Intestinal obstruction - causes, treatment and complications of intestinal obstruction. Signs of intestinal obstruction and what to do about it Stages of acute intestinal obstruction

Intestinal obstruction is an acute condition in which the passage of food through the intestines is disrupted or completely stopped. This is one of five conditions that is included in the so-called “acute surgical five” along with strangulated hernia, appendicitis, perforated gastric ulcer and cholecystitis. The danger of this disease lies in the extremely severe course of obstruction and the high probability of death, and therefore every person should know the symptoms of this disease in order to promptly seek medical help and thereby save their life. In this article we will talk in detail about the causes of intestinal obstruction, the symptoms of this dangerous condition and methods of its treatment.

Causes and types of pathology

Most often, this disease affects elderly people, as well as people who have undergone operations on the intestines and stomach. Vegetarians also face this problem.

Considering that obstruction develops as a result of a delay or complete absence of movement of food through the digestive tube, this disease is divided into 3 types:

A. Mechanical obstruction. In this condition, some physical obstacle stands in the way of the food bolus. This obstruction, in turn, is divided into:

1. Obstructive obstruction. Develops due to intestinal blockage:

• large gallstones;
• fecal stones;
• foreign bodies;
• cysts, tumors and other neoplasms that compress the intestines;
• hairballs (in people who have the habit of chewing their own curls).

2. Strangulation obstruction. This condition is caused by:

• twisting of the intestinal loop around itself;
• the appearance of a knot of several loops;
• scar cords or adhesions that compress the intestine from the outside;
• strangulation of the intestine in hernial turns.

3. Mixed obstruction. This includes obstruction, which combines both mechanisms. This is the so-called intussusception - a condition in which one part of the intestine enters another.

B. Dynamic obstruction. This condition is observed in the case of smooth muscle spasm or paralysis.

B. Vascular intestinal obstruction. This disease appears due to intestinal infarction.

Consequences of intestinal obstruction

In the absence of qualified help, this condition can lead to a number of serious complications. In particular, due to compression and disruption of blood flow, there is a high probability of necrosis of part of the intestine. In this case, part of the stomach stops digesting food and absorbing nutrients. But what’s even more dangerous is that the intestinal mucosa, deprived of protective functions, becomes a real gateway for pathogenic bacteria to enter. In this case, severe intoxication develops, which is subsequently complicated by peritonitis, sepsis and a condition in which acute failure develops in several organs at once.

Violation of the absorption of nutrients by part of the intestine also applies to water. In this case, dehydration of the body rapidly develops, especially in combination with profuse vomiting.

All these complications extremely quickly lead to death, and therefore require emergency delivery of the patient to the surgical department and provision of medical care.

Symptoms of an acute condition

It should be said that the symptoms of this acute condition change literally by the hour, and therefore it is more correct to consider the symptoms of intestinal obstruction, dividing them into three periods.

First 12 hours

This acute pathological condition begins with pain in the intestinal area, and the intensity of pain differs depending on the specific type of exacerbation. If the movement of food through the intestines is hindered by an obstacle in the form of a tumor or gallstones, the pain is paroxysmal, lasts for some time, and then disappears. If the patient has developed strangulation obstruction, the pain is constant, and its intensity can vary from barely perceptible to unbearable, which causes painful shock. Vomiting practically does not occur at this stage. They appear only if the obstruction appears at the very beginning of the small intestine.

Period from 12 to 24 hours

The most striking manifestations of intestinal intolerance become approximately 12 hours after the onset of this pathological process. Abdominal pain increases and haunts the patient constantly, his stomach swells and all this is accompanied by a constant urge to vomit. It becomes simply impossible to take food or liquid in this state, which is why the patient rapidly develops dehydration.

After 24 hours

During this period, the body begins to give a systemic response to the existing exacerbation. Because of this, a patient with intestinal obstruction:

• temperature rises (due to poisoning of the body with toxins);
• breathing quickens and heart rate increases;
• urination stops;
• signs of blood poisoning and peritonitis appear.

Another characteristic symptom of intestinal obstruction at this stage is the inability to defecate and severe bloating due to the inability to release gases. This symptom is especially pronounced if an obstruction has formed in the large intestine.

During this period, the patient's condition rapidly deteriorates, up to critical. The temperature jumps to the maximum level, tachycardia increases. All this indicates that blood poisoning is occurring. If you do not urgently provide qualified assistance to the patient, failure of the main organs will soon develop, leading to death.

Diagnosis of intestinal obstruction

Even pronounced symptoms of this acute condition are sometimes not enough to make an accurate diagnosis. To finally confirm the proposed diagnosis, specialists need to take tests and conduct an examination using equipment. Typically this is:

• General blood analysis. Thanks to this analysis, the doctor determines the level of hemoglobin, specifies the number of red blood cells (indicating the development of dehydration), as well as leukocytes (signaling the development of inflammation).
• Blood chemistry. With the development of obstruction in the patient’s blood, there is a decrease in the level of chlorine and potassium, an increase in the level of nitrogen, as well as an imbalance in acid balance (strong oxidation or, conversely, alkalization of the blood).
• X-ray of the intestines. This procedure is carried out at the first suspicion of the development of intestinal obstruction. The image in this case shows the accumulation of gas and liquid in the intestinal loops. Looking at an x-ray, a specialist can even determine the location of fecal congestion. To accurately determine the location of the obstruction, a specialist performs x-rays using contrast agents.
• CT or ultrasound. Such methods of examining the intestine can be useful if the obstruction was caused by a tumor or a foreign object entering the intestine.
• Colonoscopy and irrigoscopy. These diagnostic procedures provide an accurate diagnosis, but only if the blockage occurs in the large intestine.

In addition, an excellent research method for this condition is laparoscopy, which allows you to see with your own eyes the site of blockage, and in some cases, correct the situation by cutting existing adhesions or unrolling the loop if it is twisted.

Medical procedures

It is extremely rare, in the case of an uncomplicated condition, that specialists can resort to non-surgical treatment of the disease. This method is used at the very beginning of the development of obstruction, when the pathological process does not yet threaten systemic disorders. Among conservative approaches, doctors use:

• pumping out accumulated feces using a probe;
• carrying out a colonoscopy, which allows you to “break through” an obstacle to feces or eliminate intestinal volvulus;
• siphon enemas;
• taking antispasmodics that eliminate intestinal spasms.

In the vast majority of cases, people who experience intestinal obstruction cannot avoid surgical intervention. This is usually due to the fact that the patient consults a doctor late or that specialists are slow to identify the cause of the illness. The so-called “golden six hours” play a role here, during which intestinal obstruction can be eliminated using non-surgical methods. If the diagnosis is made later than this time, the patient ends up on the operating table.

Doctors have many methods of surgical intervention in their arsenal to restore the movement of food through the intestines. Sometimes the operation involves removing the dead part of the intestine and then suturing the edges of the intestine. If such a procedure is not required, the operation takes place in two stages. At the first stage, the affected intestine is brought to the anterior wall of the peritoneum, eliminating the cause of the existing obstruction. A few months later, the second part of the operation is performed, which consists of suturing the ends of the intestine.

If the cause of this acute condition is a strangulated hernia, the specialist performs an operation to correct the hernial orifice, and at the same time, reduces the intestinal loop. If intestinal volvulus occurs, doctors straighten them and assess their viability. If necessary, necrotic parts of these organs are removed. When the cause of intestinal obstruction lies in its blockage with fecal stones and other objects, it is necessary to open the intestine and remove those obstacles that have arisen in the way of digested food.

Appropriate preparation is required for surgical intervention. For this purpose, doctors intravenously inject the patient with solutions that prevent dehydration. In parallel with this, the patient is administered drugs against inflammation, as well as drugs that stimulate intestinal motility. If the patient develops peritonitis, antibiotics cannot be avoided.

To conclude the article, let’s say that the chances of survival of patients with intestinal obstruction largely depend on the time that passes from the appearance of the first symptoms of the disease to the provision of adequate medical care to the patient. Patients who were operated on in the first 6 hours after the onset of obstruction virtually all recover. And of those operated on on the second day, every fourth patient dies. All this indicates only one thing - if you feel an increase in abdominal pain with the development of nausea, gas formation and the inability to empty the intestines, do not waste time! Call an ambulance immediately! Only your concern for your own health and the qualified actions of doctors will help preserve your life and health.
Take care of yourself!

Partial intestinal obstruction is often a chronic pathological process, which is characterized by a violation of the movement of substances through this organ. The disease often affects people of working age, but is often diagnosed in newborns and young children. The main factors in the occurrence of the disease are the presence of various neoplasms in the intestine, complications after surgery, and also if the person has a history of adhesive disease.

The clinical picture of this disorder is periodic. The main symptoms may include abnormal stool and gas formation, pain, attacks of nausea and vomiting. There is an asymptomatic course of the disease. In such cases, complications are discovered during diagnosis, including peritonitis.

