Colonic obstruction. Acute intestinal obstruction. Why is intestinal obstruction dangerous?

Intestinal obstruction is a condition in which the passage of food through the intestines is disrupted. In this case, a complete or partial disruption of the movement of intestinal contents may occur.

Most at risk of developing intestinal obstruction, the following groups:

aged people;
persons who have undergone surgery on the intestines and stomach.

Types and reasons

Intestinal obstruction is divided into the following types:

dynamic,
mechanical,
vascular.

The type is determined by the cause that caused the given pathological condition.

Causes of dynamic obstruction:

constant spasm of the intestinal muscles, which can occur with painful irritation of the intestines by worms, with acute pancreatitis, with traumatic injuries foreign bodies;
paralysis of the intestinal muscles, which develops during surgical interventions, poisoning with morphine-containing drugs, salts heavy metals, as a result of foodborne infections.

In case of mechanical obstruction, there must be some kind of obstacle:

fecal stones, bile duct stones, foreign body, external compression of the intestinal lumen tumor formations And cystic formations other organs, intestinal tumors growing into the lumen;
volvulus of intestinal loops as a result of intestinal strangulation at the gate abdominal hernias, adhesions and cicatricial processes, a knot of intestinal loops.

Vascular obstruction is always facilitated by disturbances in the blood supply (thrombosis, embolism) of the mesenteric blood vessels.

Symptoms of intestinal obstruction

Intestinal obstruction is an acute condition, that is, all the symptoms of the disease develop quickly, within a few hours.

There are several characteristic features diseases:

pain in the abdomen;
stool retention;
vomit;
violation of the passage of gases.

Intestinal obstruction always begins with the appearance of abdominal pain. The cramping nature of the pain is explained by the presence of peristaltic contractions of the intestine, which contribute to the movement of food masses.

In the presence of intestinal volvulus, the pain is immediately intense, unbearable, and constant. If there is another type of intestinal obstruction, the pain may be cramping and gradually increase in intensity. The patient appears in a forced position - he presses his legs to his stomach.

The pain can be so severe that the patient goes into pain shock.

Vomiting develops early if the patient has an obstruction in the upper intestine (small intestine), and the patient experiences it repeatedly, but does not bring relief.

With obstruction in the lower intestines, it appears only with the development of general intoxication of the body, after 12-24 hours.

Impaired passage of stool and gases is especially characteristic of lower intestinal obstruction. The patient experiences bloating and rumbling.

If assistance is not provided to the patient, after about a day the patient develops general intoxication of the body, which is characterized by:

increased body temperature;
increased respiratory movements;
peritonitis (damage to the peritoneum);
septic process (spread of infection throughout the body);
disturbance of urination;
severe dehydration.

As a result of general intoxication, if left untreated, the patient may die.

Diagnostics

To make a diagnosis of intestinal obstruction, a number of laboratory and instrumental studies are required:

general analysis blood - there may be an increase in leukocytes during inflammatory processes;
a biochemical blood test may indicate metabolic disorders (impaired composition of microelements, decreased protein);
An X-ray examination of the intestine is mandatory when making this diagnosis. By introducing a radiopaque substance into the intestinal lumen, the level of development of intestinal obstruction can be determined;
colonoscopy (examination of the large intestine using a probe with a video camera at the end) helps with colonic obstruction, for examination small intestine used - irrigoscopy;
Ultrasound examination is not always informative, since with intestinal obstruction, air accumulates in the abdomen, which interferes with the normal assessment of data;

In difficult cases, laparoscopic examination is performed abdominal cavity, 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, adhesive process).

It is necessary to differentiate intestinal obstruction from:

acute appendicitis (ultrasound, localized in the right iliac region);
perforated ulcers of the stomach and duodenum (FGDS, radiography with a contrast agent);
renal colic (ultrasound, urography).

To clarify the diagnosis, it is always necessary to carry out additional methods research, since it is impossible to differentiate intestinal obstruction by symptoms alone.

Treatment of intestinal obstruction

If intestinal obstruction is suspected, the patient must be urgently hospitalized in the surgical department.

Important! Self-medication with painkillers and antispasmodics is not allowed.

IN early hours after the onset of the disease, in the absence severe complications conservative therapy is carried out.

For conservative treatment apply:

evacuation of gastric and intestinal contents using intubation;
for spasms - antispasmodic therapy (drotaverine, platyphylline); for paralysis - drugs that stimulate motor skills (prozerin);
intravenous administration saline solutions to normalize metabolic processes;
siphon enemas;
therapeutic colonoscopy, which can eliminate intestinal volvulus and gallstones.

