Intestinal obstruction is an acute disease of the gastrointestinal tract, in which the intestine forms an obstacle to the excretion of fecal masses. This is a very painful condition that can be fatal if you do not seek medical attention in time. Obstruction can occur at any age, from the newborn to the elderly.
Symptoms of this disease are often mistaken for signs of other diseases of the gastrointestinal tract and try to cope with them on their own. This can not be done categorically, since only time provided medical assistance can save the life of the patient. This disease is treated only in the hospital of the surgical department.
Types and causes
There are several varieties of CN.
1. According to the causes of occurrence distinguish congenital and acquired forms. Congenital form is detected in infancy and is caused by abnormal development of the small or large intestine. Acquired form becomes the result of certain processes that take place in the human body, as a rule, in a more adult age.
2. There are also functional and mechanical KN.
Functional CN – arises as a result of negative processes in the intestine, after which it completely or partially stops functioning. The causes of this type of blockage can be a variety of factors:
- associated gastrointestinal diseases;
- inflammations of the abdominal cavity (namely, such diseases as appendicitis, cholecystitis, pancreatitis, peritonitis);
- operations that were performed on the abdominal cavity;
- internal bleeding;
- abdominal trauma;
- plentiful heavy meal in large quantities after a long fast;
- intestinal colic.
All these processes can lead to functional blockage of the intestine, which manifests itself in two forms: as spastic and as paralytic obstruction. Spastic CN is characterized by spasm of a certain part of the intestines. The spasm can be manifested in the small bowel or in the large intestine. In the later stages of the disease, 18–24 hours after the onset of the spasmolytic blockage, a paralytic form may occur, during which the entire intestine is paralyzed.
The second type of disease is mechanical CN. In contrast to the functional form, with a mechanical variety of intestinal motility, it continues to work actively, but the existing barrier prevents it from bringing fecal matter out. In turn, the mechanical blockage is divided into two forms as to whether circulatory disturbances appeared in the gastrointestinal tract during blockage.
A) Strangulation obstruction. In this case, there are circulatory disorders in the gastrointestinal tract. The reasons for this phenomenon are as follows:
- neglected hernia (intestinal loops are strangled in the hernial orifice);
- twisting intestinal loops due to the activity of the intestine;
- knot formation in the intestines.
B) Obstructive intestinal obstruction, in which the violation of blood circulation of the digestive tract is not observed. It usually occurs when the intestines become blocked.
- foreign body;
- lump of worms;
- tumors (a tumor can occur both in the intestine and in other organs, for example, tumors of the uterus, kidneys, pancreas can clog the intestines);
- fecal stone.
According to the clinical course, there are acute and chronic forms of intestinal obstruction. The acute form of CN is manifested sharply and painfully, with each passing hour all the more aggravated, the flesh until death. The chronic form is caused by the growth of adhesions or tumors in the gastrointestinal tract. It develops very slowly, occasionally recalling the symptoms of flatulence, constipation, and diarrhea, alternating with each other. But sooner or later, when the tumor grows to a certain state, it clogs the intestine completely, and the problem enters the acute phase with all the negative consequences.
Symptoms of intestinal obstruction in adults
It is important to note that there is a main complex of symptoms of intestinal obstruction, which manifest themselves equally at any age. So, a sign of intestinal obstruction at an early stage are three main symptoms:
- abdominal pain (most often it is observed in the navel area);
- constipation and the impossibility of gas release;
After 12-18 hours, new symptoms may be added to the course of intestinal obstruction:
- severe peristalsis;
- the stomach swells and takes on an irregular shape;
- intestinal noise, rumbling;
- dry mouth.
On the third day after the onset of the disease, if you do not start timely treatment, the patient begins to fever and shock. The outcome of this condition may be peritonitis and death of the patient. This is a serious disease, in which it is very important to seek medical treatment on time.
There are some features of obstruction symptoms that everyone should know.
Vomiting. Vomiting with intestinal obstruction first has the color and smell of gastric masses, but after a while it acquires a yellowish color and the smell of feces. This happens when the intestines, not being able to get rid of the fecal mass in a natural way, use their way through the stomach to evacuate them. As a rule, this applies to situations in which small bowel obstruction occurs.
If there is colonic obstruction, the intestine is not able to push out all the fecal masses back along the length of the intestines. In this case, a boiling, rumbling, “transfusion”, painful spasms occur in the stomach, but there is no relief in the form of vomiting, although persistent nausea is present.
Diarrhea. Sometimes with intestinal obstruction may manifest bloody diarrhea. It testifies to internal hemorrhage.
Upon admission of a patient with suspected intestinal obstruction, it is necessary to exclude other diseases with similar symptoms:
- peptic ulcer disease;
- gynecological inflammation in women.