When diagnosing this type of intestinal obstruction, data from the medical history and physical examination must be taken into account. In this case, it is necessary to perform instrumental and laboratory examinations, in particular radiography, colonoscopy and ultrasound. Treatment in most cases is conservative, consisting of taking medications and following a diet.

Etiology

Partial intestinal obstruction occurs due to several reasons. The most common of these is the occurrence of adhesive disease in humans. The formation of adhesions, in turn, can be caused by several factors. For example, a consequence of an inflammatory process, trauma, cutting wound to the anterior wall of the abdominal cavity, or as a complication after surgery on the peritoneum. Adhesions lead to compression of a certain area of ​​the intestine, which interferes with the possibility of unhindered passage of feces.

Another predisposing factor for blockage of the intestinal lumen may be the formation of malignant and benign tumors on this organ. Sometimes neoplasms can be located outside the intestine and, as they grow, compress its loops. However, very often the formations are located from the inside, thereby closing its lumen.

In children, partial obstruction is caused by surgical operations on the abdominal cavity and pathologies of the structure of internal organs. A similar intestinal disease in newborns can be caused by a disorder such as intussusception. This is a pathological process during which the penetration of part of the large intestine into the small intestine or vice versa is observed.

Symptoms

The clinical manifestation of the disease will differ depending on the cause that caused its appearance. Thus, when adhesions form in the peritoneum, the symptoms are:

• periodic appearance of pain in the abdominal area, of varying intensity;
• disturbance of stool and gas production;
• in some cases, vomiting occurs.

Such symptoms are not acute and in most cases go away on their own. Sometimes this can be helped by conservative treatment. But there is a high probability of their reappearance.

If the cause is a tumor, regardless of whether it is located inside or outside the intestine, the symptoms of partial intestinal obstruction are increasing. The main symptoms are similar to those above, only they can intensify when eating large amounts of junk food. Such symptoms tend to increase in intensity as the malignant or benign tumor increases in size.

Partial obstruction of the intestinal lumen may be followed by periods of heavy bowel movements. The stool will look like diarrhea, accompanied by a strong foul odor.

In the later stages of such a disease, the expression of so-called fecal vomiting is observed, in which the vomit has the smell of feces. This indicates a severe disruption of the functioning of the intestines. Often the clinical picture is complemented by peritonitis, in which a person suffers from constant profuse vomiting, after which no relief is observed. In such cases, severe exhaustion and dehydration of the body occurs.

The main feature of a partial blockage is that it can turn into a complete blockage at any time. Compression of blood vessels by numerous adhesions or a gradually enlarging tumor leads to the appearance of signs of acute intestinal obstruction.

Diagnostics

The basis of diagnostic measures for this disorder is laboratory and instrumental examinations of the patient. But before performing them, the gastroenterologist must independently carry out several measures:

• study the patient’s life history and medical history to clarify the picture of the formation of the disease;
• conduct a thorough survey and physical examination, which includes mandatory palpation of the abdomen, which will reveal the presence and intensity of symptoms. Digital examination reveals an empty rectum.

Laboratory diagnostic techniques consist of:

• general and biochemical blood tests - to identify concomitant inflammatory processes, dysfunction of some internal organs, as well as changes in the composition of the blood;
• microscopic examination of feces - to confirm or refute the presence of hidden hemorrhages;
• general urine analysis.

Instrumental methods include:

• radiography - carried out to detect specific signs of partial obstruction;
• CT – for a more detailed assessment of the intestine;
• Colonoscopy is an endoscopic procedure for examining the colon mucosa;
• Ultrasound is the main method for confirming the diagnosis.

After receiving and studying all the examination results, the doctor prescribes the most effective treatment tactics and also decides to perform a surgical operation.

Treatment

Elimination of such a disease should be carried out in a medical institution, under the full supervision of doctors. First of all, conservative therapy is provided. In most cases, patients are prescribed:

• taking or intravenously administering antispasmodics - this is done to eliminate pain;
• substances to restore normal intestinal motility;
• correction of water-salt balance using intravenous administration of drugs.

Conservative treatment is accompanied by performing siphon enemas and removing intestinal contents by introducing a special probe through the oral cavity.

In cases of ineffectiveness of such measures, surgical intervention is resorted to. In case of partial obstruction of the small intestine, excision of the affected organ is necessary, followed by anastomosis. If the cause of the disease is intussusception, manual or balloon disinvagination is performed. In cases of the formation of the disease against the background of adhesive disease, laparoscopy is indicated to dissect adhesions.

In case of partial obstruction of the large intestine due to a tumor, partial resection of the affected organ is performed, followed by removal of the large intestine to the anterior abdominal wall. This is necessary for the subsequent process of defecation.

Absolutely all operations are aimed at restoring the patency of feces and eliminating the main cause of the formation of such a disease.

In addition, the disease can be treated by following a diet or using traditional medicine. However, such methods are used only after preliminary consultation with the attending physician.

Similar materials

Dynamic intestinal obstruction (functional intestinal obstruction) is a disease that consists of a significant decrease or complete cessation of the activity of the affected organ without a mechanical obstacle to progress. During the development of the disease, stagnation of intestinal contents is often observed. Among other forms of intestinal obstruction, this occurs in every tenth patient. It affects people of any age group, so it is often diagnosed in children.

Intestinal obstruction (intestinal obstruction) is a pathological condition that is characterized by a violation of the movement of contents through the intestines, provoked by a failure in the process of innervation, spasms, obstruction or compression. It is worth noting that this disease is not an independent nosology - it usually progresses against the background of other gastrointestinal pathologies. The causes of intestinal obstruction are quite varied.

Paralytic intestinal obstruction is a pathological condition that is characterized by a gradual decrease in the tone and peristalsis of the human intestinal muscles. This condition is extremely dangerous, since without timely diagnosis and proper treatment, complete paralysis of the organ can occur. Paralytic intestinal obstruction is more often diagnosed in people from the middle and older age categories. The disease has no restrictions regarding gender or age category.

Obstructive intestinal obstruction is a pathological condition that is characterized by impaired movement of contents through the intestines due to compression of the mesentery. Develops due to partial or total blockage of the intestinal lumen. Factors that contribute to the development of obstructive obstruction can be both internal and external. It is also worth noting that depending on the root cause, the most effective treatment plan will be prescribed. As a rule, obstructive intestinal obstruction is eliminated surgically.

Strangulated intestinal obstruction is a dysfunction of the gastrointestinal tract, which is characterized not only by blockage of the intestine, but also by compression of the nerve fibers and vessels of the mesentery. This pathological condition is very dangerous, since the acute form of the disease in a short period of time can be complicated by necrosis of certain parts of the organ due to disruption of blood circulation in them. In medicine, there are cases where a person died within twelve hours from the initial expression of clinical signs.

If left untreated, intestinal obstruction can lead to tissue necrosis, perforation, and acute infection. Such conditions pose a threat to life. But if treatment is started on time, the prognosis is favorable: within a few days the process of movement and evacuation of food is completely restored.

General information about the disease

Intestinal obstruction - what is it? During the normal process of digestion, the contents of the stomach enter the small intestine, are processed, partially absorbed and moved on. In the thick section, feces are formed and moved towards the anus. With intestinal obstruction, the intestinal lumen becomes narrowed or completely blocked, preventing food and liquid from moving in and out of the body.

This disease can be caused by many reasons: hernia, adhesions, tumors. It occurs in people of different age groups: from newborns to the elderly. If you suspect intestinal obstruction, you should consult a doctor as soon as possible; in some cases, emergency surgery is required.

Kinds

Intestinal obstruction can be acute or chronic. The latter is rare, develops over several weeks and even months, then it enters the acute stage.

Acute intestinal obstruction develops quickly and leads to irreversible changes in the body (which persist even after movement and evacuation of food are restored). This type of flow is divided into two types.

Dynamic intestinal obstruction

Occurs due to impaired intestinal motility.

There are two varieties of it:

• Paralytic ileus. It develops against the background of a progressive decrease in the tone and peristalsis of the walls of the organ. The violation can be partial - paresis, or complete - paralysis. It can be observed in one area or cover the entire gastrointestinal tract. Often develops as a complication of another disease, for example, peritonitis.
• Spastic intestinal obstruction. Develops as a result of a reflex spasm of any area. May last for several hours or days. Often it is a consequence of another disease, for example, urolithiasis.

Mechanical intestinal obstruction

Develops due to mechanical obstructions that interfere with the movement of food and liquid.

Types of mechanical intestinal obstruction:

• Obstructive intestinal obstruction. It is characterized by the fact that blockage of the lumen occurs from the inside, and blood circulation, as a rule, does not change. Occurs when tumors grow, enlarged scars, passage of gallstones, etc.
• Strangulating intestinal obstruction. The lumen is blocked by external pressure, accompanied by impaired circulation in the organ, which can lead to its death. A more dangerous type of intestinal obstruction than the previous ones. Develops with strangulated hernias, volvulus, adhesions, etc.