Most often, the patient undergoes surgery, the purpose of which is to eliminate obstruction and remove non-viable intestinal tissue.

The following interventions are carried out:

unwinding of intestinal loops;
dissection of adhesions;
resection (removal) of part of the intestine with subsequent stitching of the ends of the intestine;
If it is impossible to eliminate the cause of obstruction, a colostomy is performed (removal feces out);
In case of hernia formations, their plastic surgery is performed.

The duration and result of treatment directly depend on the cause of intestinal obstruction and the start date of treatment.

Complications

If hospitalization is not timely, the following dangerous conditions may develop:

pain shock;

Prevention

TO preventive measures include:

timely diagnosis and treatment of tumor processes in the intestines and neighboring organs;
treatment helminthic infestations;
prevention of adhesions after surgery;
balanced diet;
conducting healthy image life.

Symptoms, treatment and features of this disease will be presented below. We will also tell you about the causes of the disease in question and how it is diagnosed.

general information

Intestinal obstruction (symptoms in adults and children will be discussed below) is characterized by a partial or complete cessation of the movement of chyme through the intestines. This pathological condition requires urgent intervention from specialists, as it threatens the patient’s life.

Causes of development in babies

How does intestinal obstruction occur in children? The symptoms of this disease in newborns are not much different from the symptoms in adults.

According to doctors, all segments of the population are susceptible to this disease. This pathological condition can occur in both newborns and the elderly.

Usually in infants, intestinal obstruction is a consequence of abnormal intrauterine development. It can manifest itself as a result of narrowing of the intestinal lumen, or so-called stenosis, esophageal atresia, incomplete intestinal rotation, intestinal duplication (that is, duplication of the intestine) and neuronal dysplasia of the intestinal walls.

Why does it occur in adults?

Now you know why it develops. The symptoms of this disease will be presented below.

The development of such a disease in adults has many various reasons. The most common of them are the following:

Types of disease

The symptom of intestinal obstruction can vary. It often depends on the type of disease and the cause of its occurrence.

IN medical practice The disease in question is usually classified as follows:

congenital;
acquired.

Based on the causes of development and the mechanism of the disease, it should be clarified that the congenital form of intestinal obstruction is the result of intrauterine anomalies.

As for the acquired disease, it is the result of a developmental mechanism. The group of this type includes the dynamic or so-called functional type of obstruction with paralytic and spastic forms. The first is a consequence of paralysis and intestinal paresis. As a rule, it appears only in the secondary stage and may be the result of postoperative stress.

The spastic form of the disease is associated with reflex spasms of the intestines. This disease is a consequence of helminthic infestations or intoxications.

Intestinal obstruction: symptoms

Treatment in children and adults of this disease should be carried out immediately, otherwise it can be fatal.

Typically, the development of such a disease is characterized by painful sensations in the abdominal area. They can be sharp, cramping, and also increasing in nature. This condition contributes to nausea and subsequent vomiting.

After some time, the contents of the intestine (due to its overcrowding) enter the stomach. This phenomenon gives the vomit an odor characteristic of feces.

How is it recognized? The symptoms of this disease are as follows: the child experiences constipation and increased gas production.

At the very beginning of the disease, intestinal motility usually persists. Moreover, it can be observed even through the child’s abdominal wall. Subsequently, the patient with intestinal obstruction noticeably enlarges the abdomen, which takes on an irregular shape.

General signs

On different stages The development of a symptom of intestinal obstruction can manifest itself in different ways. During the diagnostic process, the following signs can be detected in a patient:

drop in blood pressure;
increased heart rate;
dry tongue;
intestinal loops filled with gas and liquid, as well as an increase in their size;
increase in body temperature.

Symptoms of acute intestinal obstruction

This pathological condition develops suddenly. It manifests itself in exactly the same way as the process of intestinal dysfunction. As a result, the patient is concerned about the following symptoms:

pain in the abdomen;
rumbling and flatulence;
diarrhea and constipation;
vomiting and nausea;
shock and increased peristalsis.

It should also be said that acute intestinal obstruction is characterized by very diverse symptoms. They usually depend on the level of obstruction of the affected organ.

Each symptom of intestinal obstruction worries a person simultaneously with others. However, the absence of any of them does not exclude the presence of the pathology in question.

Painful sensations when acute illness have a pronounced character, and from the very beginning of development. Most often, such sensations are localized in the pit of the stomach, that is, around the navel. The nature of the pain syndrome is spasmodic.

