Intestinal obtruction is an emergency condition due to mechanical obstruction of the small intestine due to
1. Lesions outside the intestine e.g. adhesive fibrous bands, hernias.
2. Lesions within the wall of the intestine e.g. diverticulitis, cancer, chronic inflammatory
3. Obstruction of the lumen of the intestine e.g. gall stones.
With obstruction of the intestine, distention takes place which is caused by the accumulation
of gas and fluid proximal to the block. Blood flow is gradually compromised with the build
up of pressures with in the intestine and as the intestine distends more and more, venous
return to the heart is slowed down considerably. Severe loss of fluids into the distended
segment occurs leading to electrolyte imbalance, renal failure, shock and death. An obstruction also can occur when part of the intestine bulges through an abnormal opening (hernia), such as a weakness in the muscles of the abdomen, and becomes trapped. Strangulation of a bowel segment may cause necrosis (death of the tissue), perforation (a hole), and loss of fluid and blood. Since intestinal contents can't go downstream from the stomach, nausea and vomiting occur in most patients.
Bowel obstruction is a mechanical blockage of the intestines, preventing the normal transit of the products of digestion. As blockage occurs gas and air distend the bowel proximal (closest) to the blockage Not only can intestinal obstruction result in an array of uncomfortable signs and symptoms - including crampy abdominal pain and swelling of your abdomen, nausea and vomiting - if left untreated, intestinal obstruction can cause the blocked parts of your intestine to die. Some causes include adhesions (scar tissue), foreign bodies, intussusception , ischemia (decreased blood supply), hernias , volvulus (twisting) or tumors. Obstruction in the large intestine may be attributed to tumors, volvulus (twisting of the intestine), diverticulitis, and other colon disorders. Bowel edema and ischemia increase the mucosal permeability of the bowel, which can lead to bacterial translocation, systemic toxicity, dehydration, and electrolyte abnormalities. Bowel ischemia can lead to perforation and fecal soilage of the peritoneal cavity. This tissue death can lead to perforation of the intestine, severe infection and shock. In adults, an obstruction of the first segment of the small intestine (duodenum) may be caused by cancer of the pancreas; scarring from an ulcer, a previous operation, or Crohn's disease; or adhesions, in which a fibrous band of connective tissue traps the intestine.
Intestinal obstruction repair is surgery to relieve a bowel obstruction . The etiology of LBO is age dependent. Distinguishing between a true mechanical obstruction and a pseudo-obstruction is important, as the treatment differs. If the condition is not treated, the intestine can rupture, leaking its contents and causing inflammation and infection of the abdominal cavity. As the process continues, gastric (stomach), bilious (bile from the liver used in digestion) and pancreatic secretions (secretions from the pancreas used for digestion) begin to form a pool. Water, electrolytes and proteins accumulate in the area. This pooling and bowel distention decrease the circulating blood volume and the blood supply to the bowel tissue. Obstruction also tends to occur (as a result of scarring and connective bands of scar tissue [adhesions]) in people who have previously undergone abdominal surgery. Because of the serious complications that can develop from intestinal obstruction, seek emergency medical attention if you develop signs or symptoms of intestinal obstruction. With prompt medical care, intestinal obstruction can often be successfully treated.
Causes of Intestinal obtruction
The common Causes of Intestinal obtruction :
- Medications, especially narcotics
- Foreign bodies (e.g. gallstones in gallstone ileus , swallowed objects)
- Intraperitoneal infection
- Malrotation in infants
- Bowel cancer
- Kidney or thoracic disease
- Mesenteric ischemia (decreased blood supply to the support structures in the abdomen)
- Ischaemic strictures
- Injury to the abdominal blood supply
- Metabolic disturbances (such as decreased potassium levels)
- Abdominal tumor
Symptoms of Intestinal obtruction
Some are common Symptoms of Intestinal obtruction :
- Intermittent abdominal cramps
- Abdominal tenderness
- Abdominal fullness, gaseous
- Swelling of the abdomen (distention)
- Abdominal pain and cramping
- Failure to pass gas or stool ( constipation )
- Inability to have a bowel movement or pass gas
- Crampy abdominal pain that comes and goes (intermittent)
Treatment of Intestinal obtruction
Here is the list of the methods for treating Intestinal obtruction :
- The objective of treatment is to decompress the intestine with suction, using a nasogastric (NG) tube inserted into the stomach or intestine.
- This will relieve abdominal distention and vomiting .
- Complete obstruction, in which nothing can pass through your intestine, is a medical emergency that requires immediate surgery to relieve the blockage.
- Surgery to relieve the obstruction may be necessary if decompression by nasogastric tube does not relieve the symptoms, or if tissue death is suspected.
- Palliative colorectal stents are an option in patients who are poor surgical candidates or have advanced cancer.
- If you have mechanical obstruction in which some food and fluid can still get through (partial obstruction), decompressing your intestine with an NG tube may improve the condition, and no further treatment is necessary.
- Endoscopically placed expandable metal stents can be used to relieve the LBO, thus allowing for a primary colorectal anastomosis.