Depending on which department the movement of food is impaired, high intestinal obstruction is distinguished (thin part) and low intestinal obstruction (thick part). The two types have different symptoms in the early stages of the disease.

Causes

What causes intestinal obstruction? There are many reasons for this disease. To find out what led to the retention of food and water, a number of diagnostic examinations are carried out.

The data obtained helps the doctor determine that the violation occurred as a result:

• reflex spasm in the intestinal area, which developed due to recent surgery, trauma to the abdomen or spine, passage of a stone through the ureter, etc.;
• paresis or paralysis of a section or the entire intestine resulting from another disease: peritonitis, diabetes, poisoning, thrombosis of small vessels, etc.;
• blocking the intestinal lumen from the inside with a mechanical obstacle: a tumor, scars, gallstones, worms, a lump of food with undigested fibers, a foreign body;
• blocking of the intestinal lumen from the outside due to compression of the area by a hernia, adhesions as a result of intestinal volvulus, malformations of the organ, or the cause was intussusception.

The causes of intestinal obstruction determine treatment tactics. Therefore, their establishment is an important stage of medical care.

Pathogenesis

The mechanisms of development of intestinal obstruction are still not fully understood. Recent studies suggest that the leading role belongs to the disturbance of local blood circulation, which occurs due to the difference in hydrostatic pressure in certain areas of the vessels. When exposed to external and internal mechanical obstacles, a zone with increased pressure appears in the intestine. The intestinal wall stretches, the speed of blood flow in it decreases and stasis develops - stopping the contents. The same thing happens with paresis, paralysis and intestinal spasm.

At first, circulatory disorders are compensated by the body's reserves, but at a certain point they reach a peak, and acute intestinal obstruction syndrome is formed. At the same time, the number of non-functioning vessels increases, and intestinal edema develops.

Subsequently, redox processes are disrupted, the walls of the organ become necrotic and perforated. The infection penetrates the abdominal cavity, causing peritonitis. At the same time, food digestion is disrupted, intoxication of the body develops, and in severe cases, sepsis (blood poisoning).

Symptoms

If you suspect intestinal obstruction, it is important to know that such a disease has symptoms that develop in 3 periods:

1. Early period, first 12 hours (or less). There is bloating and a feeling of heaviness in the stomach, nausea. Then pain occurs, the nature and intensity of which depend on the cause of the pathology. If the intestine is compressed 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 several minutes, and then disappear. Vomiting occurs when the passage of food from the stomach to the intestines is impaired. .
2. Intermediate period, from 12 to 24 hours. Symptoms of intestinal obstruction become severe. Regardless of the cause of the disease, the pain is constant, the bloating increases, and vomiting is frequent and profuse. Dehydration and intestinal edema develop.
3. 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, the temperature increases due to bacterial intoxication, urine production stops, and abdominal pain intensifies. Peritonitis and sepsis may develop.

How intestinal obstruction manifests itself depends in part on where it is located. Thus, vomiting in the early period of the disease is characteristic of pathology in the small intestine, especially in its upper parts, and constipation and impaired gas discharge are characteristic of the large intestine. But in the late period, when peritonitis develops, these symptoms develop with any type of obstruction.

Diagnostics

Data about the disease obtained during a conversation is often not enough for a doctor to make a diagnosis. How to determine intestinal obstruction?

For this purpose, laboratory and instrumental research methods are used:

• general and biochemical blood test;
• X-ray of the intestine with contrast;
• irrigoscopy or (for obstruction of the large intestine);
• Ultrasound of the digestive tract;
• computed tomography of the digestive tract;
• laparoscopy (used not only for diagnosis, but also for treatment).

Treatment in adults and children

Partial intestinal obstruction, the symptoms of which indicate the initial stages of the process, can be eliminated using conservative treatment methods. They include taking medications and using traditional methods. If peritonitis or more serious complications are detected, then surgical intervention is necessary. Treatment of intestinal obstruction in adults and children follows the same principles.

Traditional methods

In case of intestinal obstruction, the patient is hospitalized. In order to stabilize his condition, a drip with saline is installed - this helps to cope with dehydration. If the abdomen is very swollen, a probe is inserted through the nose to allow air and fluids to drain out. If urinary function is impaired, a catheter is installed. Sometimes an enema and gastric lavage are prescribed.

Functional intestinal obstruction caused by paralysis or spasm of the walls goes away on its own after some time. If after a few days there is no improvement, the doctor prescribes drugs that restore motor skills and promote the movement of food and liquid (Papaverine, Spasmol, No-shpa, etc.).

Depending on what caused the disease, you may need to take antiviral or sedatives, probiotics, and vitamins. Laxatives for intestinal obstruction can only be taken as prescribed by a doctor, in some cases it will only worsen the situation.

If intestinal obstruction is mechanical, but partial, then most often measures to stabilize the general condition are sufficient. The doctor prescribes a diet that does not contain fibrous and fermentable foods. The menu consists of ground porridges with water, broths, soufflés, jellies, jelly, and omelettes. If a person does not feel improvement, then it is carried out.

With complete mechanical obstruction of the intestine, when food and liquids do not move through the digestive tract, surgical intervention is required. The operation is performed under general anesthesia. The surgeon's actions depend on the cause and stage of the disease.

Part of the intestine can be removed, its upper end brought to the anterior abdominal wall and sutured after a few months, hernia, tumors, fecal stones removed, volvulus straightened, etc.

Anti-inflammatory and peristalsis-stimulating drugs and antibiotics are administered. The prognosis is favorable if the operation is performed within the first 6 hours after the onset of the disease. The longer this time period, the more likely the fatal outcome.

Traditional methods

Treatment with folk remedies is possible only with the permission of a doctor, when symptoms of intestinal obstruction indicate partial blockage of the lumen and chronic course of the disease. You cannot carry out such therapy on your own, since in the absence of qualified assistance there is a risk of death.

Among the traditional methods of eliminating obstruction, the most common are the following::

• bran brewed with boiling water for breakfast;
• infusion of buckthorn bark instead of tea (1 tbsp per 200 ml of boiling water);
• infusion before bed (1 tsp per 200 ml of boiling water, drink without straining);
• flaxseed enemas (1 tbsp per 200 ml of boiling water, strain);
• infusion of sedge and St. John's wort in the morning and evening (1 tablespoon of raw material, 500 ml of boiling water);
• compote from plums during the day (for 1 cup of fruit - 1.5 liters of water).

Prevention

Prevention of intestinal obstruction comes down to the following:

• timely detection and elimination of diseases that can lead to narrowing of the intestinal lumen (tumors, worms, adhesions, hernias, etc.);
• proper nutrition appropriate to age and body characteristics;
• maintaining a healthy lifestyle;
• See a doctor at the first sign of bowel dysfunction.

Intestinal obstruction often develops in older people; what can be done to prevent the disease? Nutrition plays an important role. The diet should contain foods that enhance intestinal motility (high fiber content). You need to eat 4-6 times a day at approximately the same time. You should not allow long breaks or eat a large amount of food at one time. It is necessary to perform physical activity that corresponds to the body’s capabilities: walking, gymnastics, cycling, swimming, doing housework.

Complications

The first thing to do if you have an intestinal obstruction is to seek medical help. With this disease, every hour is important. The later treatment is started, the higher the risk of complications.

Due to intestinal obstruction, necrosis (death) of their walls develops. A perforation is formed, and the contents enter the abdominal cavity, causing inflammation - peritonitis. Next, abdominal sepsis develops - a general blood infection that leads to death.

Intestinal obstruction is a dangerous condition that, in the absence of emergency medical care, can lead to death. Impaired movement of food can be complete or partial, caused by a mechanical obstruction or spasm (paralysis) of the intestines. How to treat depends on the cause of the disease: conservative methods are used for functional and partial mechanical obstruction, surgical methods are used for complete mechanical obstruction, as well as in all cases when the use of medications and diet does not help.

Intestinal obstruction is a severe pathological process, which is characterized by a disruption in the process of exiting substances from the intestine. This disease most often affects people who are vegetarians. There are dynamic and mechanical intestinal obstruction. If the first symptoms of the disease are detected, you must go to the surgeon. Only he can accurately prescribe treatment. Without timely medical help, the patient may die.

Reasons for formation

Intestinal obstruction can be caused by the following mechanical reasons:

• strangulated hernia;
• formation and blocking of the lumen by adhesions, the development of which occurs after abdominal surgery;
• intussusception of the intestinal wall, resulting in the retraction of one section of the intestine into another;
• colon cancer or neoplasm on a nearby organ;
• volvulus and nodulation;
• obstruction of the intestinal lumen by fecal or gallstones, worms, foreign bodies;
• inflammatory diseases of the abdominal organs;
• hernia of the anterior abdominal wall.