A symptom of intestinal obstruction in the form of vomiting is the most constant sign. However, experts say that this phenomenon is observed only if the obstruction in the intestines is high.

With obstruction of the colon, this sign is absent, although nausea remains. At the very beginning, vomit represents only the contents of the stomach. After some time, they acquire a yellowish tint, and then turn green and even greenish-brown.

How else does acute intestinal obstruction manifest? Symptoms (treatment of this disease should only take place in a hospital) of this pathology boil down to severe constipation. As a rule, this sign of the disease is the latest.

It should also be noted that the pathology in question is almost always accompanied by large losses of fluid during vomiting, as well as intoxication with intestinal contents.

If treatment is not timely, a person’s blood pressure decreases and their heart rate increases. Signs such as these indicate the onset of shock.

Paralytic obstruction

This form of the disease can manifest itself in the form of a progressive decrease in peristalsis and intestinal tone. As a result, complete paralysis of the affected organ often develops.

Characteristic for:

pain, uniform bloating and vomiting;
gas and stool retention.

Pain with this disease affects the entire abdominal area. They have a bursting character and do not give anywhere.

Vomiting with paralytic intestinal obstruction visits the patient many times. At first it consists of gastric and then intestinal contents. In case of diapedetic bleeding from the walls of the intestines and stomach, as well as acute ulcers, the vomit is hemorrhagic in nature.

Severe gas formation causes chest breathing. Patients are also diagnosed with low blood pressure, tachycardia and dry mouth.

Adhesive obstruction

How does adhesive chronic intestinal obstruction manifest itself? All people predisposed to its occurrence should know the symptoms of this disease. This is due to the fact that this pathology is the most common. Today there is a tendency to increase its frequency. This is due to large quantity abdominal surgeries.

Adhesive intestinal obstruction is classified as follows:

obstruction;
strangulation;
dynamic obstruction.

The first form of the disease is characterized by compression of the intestine by adhesions. At the same time, its innervation and blood supply are not disrupted.

With the strangulation type, adhesions have strong pressure on the mesentery of the intestine. As a result, necrosis of the affected organ occurs. This form is divided into three different types: knotting, twisting and pinching.

Stages of the disease

How does intestinal obstruction occur in infants? Symptoms of this disease in children and adults depend on its stage.

According to medical practice, such a disease develops in three stages:

Initial. It lasts about 3-12 hours and is also accompanied by painful sensations in the abdomen, increased peristalsis and flatulence.
Intermediate. It lasts about 13-36 hours. In this case, the pain syndrome subsides and a time of imaginary well-being begins. During this period, symptoms of intoxication and dehydration increase.
Terminal. As a rule, this stage occurs two days after the formation of the disease. The person's condition is noticeably deteriorating. In this case, there is an increase in symptoms of dehydration, damage internal organs and NS.

How to diagnose?

How is complete or partial intestinal obstruction detected? The symptoms of this disease are quite similar to the signs of other diseases occurring in the gastrointestinal tract. Therefore, when making a diagnosis, rely only on external manifestations no way.

The main way to diagnose this pathology is an X-ray examination of the abdominal cavity, as well as a blood test. In addition, some specialists use ultrasound as an adjunct.

Upon objective examination, the patient’s tongue is dry and covered with a white coating. The patient also experiences uneven abdominal bloating.

Obstruction in animals

How does intestinal obstruction manifest in a dog? The symptoms of this disease in pets are practically no different from those in humans. At the first signs of illness, you should definitely take your pet to veterinary clinic. This is the only way you can save his life.

Treatment methods

What to do if a person has been diagnosed or has suspicions (even the slightest) of intestinal obstruction? In this case, he requires urgent hospitalization. Usually such a patient is immediately sent to the surgical department.

If a patient experiences progressive, onset, or catastrophic dehydration, the intestinal obstruction is treated immediately. With such a diagnosis therapeutic measures should, if possible, be carried out during the transportation of the patient.

IN inpatient conditions Without pronounced signs mechanical obstruction is treated, which includes the following measures:

The contents of the stomach and intestines are aspirated through a thin tube that is inserted through the nose.
With increased peristalsis, the patient is given antispasmodics.

If the patient is diagnosed with mechanical obstruction, and conservative methods do not help, then emergency surgery should be performed. Typically it includes:

unwinding of the torsion;
dissection of adhesions;
bowel resection for necrosis;
deinvagination;
overlay (to release its contents in case of tumors in the colon).

