The author - Chuklin Olga, general practitioner, internist. Work experience since 2003.
Intestinal obstruction called a condition in which the passage is disturbed food mass through the intestines. In this case, it may be total or partial breach of the promotion of intestinal contents.
The most at risk of developing bowel obstruction, the following groups:
- elderly people;
- persons who performed surgery on the intestines and stomach.
Types and causes of
Intestinal obstruction is divided into the following types:
- dynamic,
- mechanical,
- Vascular.
Form is determined by the reason that caused this pathological condition.
Reasons dynamic obstruction:
- constant spasm bowel musculature, which may occur during painful stimuli intestinal worms, acute pancreatitis, traumatic injuries foreign bodies;
- paralysis of muscles of the intestine, which develops during surgery, poisoning morfinosoderzhaschimi drugs, salts of heavy metals, as a result of food borne infections.
When mechanical obstruction sure there is any obstacle:
- fecal stones from the biliary tract stones, foreign bodies, compression outside the intestinal lumen tumor formation and cystic other organs, bowel tumors growing in clearance;
- inversions intestinal loops as a result of infringement of the bowel at the gate of abdominal hernia, adhesions and scarring processes, assembly of the bowel loops.
Vascular obstruction always contribute circulatory disorders (thrombosis, embolism) mesenteric blood vessels.
Symptoms of intestinal obstruction
Intestinal obstruction is an acute condition, ie all the symptoms develop rapidly, within a few hours.
There are several characteristic features of the disease:
- pain in the abdomen;
- delayed stool;
- vomiting;
- violation of flatus.
Ileus always begins with the appearance of pain in the abdomen. Colicky pain due to the presence of peristaltic contractions of the intestine, which promote food masses.
In the presence of colon volvulus pain immediately intense, intolerable, constant. If there is another kind of ileus pain and cramping can be gradually increase in its intensity. The patient appears forced position - he draws in his legs to his stomach.
The pain can be so severe that the patient comes the painful shock.
Vomiting develops early, if patients have obstruction in the upper bowel (small intestine), while the patient is repeated, but no relief.
When the obstruction in the lower intestine, it appears only in the development of general intoxication, after 12-24 hours.
Violation discharge of stool and gas particularly true for the lower intestinal obstruction. The patient appears bloating, rumbling.
When non-assistance to a patient about a day a patient develops a general intoxication of the organism, which is characterized by:
- fever;
- more frequent respiratory movements;
- peritonitis (abdominal disease);
- sepsis (an infection spread throughout the body);
- violation of urination;
- pronounced dehydration.
As a result of intoxication, if left untreated, death can occur patient.
Diagnostics
For statement of the diagnosis of intestinal obstruction necessarily conducted a series of laboratory and instrumental studies:
- CBC - may be an increase of leucocytes during inflammatory processes;
- biochemical blood tests may indicate metabolic disorders (disturbances of micronutrients, protein reduction);
- X-ray study of intestinal necessary in the formulation of the diagnosis. When introducing radiopaque substances into the intestinal lumen can determine the level of intestinal obstruction;
- colonoscopy (Examination of the large intestine using a sensor with a camera on the end) helps with bowel obstruction, for the study of the small intestine is used - irrigoscopy;
- ultrasound is not always informative, as in intestinal obstruction occurs the accumulation of air in the stomach, which prevents the normal evaluation of data;
In difficult cases a laparoscopic examination of the abdominal cavity, which is introduced into the peritoneal cavity with the sensor camera through a small puncture. This procedure allows to examine the abdominal organs and make an accurate diagnosis, and in some cases just to spend and treatment (volvulus, adhesions).
Differentiate ileus is necessary to:
- acute appendicitis (ultrasound localization in the right iliac region);
- perforated ulcer of the stomach and duodenum 12 (holding EGD, X-ray contrast agent);
- renal colic (Ultrasound, urography).
conduct additional research methods, so as soon as the symptoms differentiating intestinal obstruction can not be always necessary to confirm the diagnosis.
Treatment of intestinal obstruction
For suspected intestinal obstruction the patient necessarily subject to emergency hospitalization in the surgical department.
Important! It is not allowed self analgesic and antispasmodic drugs.
In the early hours after the onset of the disease, conservative treatment is carried out in the absence of severe complications.
For medical treatment shall apply:
- Evacuation of gastric and intestinal contents with the help of sensing;
- spasm - antispasmodic therapy (Drotaverinum, platifillin); paralysis - motility stimulating drugs (neostigmine methylsulfate);
- intravenous saline solution to normalize metabolic processes;
- siphon enema;
- therapeutic colonoscopy, in which you can eliminate intestinal bloat gallstones.
Most often, the patient is carried out surgery, which aims to eliminate obstruction, intestinal removing nonviable tissue.
Carried out the following interventions:
- untwisting of bowel loops;
- colliotomy;
- resection (removal) of part of the intestine with subsequent crosslinking ends intestine;
- if it is impossible to eliminate obstruction causes carried overlay colostomy (excretion of feces outward);
- when hernial entities conducted their plastic.
The duration of the treatment and the result are directly dependent on the cause of intestinal obstruction, term of treatment.
complications
In case of untimely hospitalization following dangerous conditions may develop:
- painful shock;
- sepsis;
- peritonitis.
prevention
Preventive measures include:
- Timely diagnosis and treatment of tumoral processes in the intestine and the surrounding organs;
- treatment of helminthic infestations;
- prevention of adhesions after surgery processes;
- balanced diet;
- maintaining a healthy lifestyle.