Dynamic intestinal obstruction occurs immediately after surgical intervention in the abdominal cavity, in case of poisoning or the presence of peritonitis.

What are the signs of the disease?

Symptoms of intestinal obstruction begin with painful sensations in the abdominal area, which are sharp, cramping and increasing in nature. This condition contributes to the formation of nausea and vomiting. After some time, the contents of the intestine are sent to the stomach, as a result of which the vomit acquires an odor characteristic of feces. The patient is concerned about constipation and flatulence. At the initial stage of the disease, intestinal motility is preserved and can be observed through the abdominal wall. A characteristic signal of the formation of intestinal obstruction is an increase in the size of the abdomen and an irregular shape.

During the diagnosis of a patient, the following signs of intestinal obstruction can be detected:

• increased heart rate;
• drop in blood pressure;
• dry tongue;
• enlarged intestinal loops filled with gas and liquid;
• temperature increase.

How does acute intestinal obstruction manifest?

Acute intestinal obstruction develops suddenly. As a rule, it manifests itself according to the symptoms of intestinal dysfunction. As a result, the patient experiences the following symptoms:

• pain syndrome;
• flatulence and rumbling stomach;
• constipation and diarrhea;
• nausea and vomiting;
• increased peristalsis and shock.

Acute intestinal obstruction can have very diverse symptoms, and they depend on the level of obstruction of the affected organ. The presented symptoms rarely bother a person all at once, so the absence of any of them does not exclude the presence of the presented pathology. Therefore, let's look at them in more detail.

The pain syndrome is pronounced from the very beginning. As a rule, the pain is concentrated in the pit of the stomach, around the navel. Her character is spasmodic.

Vomiting is the most consistent sign of acute intestinal obstruction. Increased vomiting is observed if the obstruction in the intestines is located high. If there is obstruction of the colon, then this symptom will be absent, but nausea remains. At first, the vomit consists of the contents of the stomach, and then it acquires a yellowish tint, gradually becoming green and greenish-brown.

Constipation is a late manifestation of the disease, since the first time after the development of obstruction, a reflex emptying of the underlying sections occurs. Thus, the illusion of normality is created.

Acute intestinal obstruction is accompanied by large losses of fluid and electrolytes during vomiting, and intoxication with stagnant intestinal contents. In the absence of effective therapy, the patient experiences increased heart rate and decreased blood pressure. Such symptoms of intestinal obstruction indicate the onset of shock.

Manifestations of adhesive obstruction

Adhesive intestinal obstruction, which is assumed by the classification of the disease, is a violation of passage through the intestines, which can be caused by adhesions in the abdominal cavity. The presented pathology is considered the most common. Today there is a tendency to increase its frequency, as a large number of abdominal surgeries are being performed.

Adhesive intestinal obstruction and its classification involves the following forms of the disease:

• obstruction;
• strangulation;
• dynamic intestinal obstruction.

In the first form of the disease, compression of the intestine by adhesions occurs, but its blood supply and innervation are not disrupted.

With strangulation intestinal obstruction, adhesions put pressure on the intestinal mesenteries. The result of this process is necrosis of the affected organ. The classification of strangulation intestinal obstruction involves 3 types: volvulus, nodulation and pinching.

Volvulus is noted in those parts of the organ where the mesentery is present. The main reasons for its formation are scars and adhesions in the abdominal cavity, fasting with further filling of the intestines with rough food.

This form of strangulation intestinal obstruction, such as nodulation, is formed at any level of the small and large intestines where the mesentery is present. The reasons for the formation of a pinching ring are based on pinching of the sigmoid colon.

Symptoms of paralytic ileus

The presented type of disease manifests itself in the form of a progressive decrease in the tone and peristalsis of the intestinal muscles. This condition can lead to complete paralysis of the affected organ. It can affect all parts of the gastrointestinal tract or be concentrated in one.

Paralytic ileus has the following symptoms:

• uniform bloating;
• pain;
• vomit;
• retention of stool and gases.

The pain syndrome affects the entire abdominal area, has a bursting character and does not radiate. The patient vomits repeatedly, first with gastric and then with intestinal contents. If there is diapedetic bleeding from the wall of the intestine and stomach, acute ulcers of the digestive tract, then the vomit is hemorrhagic in nature. Severe flatulence causes chest breathing. Patients are diagnosed with tachycardia, low blood pressure and dry mouth.

How does the disease manifest in children?

Intestinal obstruction in newborns can occur due to a malformation of the organ:

• lengthening or narrowing of a certain section of the intestine;
• individual location or rotation of the intestinal loop, which helps to delay the movement of intestinal contents. Characteristic manifestations are bloating, gases and constipation.

In infants, there is a specific type of disease - intussusception. It is characterized by inversion of part of the intestine and insertion into another. As a rule, this pathology is diagnosed in children 5–10 months old. In children one year and older, this disease is rarely detected. The main reasons for the formation of this phenomenon are the immaturity of the peristalsis mechanism and the mobility of the colon.

Disturbances in peristalsis can be provoked by sudden disruptions in the diet of young children, the start of complementary feeding and infection. The following symptoms are characteristic of intussusception:

• frequent attacks of abdominal pain;
• vomit;
• instead of feces, bloody discharge with mucus from the anus;
• the children are very restless and cry constantly;
• the end of the attacks occurs as suddenly as their beginning.

Infants may be diagnosed with dynamic intestinal obstruction in the form of spasms or paralysis. The reasons for this pathology are the immaturity of the digestive system due to operations, intestinal infections, and pneumonia.

Stages of the disease

A disease such as intestinal obstruction develops in three stages:

1. Initial – its duration is 2–12 hours, accompanied by pain in the abdomen, flatulence and increased peristalsis.
2. Intermediate – lasts 12–36 hours. The pain syndrome decreases, a period of imaginary well-being begins, meanwhile, signs of dehydration and intoxication increase.
3. Terminal – occurs 2 days after the formation of the disease. The patient's condition worsens significantly, there is an increase in signs of damage to internal organs, dehydration and damage to the nervous system.

Diagnostic methods

The main methods of diagnosing this disease are an X-ray examination of the abdominal organs and a blood test. Ultrasound may be used as an addition.

In the case of an objective examination, the patient’s tongue should be dry, covered with a white coating, and uneven bloating.

Therapy

When a patient has been diagnosed or suspected of intestinal obstruction, he needs urgent hospitalization in the surgical department. If there is a rapidly occurring, progressive, catastrophic dehydration, then urgent treatment of intestinal obstruction is necessary. Such therapeutic measures should be carried out, whenever possible, while the patient is being transported. Until he is examined by a doctor, he is prohibited from giving laxatives, painkillers, enemas, or gastric lavage.

In the hospital, in the absence of pronounced symptoms of mechanical obstruction, intestinal obstruction is treated, which includes a number of measures:

1. Suctioning the contents of the stomach and intestines through a thin probe inserted through the nose.
2. In case of increased peristalsis, antispasmodics are prescribed.

If mechanical obstruction occurs, and conservative therapy does not give the desired result, then emergency surgery is required. It includes:

• dissection of adhesions;
• unwinding of the torsion;
• deinvagination;
• resection of the intestine with its necrosis;
• the imposition of an intestinal fistula in order to release intestinal contents in case of colon neoplasms.

The postoperative period includes all the same measures that are aimed at normalizing water-salt and protein metabolism. For these purposes, intravenous administration of saline solutions and blood substitutes is used. Anti-inflammatory treatment and stimulation of the motor-evacuation function of the gastrointestinal tract are also carried out.

Intestinal obstruction is a very insidious disease, which, if timely treatment is not carried out, will lead to death. Very often, the only method of therapy is surgery, after which the patient must perform a series of measures aimed at restoring the body.

The appearance of intestinal obstruction in all of the above pathologies is caused by overstimulation of pain nerve receptors located in the peritoneum, retroperitoneal and pleural spaces. That is, intestinal obstruction in such cases occurs reflexively and is paralytic in nature. The muscular layer of the intestine is simply temporarily incapable of peristaltic movements, which makes the movement of intestinal contents difficult.

Heavy metal poisoning

In case of lead poisoning, the so-called lead colic is quite common, which is a clinical syndrome accompanied by the patient experiencing severe abdominal pain, constipation, a metallic taste in the mouth, stomatitis ( gum inflammation), bradycardia ( decrease heart rate) and some other signs. With such colic, the muscular wall of the intestine is in a spastic-atonic state ( that is, some parts of it are strongly spasmed, while others are completely relaxed), resulting in disruption of normal intestinal motility and patency.