After the operation, the patient awaits recovery period. It includes procedures aimed at normalizing protein and water-salt metabolism. For this purpose, specialists use intravenous administration of blood substitutes and saline solutions. They also carry out anti-inflammatory treatment and stimulate the motor-evacuation work of the gastrointestinal tract.

Nutrition

Now you know what they are, the same as in humans and other animals). In addition to medication and surgical treatment For such a disease, the patient is prescribed a special diet.

After surgery for intestinal obstruction, it is prohibited to eat or drink for half a day. Sometimes the patient is fed parenterally. Nutrient solutions are injected into him through a vein.

With such a disease, a person is allowed to use dairy products, as well as infant formula (in frequent and very small portions).

Some time after the operation, easily digestible liquid foods are introduced into the patient’s diet. At the same time, salt consumption is limited. Next, they switch to a diet that is close to table No. 4. This diet was developed to be as gentle as possible on the intestines, as well as to reduce the fermentation process in it.

For any type of obstruction, a person must limit himself to fats, carbohydrates, smoked foods, spices, fiber, pickles and milk. All dishes served to the patient are well boiled or steamed, and then thoroughly ground.

After some time diet menu expands a little. In this case, the patient completely switches to diet No. 4. By the way, it is designed specifically for those who have intestinal diseases.

The table for people with diseases of the gastrointestinal tract should provide good nutrition, which will be especially gentle on the intestines. The diet for intestinal obstruction (after recovery) becomes more varied. In this case, the food is not pureed, and all dishes are boiled or steamed. This will allow the diseased organ to digest it more thoroughly.

Diets for acute and chronic obstruction do not allow putrefactive and fermentative processes to develop.

It should also be noted that with such a diagnosis, irritants of thermal, chemical and mechanical types should be completely excluded.

Let's sum it up

Intestinal obstruction is a rather insidious disease. If not treated in a timely manner, it often leads to death. It should also be noted that very often the only way to treat this disease is to surgery. After it, the patient is obliged to follow a number of doctor’s recommendations aimed at restoring the body.

Acute intestinal obstruction is a disruption of the normal movement of food through the gastrointestinal tract, caused by mechanical (obstruction of the intestinal lumen from the inside or outside), functional or dynamic (spasm or paralysis of the intestinal wall) reasons. Considering the above, mechanical and dynamic intestinal obstruction are distinguished.

Causes of acute intestinal obstruction.

Among the mechanical factors leading to intestinal obstruction, the following can be identified:

Strangulated hernia;
formation and blocking of the lumen by adhesions developing after abdominal surgery;
intussusception of the intestinal wall, when one section of the intestine is pulled into another, blocking its lumen;
colon cancer or tumor of a nearby organ;
volvulus and nodulation;
obstruction of the intestinal lumen with gall or fecal stones, foreign bodies, a ball of worms.

Dynamic intestinal obstruction can occur immediately after abdominal surgery, with peritonitis, or with poisoning (for example, lead - lead colic develops, occurs in people working in battery production plants).

Previous operations on the abdominal organs, open and closed injuries abdomen, dolichosigma (abnormally long sigmoid colon), diverticular disease of the large intestine, anterior hernia abdominal wall, inflammatory diseases abdominal organs can contribute to the development of intestinal obstruction.

Symptoms of acute intestinal obstruction.

Acute intestinal obstruction does not develop suddenly. It is usually preceded by symptoms of intestinal dysfunction: periodic pain, bloating and rumbling in the abdomen, alternating constipation with diarrhea.

Symptoms of intestinal obstruction are very varied and depend mainly on the level of intestinal obstruction: the obstruction can be located in the upper and lower sections small intestine or in the colon. We will list the main symptoms that occur with intestinal obstruction. It should be understood that they are rarely present all at the same time, so the absence of several of them does not exclude the presence of intestinal obstruction.

So, the symptoms of acute intestinal obstruction include: pain, vomiting, constipation, bloating and abdominal tension, increased peristalsis and shock.

The pain is always pronounced from the very beginning. It is usually localized in the epigastrium (under the pit of the stomach) or around the navel, less often in the lower abdomen, and is of the nature of spasms.

Vomiting is one of the most persistent symptoms of acute intestinal obstruction. The higher the obstruction in the intestines is located, the earlier and more severe the vomiting will be. With colonic obstruction, there may be no vomiting, but there will certainly be nausea. Vomiting of stomach contents begins, then the vomit becomes yellowish color, gradually becoming green and greenish-brown.