After this, a study is conducted to confirm the diagnosis of CN and the correct medical or surgical treatment.
- First of all, examination and questioning of the patient (in acute form, the patient can tell the exact time when the painful processes started), palpation of the abdomen is necessarily performed. With the help of palpation, it is possible to assess the patient’s condition, identify the site of the blockage and even in some cases determine its cause, be it a fecal stone, adhesions or volvulus.
- X-ray with a contrast agent (barium). This procedure determines if there is obstruction. Also with the help of X-rays, you can accurately find out the place of its localization in the small or large intestine.
- Ultrasound examination of the digestive tract.
- Collonoscopy. This procedure provides an opportunity to explore the entire intestine, to find and examine its problematic part.
Treatment of intestinal obstruction
Features of treatment depends on the form of intestinal obstruction, from its neglect and medical projections in each case. If the patient asked for help in the early stages of CN, then there is a chance that conservative therapy will be performed:
- cleansing the upper part of the gastrointestinal tract through a special probe;
- the introduction of drugs that stimulate motility;
- the introduction of drugs that relieve cramps from the gastrointestinal tract.
If after conservative treatment within 12 hours there is no improvement in the patient’s condition, surgical intervention is applied. During the operation, surgeons make an abdominal incision, determine the cause of the problem and eliminate it depending on the form of the disease, for example:
- remove part of the intestine with its necrosis;
- remove adhesions and tumors;
- correct torsions and intestinal knots;
- with peritonitis, sanation and drainage of the abdominal cavity is performed.
To a greater extent, the postoperative period in case of intestinal obstruction depends on the severity of the patient’s condition and the operation performed. As a rule, in the first few days the patient is given bed rest.
At first, nutrition can be administered to the patient intravenously. After a few days, you can take a grated protein food. Next appointed diet table number 2. Along with this, be treated with medication. Antibacterial drugs are prescribed to avoid inflammatory processes in the body. In addition, it is necessary to normalize the water-salt metabolism, which was disturbed during the illness. For this purpose, special drugs are prescribed intravenously or subcutaneously.
After discharge, you must follow the diet number 4, which is designed for people with diseases of the gastrointestinal tract.
After treatment of any form of intestinal obstruction, it is necessary to strictly follow the diet and stick to the diet.
As with any bowel disease, with CN it is often indicated that there are also small portions. This reduces the load on the gastrointestinal tract, discharges the secretion of gastric juices and bile acids, facilitates the work of the small and large intestines.
Avoid eating too hot and too cold food. Also, do not eat coarse food that is hard to digest. Minimize salt intake. Drink plenty of water.
In the first month after the operation, feed on grated food. The following products are allowed:
- cereals (semolina, buckwheat, rice, oat groats);
- lean meat and fish;
- vegetables after heat treatment, not causing bloating;
- fruits that do not cause bloating, abraded, can be baked;
- low-fat cottage cheese, acidophilus;
- compotes and kissels from fruits and berries.
In case of intestinal obstruction, products that promote flatulence and constipation are strictly prohibited:
- fatty meat, fish;
- cereals that are hard to digest (millet groats, barley);
- legumes, mushrooms;
- smoked, salty, spicy, spicy foods;
- soda, coffee, alcohol;
- sweets and chocolate;
- fresh bread and pastry;
- white cabbage;
- kefir, sour cream, cheese, cream, milk.
Intestinal obstruction is a very dangerous disease with serious complications that occur already after 2-3 days. If you do not go to the doctor in time, you can greatly aggravate the situation until death. A few days after the onset of acute blockage of the small or large intestine, such negative processes as gut perforation can begin.
Perforation of the intestine in CN occurs when necrosis (necrosis) of some part of the intestine occurs due to impaired blood circulation. Since the fecal masses accumulate for a long time without an outlet, and under their pressure, the walls of the dead intestine rupture, so its walls lose elasticity.
Peritonitis – infection of the abdominal cavity. As a rule, it occurs due to perforation of the intestine and penetration of feces into the peritoneum. With peritonitis, urgent surgical intervention is indicated.
In order to minimize the occurrence of intestinal obstruction or prevent its recurrence after surgery, it is necessary to follow the following rules.
- Promptly treat diseases of the gastrointestinal tract, which can directly cause CN: inguinal hernia and umbilical hernia, tumors in the intestines and other organs close to it.
- When performing forced abdominal operations, give preference to laparoscopic methods of surgical intervention, since after laparoscopy, the formation of adhesions is minimal.
- Stick fractional nutrition. Overeating can adversely affect the intestines after an operation of obstruction, which was carried out earlier. Eliminate junk food from the diet.
- An active lifestyle is very important for the health of the digestive tract, because it keeps the intestinal motility at the required level.