The mechanism of development of lead colic can be explained by the adverse effects that lead has on the nervous system. The fact is that this chemical element causes overexcitation of the autonomic parts of the human nervous system, which are responsible for intestinal motility. Mercury poisoning may also cause intestinal obstruction. The penetration of large amounts of mercury into the body leads to overexcitation and damage to the tissues of the central nervous system, as a result of which proper intestinal motility is disrupted.

Thrombosis and embolism of the intestinal mesentery vessels

Thrombosis and embolism ( blockage of a vessel by a foreign body, for example, a drop of fat, a gas bubble, etc.) mesenteric vessels can cause intestinal infarction ( since inside the mesentery its vessels approach the intestine), that is, an acute disruption of the blood supply to its tissues, accompanied by their immediate death. With necrosis ( dying off) intestinal tissues, the function of the intestine itself is disrupted, it loses the ability to digest food, secrete mucus, and also to push intestinal contents further along the digestive tract ( due to its peristalsis). Thrombosis and embolism usually occur with a variety of injuries to the abdominal wall, cardiovascular diseases ( myocardial infarction, heart failure, heart defects, atherosclerosis, arterial hypertension, etc.), blood diseases, surgical interventions on the abdominal organs, arteritis ( inflammatory vascular diseases), abdominal tumors, etc.

Spasmophilia

Spasmophilia is a pathological syndrome caused by a disorder of phosphorus-calcium metabolism ( metabolism). Spasmophilia most often occurs in young children ( from 2 months to 2 – 3 years) and is characterized by low calcium levels and high concentrations of phosphorus and vitamin D in the blood, as well as some symptoms ( for example, convulsions, increased sweating, increased heart rate, muscle twitching, spasm of the glottis, blue and pale skin, etc.).

With this pathology, intestinal obstruction may occur. The mechanism of its appearance is directly related to hypocalcemia ( decreased amount of calcium in the blood). With hypocalcemia, the nervous system becomes hyperexcitable, as a result of which a large number of nerve impulses are sent to the cells of the muscular layer of the intestine, causing it to become severely spasmodic ( shrinks) and loses the ability to develop adequate motor skills. Violation of intestinal peristalsis slows down the movement of intestinal masses through the digestive tube and leads to the development of intestinal obstruction.

Fecal stones

If the digestive processes in the intestines are disrupted, in rare cases fecal stones may form ( coprolites), which are hardened and formed feces. In most cases, they are found in older people who have certain problems with the gastrointestinal tract. Fecal stones, under certain circumstances, can cause blockage of the intestinal lumen. If they are present, the patient always has some risk of developing intestinal obstruction.

Predisposing factors to the occurrence of coprolites in the intestine are impaired peristalsis and intestinal secretion, prolonged stagnation of intestinal contents inside the digestive tract. The main reasons for the appearance of fecal stones in the intestine are various developmental anomalies of the small or large intestine, Parkinson's disease, a sedentary lifestyle, injuries to the brain and spinal cord, chronic inflammatory bowel diseases, malignant neoplasms of the intestine, etc.

Intussusception

Intussusception is a pathology of the gastrointestinal system in which retraction is observed ( implementation) one section of the intestine into the lumen of another – the neighboring section. This pathology can occur in a wide range of diseases of the intestinal system ( developmental anomalies, tumors, infectious intestinal diseases, etc.), as well as in case of mechanical injuries of the anterior abdominal wall and dietary disturbances. With intussusception, intestinal obstruction very often occurs. This is caused by compression of the mesenteric vessels ( strangulation) intestines, and internal obstruction ( blockage) its lumen. Intestinal blockage is localized at the level of the section into which the neighboring section has been drawn in. The intestine pulled into the lumen simply mechanically interferes with the normal movement of feces.

Such obstruction is further complicated by compression of the mesenteric vessels. Clamping of the mesenteric vessels occurs at the time of intussusception ( implementation) intestines and as edema develops in the tissues of the retracted portion of the intestine, it progresses. Compression of blood vessels leads to the death of all tissues of the intussusception ( retracted intestine), as a result of which intestinal motility and secretion are disrupted and its patency worsens.

Volvulus

Volvulus is a pathological condition in which the intestinal loop twists around its axis or the axis of its mesentery ( double layer of peritoneum, through which the intestine is suspended from the posterior wall of the abdominal cavity). When intestinal volvulus occurs, external infringement of its walls occurs, as a result of which its patency is impaired and intestinal obstruction appears. The development of such obstruction during intestinal volvulus is also favored by compression of the vessels located in its mesentery, which leads to disruption of the blood supply and necrosis ( dying off) tissues of the intestinal walls. Intestinal volvulus is often observed with abdominal injuries, nutritional disorders ( overeating, vegetarianism, etc.), malformations of the abdominal organs, inflammatory diseases of the intestines and peritoneum, after surgical interventions, food intoxication, physical overload.

Splenomegaly

Splenomegaly is an enlargement of the spleen due to various reasons. The size of the spleen can increase significantly with blood diseases ( hemolytic anemia, leukemia, lymphoma, hemoglobinopathies, thrombocytopenic purpura, etc.), autoimmune diseases ( systemic lupus erythematosus, rheumatoid arthritis, periarteritis nodosa, etc.), infections ( malaria, sepsis, typhoid, blastomycosis, mononucleosis, echinococcosis, histoplasmosis, brucellosis, etc.). A significantly enlarged spleen can put pressure on the outside of the intestinal loops, which can cause intestinal obstruction.

Cystic fibrosis

Cystic fibrosis is a genetic disease in which the functioning of glandular tissue in the exocrine glands is disrupted. Cystic fibrosis is caused by a mutation in the CFTR gene ( transmembrane regulator of cystic fibrosis), located on the seventh chromosome. This gene encodes a special protein responsible for transporting chlorine ions inside various cells. Since expression ( that is, activity) of the cystic fibrosis gene is more expressed in the salivary glands, respiratory tract tissues, glandular cells of the intestines, pancreas, then, first of all, it is these tissues that suffer from this disease. In them, the production of secretion is disrupted, it becomes thick, and is difficult to separate from the surface of the cells, which causes the clinical picture characteristic of cystic fibrosis.

Intestinal obstruction in this pathology is associated with impaired digestion of food in the upper parts of the digestive tract ( stomach, duodenum) due to lack of appropriate secrets ( gastric, pancreatic and intestinal juice) and slowing of intestinal motility ( due to the presence of undigested food and a deficiency of intestinal mucus, which facilitates the movement of feces through the intestine).

Types of intestinal obstruction

There are many types of intestinal obstruction. She may be tall ( obstruction at the level of the small intestine) or low ( obstruction at the level of the large intestine), acute or chronic, complete or partial, congenital or acquired. However, first of all, this obstruction is classified depending on the mechanism of its occurrence. There are mechanical, dynamic and vascular intestinal obstruction. This classification is fundamental because it explains not only the mechanism of origin of intestinal obstruction, but also its causes, as well as some morphofunctional features of the course of the pathology.

Mechanical intestinal obstruction

Mechanical intestinal obstruction is of three types. The first of these is obstructive intestinal obstruction. It occurs with mechanical occlusion ( blockage) intestinal lumen at any level. Closure of the lumen of the small or large intestine may be due to a pathological process ( Crohn's disease, tumor, tuberculosis, scar adhesions, etc.), located in the intestinal wall ( from the inside), or may be associated with the presence of gallstones, foreign bodies, fecal stones, and accumulations of helminths inside the intestinal cavity ( worms).

Obstructive intestinal obstruction sometimes occurs when intestinal loops are compressed from the abdominal cavity. This is usually observed with tumors and cysts of organs located in the abdominal cavity and adjacent to the intestines. They can be the liver, pancreas, gall bladder, stomach. In some cases, a tumor growing from the intestine can compress its neighboring loops, which will also make it difficult for its contents to pass through the digestive tract. Mechanical compression of the intestine from the abdominal cavity also occurs with splenomegaly ( enlargement of the spleen), caused by various pathologies.

The second type of mechanical intestinal obstruction is strangulation intestinal obstruction. This type of obstruction occurs in cases where intestinal loops are strangulated in the hernial orifice ( with a hernia) or connective tissue adhesions or form nodes or twists ( twisting a loop around its axis) between themselves. In such cases, not only partial or complete blocking of the movement of intestinal contents occurs, but also compression of the intestinal mesentery occurs, which is accompanied by a disruption of its blood supply. Sudden ischemia ( lack of blood supply) of the intestinal wall leads to the rapid death of the tissues of which it consists.

The last type of mechanical intestinal obstruction is mixed intestinal obstruction. With it, simultaneous mechanical obstruction is observed ( blockage) intestinal lumen and strangulation ( compression) its mesentery, that is, a combination of the first two types of mechanical intestinal obstruction. Mixed intestinal obstruction is usually observed with intussusception ( pulling one loop into another) intestines, hernias ( external and internal) and abdominal adhesions. Mixed intestinal obstruction is very similar to strangulating intestinal obstruction ( In both the first and second cases, there is a blockage of the intestinal lumen and compression of its mesentery), however it is slightly different from it. In case of mixed intestinal obstruction, obstruction ( blockage) and strangulation run parallel and are independent of each other. With strangulation intestinal obstruction, occlusion of the intestinal lumen always depends on the degree of strangulation of its mesentery. The stronger the strangulation, the more severe the blockage of the intestinal cavity.