Lack of stool is a fairly late symptom (develops 12–24 hours after the onset of the disease), since the first hours after the development of obstruction lower departments can reflexively empty their bowels, creating the illusion of normalcy.

The severity of bloating and abdominal tension depends on the level of intestinal obstruction. With obstruction of the colon, the abdomen may be swollen, like a “drum”.

With the development of intestinal obstruction, sometimes you can hear seething, splashing, or rumbling in the stomach from a distance, which indicates increased intestinal motility. If left untreated, these sounds may disappear, which may mislead the condition as it improves. In fact, this may indicate the development of peritonitis. Rarely in thin people can you see intestinal peristalsis through the abdominal wall.

Considering the large losses of fluid and electrolytes during vomiting, intoxication with stagnant intestinal contents, rather quickly in the absence of treatment, an increase in heart rate and a drop in blood pressure, which may indicate the onset of shock.

These symptoms can also develop with other diseases. Among the latter: acute appendicitis, acute pancreatitis, perforated gastric and duodenal ulcer, acute cholecystitis, peritonitis, ovarian cyst torsion, ectopic pregnancy, thromboembolism of intestinal mesenteric vessels, renal colic and myocardial infarction. However, in any case, these diseases also require urgent medical care and urgent examination by a doctor.

Diagnosis of acute intestinal obstruction.

If these symptoms occur, you should consult a surgeon. After the examination, you will need to take a general blood and urine test, undergo an X-ray and ultrasound examination.
With fluoroscopy of the abdominal organs, you can see swollen intestinal loops, overflowing with liquid contents and gas, the so-called Kloiber cups and intestinal arches - these are specific symptoms intestinal obstruction.

Distended intestinal loops on x-ray.

At ultrasound examination abdominal organs, you can determine the diameter of the intestinal loops, the presence free liquid in the abdominal cavity, which will confirm the diagnosis.
If symptoms are present, as well as a typical X-ray and ultrasound picture, urgent hospitalization in a surgical hospital is necessary.

As a survey method in surgical department it is possible to carry out a repeat x-ray examination with the study of the passage of barium suspension through the intestines. Barium suspension (or barium sulfate suspension) is visible under fluoroscopy and allows you to establish the level of obstruction, as well as assess the dynamics of the disease. To identify pathologies in the colon, emergency irrigoscopy is performed - giving an enema with a barium suspension. In this case, the entire colon is filled and its condition is assessed using fluoroscopy.

A more invasive method is colonoscopy. After cleansing the colon, a flexible endoscope is inserted through the anus and the entire colon is examined. Using colonoscopy, you can detect a tumor of the colon, take a biopsy, and also intubate the narrowed area, thereby resolving the manifestations of acute intestinal obstruction. This makes it possible to perform surgical intervention for cancer in more favorable conditions.

In diagnostically difficult cases, laparoscopy is performed - an endoscope is inserted through a puncture in the anterior abdominal wall and the condition of the internal organs is visually assessed.

Treatment of acute intestinal obstruction.

Treatment of acute intestinal obstruction begins with conservative measures. Regardless of the cause of this condition, all patients are shown hunger and rest. A nasogastric tube is passed through the nose into the stomach. It is necessary to empty the stomach, which helps stop vomiting. Intravenous administration of solutions and medications (antispasmodics, analgesics and antiemetics) is started. Stimulates intestinal motility subcutaneous injection Proserina. If a hernia is strangulated, it is necessary to perform emergency surgery– it is impossible to relieve intestinal obstruction in such a situation without surgical intervention. In other cases, if conservative treatment is ineffective, surgical intervention is also necessary.

Elastic bandaging is required before surgery lower limbs for the prevention of thrombus formation in the veins of the legs.

Surgery for intestinal obstruction is performed under general anesthesia (intubation endotracheal anesthesia with muscle relaxants). For this pathology, it is necessary to perform a wide median laparotomy - a median incision on the anterior abdominal wall. Such an incision is necessary for an adequate examination of the abdominal organs and search for the disease that caused intestinal obstruction. Depending on the established cause carry out the appropriate operational assistance.

Features of the postoperative period.

The first day after surgery is indicated bed rest. You can take food and water in consultation with your doctor, as it depends on the extent of the operation. You can only get up and walk with a special orthopedic bandage, which reduces the load on the seams and reduces pain when moving. In order to choose the right bandage, you need to know the patient’s waist size. IN postoperative period, until discharge from the hospital, the legs should be bandaged with an elastic bandage.

Prevention of acute intestinal obstruction.

