process.
- laparoscopy
It is used more and more often in modern surgery. Through small incisions on the anterior abdominal wall, the doctor introduces an endoscopic device with a camera into the abdominal cavity, on the monitor screen, which is connected to the endoscope, organs and pathological changes are visualized with high accuracy.
In addition to the diagnostic method, the method can be used for therapeutic purposes: laparoscopically, some manipulations can be performed to dissect adhesions, remove foreign bodies, and carry out detorsion.
- Ultrasound of the OBP (due to the increased accumulation of gases, it can be difficult to carry out)
Both methods are very informative in determining the fluid in the abdominal cavity, tumors, infiltrates.
Intestinal obstruction treatment
All patients with a presumptive diagnosis should be urgently admitted to a surgical hospital.
After a thorough questioning, examination, diagnosis, the doctor determines the type of obstruction and, taking into account the patient's condition, chooses the treatment tactics.
Patients with an established diagnosis are urgently subject to surgical intervention, with:
- signs of peritonitis
- strangulation form of the disease
Surgical intervention in this form is necessary, since the developing disturbances in blood flow and ischemia very quickly lead to necrosis, necrosis of the organ wall.
- severe obstructive form
- severe intoxication syndrome
- in a state of shock
In other forms of obstruction (paralytic, spastic), if the patient's condition is stable, therapy begins with conservative methods. In more than half of the cases, such methods are effective and avoid surgery.
Such methods include:
- Cleansing or siphon enema.
- Removal of the contents of the gastrointestinal tract by continuous aspiration - suction with a special device that is inserted through the pharynx and esophagus. This is necessary for unloading, reducing the pressure inside the hollow organ.
- Novocaine blockade in the lumbar region on both sides. Allows to stop pain syndrome.
- Colonoscopy with localization of the process in the distal regions. This method allows, in some cases, to eliminate sigma volvulus, as well as to endoscopically place a small stent - a metal frame that expands the wall from the inside and eliminates stagnation phenomena, to remove a mechanical obstacle in the form of a foreign body.
- Medical treatment. Intravenous administration of antispasmodics, non-narcotic analgesics, ganglion blockers, anticholinesterase substances. With the help of drip infusions, the water-electrolyte balance is corrected, the fight against intoxication.
An important rule: if the choice of a surgeon (for certain indications) is stopped for conservative therapy, but after 2 hours from its start, the patient does not feel relief, there is no positive trend, or the condition worsens, it is necessary to change the treatment tactics in favor of surgical therapy.
Operative treatment
Before the operation, the preparation of the patient should be carried out in a short time, which includes catheterization of the urinary bladder, the introduction of saline, plasma-substituting solutions into the vein. This training is aimed at stabilizing the vital functions of the patient so that he can tolerate surgery well.
Depending on the reason that caused the obstruction, the surgeon takes one or another action aimed at eliminating it. This can be a resection - removal of a part of the intestine due to developed necrosis or due to tumor damage, straightening of loops, twists or knots, dissection from rations.
Sometimes situations in the abdominal cavity are so serious that it is difficult to manage with one operation. In such cases, interventions are performed on a delayed basis, in two or three stages.
Any operations are aimed at the maximum possible preservation of the organ, but if the doctor sees that the intestine is not viable (it is gray, does not peristalize, the vessels do not pulsate), it is removed.
Any interventions on the intestines are quite traumatic and require careful monitoring and observation in the postoperative period.
Permeability restored - what's next
If it was possible to cope with the cause of the disease by surgery, it is very important to stabilize the patient's condition, to return him to normal life as soon as possible through the correct management of the postoperative period.
This period includes:
- getting rid of toxins and decay products
Infusion preparations, saline solutions, blood plasma analogs are prescribed. Forced diuresis can be used: the appointment of large volumes of plasma-substituting drugs, and then a diuretic drug that stimulates diuresis. The increase in urine flow "flushes" all toxins from the body.
- prevention of possible infection
It is imperative to prescribe broad-spectrum antibiotics intravenously, as well as through drainage tubes into the postoperative wound, if necessary.
- prevention of thromboembolism and thrombosis
Tight bandaging of the lower extremities is necessary, the appointment of aspirin, warfarin or heparin, which have a thinning effect on the blood. It is important not to let the patient "lie down": verticalization should be done as early as possible.
- normalization of bowel function
For several weeks, the contents of the gastrointestinal tract continue to be aspirated through the probe, prokinetics that stimulate motor skills are injected, and physiotherapy sessions with electrical stimulation are prescribed.
Success in the treatment of this pathology depends on timely diagnosis, so you should listen to your body. If he gives signals of trouble in the form of abdominal pain, bloating or vomiting, you should not self-medicate, it is better to consult a specialist as soon as possible!
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