Dynamic intestinal obstruction

Dynamic obstruction develops due to impaired intestinal motility. In some conditions, a disorder occurs in the periodic and sequential change of contractile movements of the muscular layer of the intestinal wall, ensuring the gradual movement of intestinal contents along the entire digestive tract. Slowing or complete absence of intestinal motility leads to blocking the transit of intestinal mass through the intestinal system. This is the essence of dynamic ( functional) intestinal obstruction. It is worth noting the fact that with this obstruction there is no mechanical obstruction ( blockages) no bowel lumen or strangulation of its mesentery is observed. Depending on the mechanism of occurrence, dynamic intestinal obstruction is divided into paralytic and spastic.

Paralytic obstruction develops as a result of a significant decrease in myocyte tone ( muscle cells) intestinal wall. With such obstruction, the smooth muscles of the intestine lose the ability to contract and peristalsis, that is, its total ( full) paresis ( paralysis). There are a large number of reasons that contribute to the occurrence of this form of dynamic intestinal obstruction. They may be metabolic disorders ( metabolism) in organism ( uremia, hypoproteinemia, hypokalemia, etc.), disorders of the central nervous system ( injuries and tumors of the brain and spinal cord, strokes, etc.), inflammatory diseases of abdominal organs and tissues ( peritonitis, appendicitis, pancreatitis, cholecystitis, etc.) and chest ( pneumonia, myocardial infarction, pleurisy) cavities, etc. With paralytic intestinal obstruction, all its loops are uniformly swollen and tense ( with mechanical intestinal obstruction, bloating is observed only above the area of ​​blockage).

Symptom	The mechanism of appearance of this symptom	How does this symptom manifest itself?
Stomach ache	Abdominal pain due to intestinal obstruction is caused by damage to the nerve receptors located in the intestinal wall. Damage to receptors during mechanical and dynamic obstruction is caused by compression ( for example, when forming knots, twists between loops) or hyperextension ( with bloating) intestinal walls. Damage to the intestinal receptor apparatus during vascular obstruction, in most cases, is triggered by rapid tissue death due to a lack of blood supply. With strangulation obstruction ( a type of mechanical obstruction) nerve damage is also associated with a lack of blood supply to the intestinal walls.	Abdominal pain is the leading and most pronounced symptom. At the beginning of the disease, they occur in the form of attacks, which are followed by periods of calm. As the pathology progresses, the pain becomes constant. Abdominal pain due to intestinal obstruction is initially acute and unbearable, then it becomes aching and dull. The pain can be diffuse, diffuse, without clear localization or have a clear location.
Nausea	Nausea and vomiting in the initial stages of the disease develop as a reflex response of the body to a violation of the passage of gastrointestinal contents through the digestive canal. In later stages, these symptoms are caused by general intoxication of the body ( harmful toxins formed in the intestines and entering various organs through the blood) and hyperdistension of the upper parts of the small intestine.	Nausea and vomiting are fairly common symptoms of intestinal obstruction. They are observed in 70–90% of cases. At the beginning of the disease, the vomit consists of gastric and duodenal contents, a little later they acquire a putrid, fetid character ( fecal vomiting), which indicates serious stagnation in the small intestine.
Vomit
Headache	Headache and weakness develop as a result of intoxication of the body with harmful metabolic products formed during the life of the intestinal microflora.	Headache and weakness are not specific symptoms of intestinal obstruction, but their occurrence is not uncommon in this pathology. These two symptoms can occur at any time during the illness.
Weakness
Bloating	Abdominal bloating is caused by a significant expansion of the intestinal loops, the causes of which are usually certain pathogenetic factors, such as the accumulation of gases and feces in the intestinal lumen, transudation of excess fluid from the vessels into its cavity, a disorder of nervous regulation ( paresis or paralysis of the nerve endings innervating the intestinal wall).	Bloating is one of the main ( but not permanent) symptoms of intestinal obstruction ( occurs in 75–85% of cases). Abdominal bloating is usually not observed with spastic intestinal obstruction ( one of the forms of dynamic obstruction). With paralytic and vascular obstruction, abdominal bloating is most often diffuse. With obstructive and strangulation it is uneven, asymmetrical ( swelling occurs only in the area of ​​the adductor loop, while the abducent loop collapses).
Retention of stool	Stool retention with mechanical intestinal obstruction is caused by a violation of the patency of the intestinal tube, which occurs as a result of the appearance of any obstacle to the transit of intestinal contents. With dynamic intestinal obstruction, stool retention occurs as a result of disruption of its normal peristalsis. With vascular obstruction, the slowdown in the movement of intestinal contents through the intestine is associated with impaired blood supply to the intestinal walls.	Stool retention due to intestinal obstruction is not a permanent symptom. This should be remembered. According to statistics, this symptom occurs only in 60–70% of new cases. The patient's stool may persist if the intestinal blockage occurs in its upper sections. In such cases, the remaining intestinal contents below the area of ​​compression or strangulation will freely move towards the anus. In rare cases, only stool retention with normal gas discharge may occur.
Dry tongue	Dry tongue, tachycardia ( ), shortness of breath, decreased blood pressure occur with intestinal obstruction due to endotoxicosis and a decrease in the total volume of circulating blood ( BCC). Endotoxicosis ( internal intoxication) in the patient’s body is caused by the absorption of toxic waste products of bacteria from the intestines into the blood. A decrease in BCC is associated with extravasation ( penetration) excess fluid from the intestinal vessels into its cavity.	These symptoms ( dry tongue, tachycardia, shortness of breath, decreased blood pressure) do not develop in the patient immediately. As a rule, this occurs in the middle of the disease ( 12 – 17 hours from the onset of the disease). Some of these symptoms may develop earlier ( especially with significant pain in the abdominal area). Here everything depends on the type of intestinal obstruction, its severity, the presence of complications, and the cause of obstruction of the digestive tract.
Tachycardia
Dyspnea
Lower blood pressure

Stages of intestinal obstruction

At the very beginning of the disease ( ileus cry phase) the patient experiences acute pain in the abdominal area. The pain syndrome is sometimes very pronounced, so it is often accompanied by signs of shock ( decreased blood pressure, increased breathing and heart rate, pale skin, etc.). The pain is not constant and often disappears for some indefinite period, after which a new attack of abdominal pain occurs. This phase usually lasts from 12 to 17 hours. The phase of ileus cry is immediately followed by the phase of intoxication. At this stage of the disease, the patient, in addition to abdominal pain, experiences vomiting, nausea, and constipation ( stool and gas retention), palpitations, sometimes blood pressure decreases, a splashing noise appears when moving in the abdominal area. Painful sensations in the abdomen become constant.

The duration of the intoxication phase does not exceed 36 hours. After 30 - 36 hours from the onset of the disease, the terminal phase begins, characterized by severe metabolic disorders and disruption of the normal functioning of many organs ( heart, kidneys, liver, lungs, brain, etc.) bloating, a sharp decrease in blood pressure, a small and rare pulse, the appearance of fecal vomiting and peritonitis ( inflammation of the peritoneum). The terminal phase of intestinal obstruction very often ends in the death of the patient.

Diagnosis of intestinal obstruction

Diagnosis of intestinal obstruction is quite difficult, since this pathology is easily confused with a large number of other diseases of organs located both inside the abdominal cavity and outside it. The main methods of its diagnosis are clinical ( anamnesis, external examination, palpation, percussion, auscultation) and radial ( radiography and ultrasound examination) research methods. In addition to them, in case of intestinal obstruction, additional examinations are also prescribed, for example, a half-glass Schwartz test, probe enterography, and some types of laboratory tests ( general blood test and biochemical blood test).