The main method of preventing the occurrence and recurrence of intestinal obstruction is timely treatment diseases, causing disruption passage of food through the intestines. This includes timely treatment of hernias of the anterior abdominal wall, routine clinical examination of the large intestine for the presence of cancer and radical treatment colon tumors.

When performing operations on the abdominal organs, preference should be given to videolaparoscopic methods of surgical treatment, after which the adhesive process is minimally expressed, respectively less likely development of adhesive disease.

After surgery on the abdominal organs, it is important to change your diet. It is necessary to eat in small portions (every 2 - 3 hours) with limiting foods containing large amounts of fiber and various spices that irritate the intestinal mucosa.

It is necessary to deal with constipation in a timely manner. Bisacodyl suppositories often help, Vaseline oil, which is taken when chronic constipation 1 - 2 tablespoons during meals, and when acute conditions 50 ml per day, enemas.

Complications of acute intestinal obstruction.

Lack of timely adequate treatment can lead to necrosis of the intestinal walls with the outflow of the contents of the intestinal tube into the free abdominal cavity with the development of peritonitis. Peritonitis (inflammation of the peritoneum) - serious condition, difficult to treat with a high percentage of deaths, leads, in turn, to abdominal sepsis (blood poisoning) and death.
Therefore, a positive outcome for this disease is possible only if you seek medical help early.

Take care of your health. It is better to overestimate the severity of your symptoms than to seek medical help late.

Surgeon Tevs D.S.

Video about acute intestinal obstruction:

Intestinal obstruction consists of a partial or complete cessation of the movement of contents (chyme) through the intestines. Intestinal obstruction requires urgent medical intervention, as it is a life-threatening condition.

Types and causes of intestinal obstruction

According to the nature of the course, acute intestinal obstruction is distinguished from chronic; intestinal obstruction can also be complete or partial.

By origin it can be congenital or acquired. Congenital intestinal obstruction in children is caused by abnormalities in the development of the intestine or blockage of it by dense meconium - feces formed during the intrauterine development of the fetus.

Depending on the cause that caused it, intestinal obstruction is divided into two types: dynamic and mechanical.

Dynamic intestinal obstruction is caused by disorders of innervation and blood circulation in the intestines.

In turn, it is divided into the following forms:

Paralytic intestinal obstruction. It occurs as a result of paralysis of the muscular layer of the intestine, which stops peristalsis - the movements that move chyme through the intestines. It is a complication of peritonitis (inflammation of the peritoneum). Paresis (partial paralysis) of the intestines occurs with renal and biliary colic, acute attacks pancreatitis, injuries of the pelvis, spine and hematomas of the abdominal cavity, and may also be postoperative;
Spastic intestinal obstruction. The cause of spastic intestinal obstruction is intestinal spasm as a result of poisoning by certain medicines and salts of heavy metals.

Mechanical intestinal obstruction is the most common type of intestinal obstruction. Divided into the following subspecies:

Obstructive intestinal obstruction. Occurs in the presence of a neoplasm that partially or completely blocks the intestinal lumen (fecal stones, tumors, cysts, helminth balls), it is characterized by a gradual increase in symptoms;
Strangulating intestinal obstruction. Associated with compression or strangulation of the intestinal mesentery (volvulus, intestinal nodes), this type is characterized by rapid development, 4-6 hours from the moment of onset until complete obstruction;
Mixed or combined intestinal obstruction. Occurs during intussusception, when the intestinal lumen is clogged by an invading intestine, and the mesentery of the invading loop is compressed. Intussusception is the most common reason intestinal obstruction in children.

Intestinal obstruction is also classified by level:

Small intestinal obstruction;
Large intestinal obstruction;
High intestinal obstruction;
Low intestinal obstruction.

Symptoms of intestinal obstruction

Each type of intestinal obstruction has different symptoms, but there are signs that are common to all cases:

The appearance of sharp pain in the abdomen;
The appearance of vomiting;
Stopping the passage of gases and stool retention.

These three symptoms of intestinal obstruction have characteristics characteristic of this state, so it’s worth talking about them in a little more detail.

Pain. It has a cramp-like character, painful contractions coincide with the rhythm of peristalsis. At the initial stage, in the interval between pain, the patient may not be bothered by anything at all, or there may be a slight aching sensation. Blunt pain. During an attack, the pain becomes so intense that patients rush around, trying to find a position in which it would decrease. At the peak of pain, the patient can neither scream nor speak, and one of the characteristic symptoms intestinal obstruction is a quiet groan (“ileus groan”). At this time he performs cold sweat, the pulse quickens - signs appear painful shock.
Vomit. In the case of small intestinal obstruction, it is repeated, debilitating, abundant, does not bring relief, first containing the remains of undigested food, then consisting of intestinal juices mixed with bile. IN next period, when peritonitis occurs, painful vomiting occurs with stagnant contents of the lower parts of the intestine, which has the appearance and smell of feces - “fecal vomit”. With large intestinal obstruction, vomiting may occur no more than once or twice; fecal vomiting is not observed.
The symptom of stool retention and passing gas also varies depending on the form of the disease. With low or large intestinal obstruction, stool and gas may be completely absent for several days before the onset of acute intestinal obstruction. But with high or small intestinal obstruction, at the initial stage there may be independent stool, or stool caused by an enema. In this case, the absence of stool and gas formation may already be late symptoms intestinal obstruction.

Other symptoms of intestinal obstruction include: thirst, bloated abdomen, increased peristalsis at the beginning of the disease, and its complete cessation as the condition worsens. At the beginning of the disease, due to strong peristalsis, loud sounds are heard. bowel sounds, then peristalsis stops, and complete silence sets in - a symptom of “deafening silence”.

During acute intestinal obstruction there are three stages:

The initial, or period of “ileus moaning,” lasts from 2 to 12 hours. Characterized by pain syndrome, bloating, increased peristalsis;
Intermediate, from 12 to 36 hours. The pain stops altogether, or loses its attack-like nature and intensity, which is why this stage is called the stage of imaginary well-being. Dehydration and intoxication increase. Peristalsis stops;
Terminal, or late. Occurs 36 hours after the first signs of acute intestinal obstruction appear. At this stage, the patient’s condition becomes significantly more serious, and all life-supporting systems of the body fail.

Diagnosis of intestinal obstruction

Diagnosis of acute intestinal obstruction should be immediate. The initial diagnosis is made based on a thorough examination, identification of characteristic symptoms and tests, as well as on the basis of x-ray examination.

Treatment of intestinal obstruction

Treatment of intestinal obstruction begins with emergency measures to replenish lost fluid and relieve pain shock. Upper sections gastrointestinal tract free from residual contents using a probe, lower sections - using siphon enemas. To terminate increased peristalsis V initial stage antispasmodics are administered to relax the muscle wall. Sometimes, for the treatment of intestinal obstruction of a dynamic form, these measures are sufficient to restore normal function intestines.

If therapeutic methods for treating intestinal obstruction in its dynamic form are ineffective, and in all cases of mechanical intestinal obstruction, resort to surgical intervention, which consists of eliminating the cause of the disease, in the event of necrosis of a section of the intestine - excision and restoration of intestinal patency.

Video from YouTube on the topic of the article:

AND . High probability extremely severe course with an often inevitable fatal outcome, makes it so dangerous that every doctor should be able to recognize it. And not only him.

Causes and types of acute intestinal obstruction

The term “intestinal obstruction” means a delay or complete absence passage of contents through the digestive tube due to a number of reasons. It is on this basis that the disease is mainly divided into types:

A) Mechanical, in which there is a physical obstacle to the passage of the food bolus. In turn, it is divided into:

Obstructive CI resulting from intestinal blockage:
- fecal stones;
- bezoars (a lump of hair that accumulates in the stomach mainly in women who love to gnaw on their own curls);
- large gallstones;
- foreign bodies;
- tumors compressing the intestines from the outside, cysts of other localizations.
Strangulation, in which obstruction is caused by:
- twisting of the intestinal loop around itself;
- the formation of a knot of several loops;
- strangulation of the intestine, its mesentery and vessels in the hernial orifice;
- adhesions or scar cords compressing the intestine from the outside.
Mixed, combining both mechanisms - intussusception, or the introduction of one part of the intestine into another.

B) D dynamic, in which the contents of the intestines do not pass through it due to:

Constant spasm of smooth muscles;
Her permanent paralysis.

Consequences of intestinal obstruction

This disease, if left untreated, leads to mass serious complications. Thus, turning off part of the intestine, which becomes dead due to a disruption in its blood supply, provokes a disruption in its digestion and absorption of nutrients.

Decline protective functions 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, multiple organ failure.

The cessation of absorption in the dead intestine also applies to water. Insufficient entry into the blood, coupled with frequent vomiting leads to rapid dehydration of the body.

All these phenomena develop relatively quickly and lead to inevitable death within a few days if the patient is not promptly transported to a surgical hospital.