Methods used in the diagnosis of intestinal obstruction

Diagnostic method	Methodology	What signs of disease does this method reveal?
Anamnesis	Taking an anamnesis involves asking the patient’s doctor about his complaints, the time and place of their occurrence, the duration of the pathology, factors ( for example, physical activity, abdominal injuries, etc.), contributing to the development of the disease. When collecting anamnestic information, the doctor is also obliged to ask the patient about the presence of additional diseases and previous surgical interventions on the abdominal organs.	By collecting anamnesis, it is possible to determine whether the patient has symptoms and signs characteristic of intestinal obstruction ( abdominal pain, bloating, lack of stool, nausea, vomiting, etc.). In addition, you can obtain a lot of useful additional information that helps the doctor more accurately assess the patient’s condition, predict the course of the disease, determine and plan effective treatment tactics.
External examination of the abdomen	An external examination is a mandatory procedure that every doctor uses in his daily practice. The patient is examined in a lying position, undressed to the waist, after or during anamnesis collection.	With intestinal obstruction, abdominal bloating, asymmetry, and, quite rarely, visible intestinal peristalsis can be detected. The tongue of such patients is dry and covered with a white coating. Their general condition is usually moderate or severe. Their skin is pale. The patients themselves are quite restless, occasionally having elevated body temperature and shortness of breath.
Palpation	During palpation, the doctor examines the patient's abdomen using his fingers. This is necessary to more accurately establish the localization of abdominal pain, detect its bloating and various pathological processes ( e.g. tumors, cysts).	Thanks to palpation, it is possible to identify the most painful points, which helps to suggest the level of obstruction ( blockages) intestines. If space-occupying lesions are detected, a possible cause of obstruction can also be inferred.
Percussion of the abdomen	During abdominal percussion, the doctor taps his fingers on the abdominal wall of the patient's abdomen. With this tapping, various sounds arise, which he analyzes.	With intestinal obstruction, a pronounced tympanic sound is heard ( drum) sound, indicating severe distension of the intestinal loops. Such sound can be local or, conversely, diffuse ( widespread). In some cases, with intestinal obstruction, percussion can reveal the sound of splashing in the abdomen.
Auscultation of the abdomen	During auscultation, the patient's abdomen is heard using a phonendoscope. This device helps to determine the presence of various noises inside the abdominal cavity.	Characteristic signs of intestinal obstruction during auscultation are hyperperistaltic sounds ( that is, noises associated with increased intestinal motility). In later stages, intestinal peristaltic sounds may disappear altogether. In such cases, the noise of a falling drop is often detected.
Radiography	An X-ray is taken with the patient standing. In case of a serious condition of the patient, such an examination is performed in the lateral lying position ( that is, lying on the left side). X-rays passing through the patient's body fall on a special film that captures them, resulting in an image being formed in which the abdominal cavity can be seen from the inside.	In case of intestinal obstruction on an x-ray ( X-ray image), as a rule, it is possible to identify Kloiber bowls ( horizontal fluid levels in intestinal loops), pneumatosis intestinalis ( accumulation of gas in its lumen). In addition to these two signs, with this pathology it is also possible to detect transverse striations in the intestinal loops, which is formed due to the thickening of the round folds of its mucous membrane.
Half-glass Schwartz test	To carry out this test, the patient is given 100 ml of a radiopaque substance to drink, and then a plain radiography of the abdominal cavity is taken.	The half-glass Schwartz test, compared with conventional radiography, can more effectively detect intestinal occlusion ( blockage) and determine its location.
Tube enterography	Probe enterography is a much more progressive diagnostic method, in contrast to the half-glass Schwartz test or simple radiography. With this method, a radiopaque substance is injected through a special catheter directly into the cavity of the duodenum. After this procedure, an x-ray of the abdominal cavity is taken.	Probe enterography, like the half-glass Schwartz test, helps to quickly and accurately determine the presence of intestinal obstruction in a patient and establish its localization.
Ultrasonography (Ultrasound)	During this study, an ultrasonic wave transmitter is placed on the anterior abdominal wall. It is used to examine the entire abdominal cavity. This sensor not only reproduces ultrasonic waves, but also registers them. The echo signals that return to the transmitter are transported to a computer, in which the information is converted into electronic information and displayed on the screen of the ultrasound machine in the form of a picture.	In case of intestinal obstruction, ultrasound can reveal a significant expansion of its lumen, thickening of its walls, separation of round intestinal folds from each other, and accumulation of fluid in areas of the intestine that are localized above the blockage. Also, with the help of ultrasound, you can discern the presence of back-and-forth movements of the muscular wall of the intestine, which will serve as a sign of mechanical intestinal obstruction. With dynamic obstruction, a complete absence of intestinal motility can be observed.
General blood analysis	Blood sampling for general, toxicological and biochemical analysis is carried out directly from the ulnar vein. Blood is taken in the morning, on an empty stomach, into special disposable vacuum syringes ( vacutainers). Then it is delivered to the laboratory. Blood for general analysis is placed in hematological analyzers, which are necessary to count the number of cellular elements in it, as well as some other indicators. Blood for biochemical ( toxicological) analysis is placed in a biochemical ( toxicological) an analyzer that calculates the percentage of various chemicals contained in blood plasma.	With the help of a general blood test for intestinal obstruction, anemia can be detected ( decrease in the number of red blood cells and hemoglobin in the blood), leukocytosis ( increase in the number of leukocytes in the blood), increased ESR ( erythrocyte sedimentation rate) . Sometimes ( for example, with thrombosis of mesenteric vessels, splenomegaly) thrombocytosis can be detected ( increase in platelet count), shift of the leukocyte formula to the left ( that is, an increase in the blood of young forms of leukocytes - myelocytes, promyelocytes, etc.).
Biochemical and toxicological blood test		Using a biochemical analysis in the blood, some pathological changes can be detected ( increased creatinine, urea, aspartate aminotransferase, alanine aminotransferase, bilirubin, decreased total protein, albumin, potassium, calcium, iron, etc.). If intestinal obstruction was caused by poisoning, then using a toxicological analysis it is possible to determine the toxic substance that caused the intoxication.

Can intestinal obstruction be treated without surgery?

Intestinal obstruction is treated by a surgeon. If a patient has symptoms of intestinal obstruction, he should immediately contact this specialist, since this disease is quite serious and can quickly lead to death. It is categorically not recommended to treat intestinal obstruction at home, since, in most cases, such treatment turns out to be useless, and in some cases it also leads to a worsening of the patient’s condition and smearing ( masking) the true clinical picture at the time of admission to the surgical department, which adversely affects the speed and accuracy of establishing the final diagnosis. It is believed that only in 40% of patients, when they are admitted to the surgical department, conservative treatment helps eliminate intestinal obstruction.

This treatment, first of all, includes intestinal decompression, that is, the evacuation of their contents from the stomach and intestines. Nasogastric tubes are commonly used to decompress the upper bowel ( special tubes inserted into the gastrointestinal tract through the nose) or endoscopes. To resolve colonic obstruction, a siphon enema is prescribed ( rinsing the colon with warm water through a special probe). Decompression measures allow you to unload the gastrointestinal system, reduce pressure in it and reduce the amount of harmful substances in the intestines that, when released into the blood, cause general intoxication of the body.

In addition to these measures, the patient with intestinal obstruction is prescribed drug therapy, including the administration of detoxifying drugs through a drip ( rheopolyglucin, refortan, polyglucin, etc.) and protein ( albumin, plasma) drugs. These medications help normalize microcirculation in blood vessels, equalize blood pressure, reduce internal toxicosis, and compensate for water and electrolyte losses. In addition to these drugs, novocaine paranephric drugs are also prescribed ( perirenal) blockade ( a type of pain-relieving procedure) and antispasmodics ( no-spa, papaverine, atropine, etc.). They are needed to restore normal intestinal motility. In some cases, such patients are prescribed a variety of antibacterial drugs to prevent rapid necrosis ( dying off) intestinal walls with actively multiplying in an obstructed ( clogged) intestinal microflora.

For intestinal obstruction caused by heavy metal poisoning ( mercury, lead), appropriate antidotes are prescribed ( antidotes), for example, for mercury poisoning, sodium thiosulfate or unithiol is prescribed, for lead intoxication - dimercaprol, D-penicillamine. For conditions associated with hypokalemia, which may be one of the causes of intestinal obstruction, potassium supplements are prescribed. Spasmophilia ( one of the causes of intestinal obstruction) are treated with anticonvulsants ( for example, gamma-hydroxybutyric acid, seduxene), calcium chloride, calcium gluconate, magnesium sulfate. In the early stages of vascular thrombosis of the intestinal mesentery, anticoagulants are prescribed ( heparin) and thrombolytics ( streptokinase, alteplase, tenecteplase, etc.). These medications promote rapid resolution of intravascular blood clots and restore blood supply to the tissues of the intestinal walls.

Regardless of the cause of intestinal obstruction, the degree of effectiveness of conservative treatment is assessed by the general condition of the patient. If during the first 3 to 4 hours from the moment the patient was admitted to a medical facility, all therapeutic measures did not cause an improvement in his well-being, did not reduce the pain in his abdomen, did not relieve the main symptoms of the disease and did not contribute to the normal passage of gases and stool, then a conclusion is drawn about its inappropriateness, as a result of which the patient is referred for surgical intervention.

Alternative treatment for intestinal obstruction

Due to the high risk of various complications ( for example, peritonitis, intestinal perforation, internal bleeding, sepsis, etc.) and death due to intestinal obstruction, it is not recommended to use folk remedies as treatment without first consulting with your doctor.

When is surgery necessary?

Emergency surgery ( that is, the operation is performed within the first 2 hours from the moment the patient is admitted to the hospital) for intestinal obstruction is necessary when, in addition to the signs and symptoms of obstruction, there are also signs of peritonitis ( inflammation of the peritoneum), severe intoxication and dehydration ( dehydration). Such signs may be low blood pressure, increased body temperature, tachycardia ( increased heart rate), tension in the abdominal wall muscles, positive Shchetkin-Blumberg symptoms ( increased abdominal pain with special palpation of the anterior abdominal wall) and Mendel ( increased abdominal pain when tapping fingers on the anterior abdominal wall) etc. Emergency surgery is also required in cases where, based on anamnesis and external examination, the doctor has the impression that intestinal obstruction is strangulation. For example, this often happens when a patient has an external abdominal hernia.

According to statistics, only 25% of new patients require emergency surgical treatment, while the rest are examined within a few hours to establish an accurate diagnosis and receive conservative treatment, which includes decompression of the gastrointestinal tract and drug therapy to reduce the degree of internal intoxication and enteral ( intestinal) insufficiency. Conservative treatment should be carried out only for the first 3 to 4 hours from the moment the patient is admitted; if it is ineffective, then this fact also serves as an indication for surgical treatment of intestinal obstruction.

Surgical treatment of intestinal obstruction

Surgical treatment of intestinal obstruction consists of several successive stages. First of all, such patients are given anesthesia ( general anesthesia). In the vast majority of cases, endotracheal anesthesia is used ( sometimes with epidural anesthesia). The duration of the surgical intervention, as well as its volume ( that is, the number of different surgical procedures), depends on the type of intestinal obstruction, its severity, cause, presence of complications, additional diseases of the cardiovascular, gastrointestinal, genitourinary and other systems. After anesthesia, a median laparotomy is performed ( an incision of the anterior abdominal wall of the abdomen right along its middle) to open the abdominal cavity and examine it. Then the abdominal cavity is cleaned of the transudate accumulated in it ( effusion of fluid from blood vessels), exudate ( inflammatory fluid), blood, feces ( which may end up in the abdominal cavity due to intestinal perforation) and etc.

Revision ( inspection) of the abdominal cavity for the presence of a blocked section of the intestine in it, they begin with a novocaine blockade ( pain relief) root of the intestinal mesentery. During the examination, attention is paid to all areas of the small and large intestines, especially their hard-to-reach and invisible parts. After determining the cause of intestinal obstruction, they begin to eliminate it. Treatment methods always vary because there are different causes of intestinal obstruction. So, for example, with the usual volvulus of a loop of the small intestine without connective tissue adhesions, they are simply unfolded in the opposite direction, without any additional surgical measures, and in the case of an intestinal tumor, it is completely removed with partial resection ( by cutting) its adductor and abducens sections.

During the operation ( or after it) carry out decompression ( evacuation of intestinal contents) gastrointestinal tract. This procedure is carried out using special transnasal or transrectal probes ( inserted either through the nose or anus), the choice of which depends on the level of intestinal obstruction. For small intestinal obstruction, transnasal probes are used, and for colonic obstruction, transrectal ones are used. Bowel emptying can be carried out through a probe and from the intestine itself, after its enterotomy ( cutting a healthy loop of intestine). After decompression, the wound edges are sutured and the patient is prescribed various groups of drugs ( detoxifying, anti-inflammatory drugs, antibiotics, anticoagulants, microcirculation correctors, vitamins, mineral elements, etc.) to maintain normal general condition and prevent various adverse complications ( for example, peritonitis, suture ruptures, thrombosis, sepsis, etc.).

Prevention of intestinal obstruction

Due to the presence of a large number of causes and factors that can contribute to the occurrence of intestinal obstruction, its prevention is quite difficult. However, if the patient pays close attention to his health, then this will not be such a serious problem for him.

What complications can arise from intestinal obstruction?

Despite the fact that intestinal obstruction itself is, in fact, a complication, this does not prevent it from causing other equally serious complications. In fact, intestinal obstruction is dangerous because it can lead to other most catastrophic complications ( for example, sepsis, peritonitis, intestinal perforation, etc.), which lead, in most cases, to the death of the patient. The problem is that often intestinal obstruction is complicated not by one single pathology, but by several. For example, with intestinal obstruction, bowel perforation may occur with massive internal bleeding, which then leads to peritonitis ( inflammation of the peritoneum). The appearance of such complex cascades is due to various predisposing factors, which often cannot be controlled during the treatment of intestinal obstruction, therefore, if the patient shows the slightest signs of this pathology, he should contact a surgeon as soon as possible.

The main complications of intestinal obstruction can be:

• Peritonitis. Peritonitis is a pathology in which the layers of the peritoneum, a thin membrane covering the abdominal organs from the outside and the abdominal cavity from the inside, become inflamed. The occurrence of peritonitis with intestinal obstruction is mainly due to the penetration of microflora from the cavity of the intestinal tube ( through its damaged walls) into the abdominal cavity.
• Sepsis. Sepsis is an excessive inflammatory response of the body that occurs in response to a systemic infection in which a large number of microbes multiply in the patient's blood. Bacteria entering the bloodstream during intestinal obstruction is possible due to the fact that during intestinal obstruction the tissue of its walls often undergo necrosis, which is why the vessels are exposed and the intestinal contents, containing a large number of microbes, come into contact with them.
• Intestinal perforation. Perforation ( perforation) intestine is a pathological condition in which one or more holes of varying diameters form in the intestinal wall. Through this hole ( holes) intestinal contents can enter the abdominal cavity, so intestinal perforation is a very serious complication. The appearance of perforation during intestinal obstruction is associated with an increase in intracavitary pressure in the blocked intestine, disruption of its blood supply and damage to its wall under the influence of microflora.
• Necrosis of the intestinal wall. Necrosis ( dying off) tissue of the intestinal wall occurs as a result of disruption of its blood supply. Such necrosis is a fairly common occurrence with intussusception, volvulus, thrombosis and embolism of the vessels of the intestinal mesentery, tumors and cysts of the abdominal organs. In all these cases, the intestinal vessels are either compressed mechanically or clogged with a blood clot or other foreign bodies ( for example, drops of fat), due to which their permeability to blood is impaired.
• Internal bleeding. Internal bleeding is a common occurrence with intestinal obstruction, complicated by perforation ( perforation) and/or partial rupture. It appears as a result of mechanical rupture of the vessels feeding the intestines.

How to distinguish constipation from intestinal obstruction?

Constipation ( or constipation) is a symptom characterized by difficult and untimely bowel movements ( bowel movement). With constipation, there is a rare passage of small amounts of hard, dry feces, and almost every trip to the toilet causes the patient serious discomfort. To relieve himself, he often has to strain or resort to some specific techniques that can speed up the evacuation of the contents of the rectum ( for example, during bowel movements, help yourself with your fingers). The frequency of trips to the toilet “in a big way” in such patients is usually reduced ( less than three times a week).

There are so-called chronic and acute constipation. The first torment patients for quite a long time and usually arise as a result of poor nutrition, physical inactivity ( passive lifestyle), pregnancy, stress, insufficient fluid intake, significant physical activity, chronic diseases of the gastrointestinal tract, taking certain medications. In acute constipation, the patient most often does not have bowel movements for several days. The causes of such constipation are usually various forms of intestinal obstruction ( mechanical, dynamic, vascular), so that in addition to the absence of stool, he also has a variety of symptoms that are observed in patients with intestinal obstruction ( abdominal pain, nausea, vomiting, fever, etc.).

Thus, acute constipation is not a separate disease, but serves ( more precisely - sometimes it can serve) is only one of the symptoms of intestinal obstruction, while chronic constipation serves as an indicator of an unfavorable state of the gastrointestinal system.

Can I use a laxative if I have an intestinal obstruction?

Laxatives cannot be used for mechanical or vascular intestinal obstruction. In such situations, they will only worsen the clinical picture and increase the patient’s risk of various complications. These drugs can be prescribed only for dynamic intestinal obstruction, which appears as a result of disruption of the innervation of the intestinal walls. Considering the fact that the patient is not able to independently determine the type of intestinal obstruction that is bothering him, before using any laxative, he is recommended to first consult a doctor who can help him in this matter.

Does an enema help with intestinal obstruction?

Enemas, as a means of conservative treatment, are often used in the fight against intestinal obstruction. However, they are not used for all types of this pathology ( for example, they are not prescribed for strangulation and vascular intestinal obstruction). The main indication for an enema, as a rule, is mechanical colonic obstruction, that is, obstruction resulting from internal blockage of the lumen of the large intestine by some obstacle. Enemas are usually not recommended for patients with hemorrhoids, inflammatory and oncological diseases of the rectum, prolapse ( loss) rectum, gastric and intestinal bleeding. It should be noted that enemas for mechanical colonic obstruction do not always bring a positive effect.