Symptoms of intestinal obstruction

There are three periods in the development of CI, each of which has its own symptoms.

Early period (up to 12 hours)

The disease debuts with pain, the nature and intensity of which differs depending on the type of obstruction. During obstruction, the pain comes in the form of an attack, lasts several minutes, after which it subsides completely. During strangulation, they are constant, but change their intensity from moderate to unbearable, sometimes provoking painful shock.

Vomiting during this period occurs rarely and only if there is an obstruction at the very beginning of the small intestine.

Intermediate period (12 to 24 hours)

12 hours after the onset of pain clinical picture becomes as bright as possible. The pain ceases to be paroxysmal with any type of CI, the abdomen swells, frequent profuse vomiting. Because of this, as well as the inability to take liquids by mouth, swelling of the intestines and the cessation of water absorption, dehydration rapidly increases.

Late period (>24 hours)

During this period, the phenomena of the body’s systemic response to the existing disease increase:

breathing rate increases;
body temperature rises, which indicates an increase in poisoning of the body with bacterial toxins;
urine production stops;
arise severe violations acid-base balance;
signs of damage to the peritoneum appear - peritonitis;
the development of sepsis is possible.

Stopping stool and passing gas - frequent, although not persistent symptom KN. It is more pronounced with low obstruction (obstruction in the colon) and much less pronounced with upper obstruction. However, even in the latter case, at the onset of peritonitis, paralysis of the motor functions of the intestines is noted, leading to a stop in the passage of feces through it.

The patient's condition progressively worsens from moderate to critical, increasing tachycardia is noted, the temperature gradually rises to high numbers (sometimes to extremely high - in the case of sepsis).

If left untreated, the disease inevitably leads to the development of multiple organ failure and death of the patient.

Diagnosis of intestinal obstruction

Objective data alone about the history of the development of the disease and its symptoms are often not enough to diagnose accurate diagnosis. Here equipment comes to the aid of doctors and lab tests:

or colonoscopy can clarify the diagnosis of large intestinal obstruction.
Ultrasound in some cases provides valuable information about the presence, for example, of a tumor that caused obstruction.
Very informative diagnostic method laparoscopy is considered, during which you can directly see the site of obstruction and even carry out some therapeutic manipulations - cut adhesions, unravel a loop of intestine when it is twisted.

Treatment of intestinal obstruction and first aid

In quite rare cases, with uncomplicated obstructive obstruction, doctors may resort to conservative treatment. This approach is used at the most early stages when the process of destruction of the intestinal wall has not yet caused systemic effects. As part of conservative treatment, the following is used:

constant pumping of the contents of the stomach and intestines through a tube;
siphon enemas;
colonoscopy, which sometimes allows you to eliminate intestinal volvulus or “break through” an obstacle, for example, by removing a stone;
antispasmodics that relieve intestinal spasms.

In the vast majority of cases, it is still necessary to resort to surgical treatment of intestinal obstruction. This is due to the fact that the start of treatment is often delayed due to late presentation or delayed transportation of the patient and delayed diagnosis of the disease. The “golden 6 hours,” during which there is a chance to eliminate the obstruction without surgery, are missed and the patient ends up on the surgeon’s table.

There are many types of operations that allow you to restore the passage of a food bolus through the intestines. In some cases, part of the dead intestine is removed and the edges of the incisions are sutured; in others, the operation is carried out in two stages:

stoma removal ( top end the intestines are brought out onto the anterior abdominal wall);
suturing the ends of the intestine after a few months.

At strangulated hernia The hernial orifice is repaired and the intestinal loop is reduced if it is viable or removed in case of necrosis. When intestinal volvulus occurs, the knot is straightened and the viability of the intestine is assessed. In case of obstructive obstruction, it may be necessary to open the intestine and remove fecal stones, bezoars, etc. from it.

Before the operation, the patient is prepared for a short time by intravenous infusion solutions, the same thing happens in the intensive care unit after surgical intervention. At the same time, anti-inflammatory drugs and stimulants are used. motor function intestines, and for peritonitis - antibiotics.

A person’s chance of survival with intestinal obstruction directly depends on the speed of providing him with medical care. People operated on in the first 6 hours after the onset of the disease almost all recover, while during an operation performed a day later, every fourth person dies. Depressing statistics allow us to say one thing with confidence - don’t waste time! If there is a long absence of gas and stool, increasing pain and bloating, immediately call an ambulance. Time is the only currency with which you can buy life with intestinal obstruction.