Intestinal obstruction: main signs, causes and treatment methods. The first signs of intestinal obstruction in an adult The first signs of intestinal obstruction symptoms

– a violation of the passage of contents through the intestine, caused by obstruction of its lumen, compression, spasm, hemodynamic or innervation disorders. Clinically, intestinal obstruction is manifested by cramping abdominal pain, nausea, vomiting, stool retention and the passage of gas. In the diagnosis of intestinal obstruction, data from a physical examination (palpation, percussion, auscultation of the abdomen), digital rectal examination, plain radiography of the abdominal cavity, contrast radiography, colonoscopy, and laparoscopy are taken into account. For some types of intestinal obstruction, conservative tactics are possible; in other cases, surgical intervention is performed, the purpose of which is to restore the passage of contents through the intestine or its external diversion, resection of a non-viable section of the intestine.

General information

Intestinal obstruction (ileus) is not an independent nosological form; in gastroenterology and coloproctology, this condition develops in a variety of diseases. Intestinal obstruction accounts for about 3.8% of all emergencies in abdominal surgery. With intestinal obstruction, the movement of contents (chyme) - semi-digested food masses through the digestive tract - is disrupted.

Intestinal obstruction is a polyetiological syndrome that can be caused by many reasons and have various forms. Timely and correct diagnosis of intestinal obstruction are decisive factors in the outcome of this serious condition.

Causes of intestinal obstruction

The development of various forms of intestinal obstruction has its own reasons. Thus, spastic obstruction develops as a result of a reflex intestinal spasm, which can be caused by mechanical and painful irritation due to helminthic infestations, intestinal foreign bodies, bruises and hematomas of the abdomen, acute pancreatitis, nephrolithiasis and renal colic, biliary colic, basal pneumonia, pleurisy, hemo- and pneumothorax, rib fractures, acute myocardial infarction and other pathological conditions. In addition, the development of dynamic spastic intestinal obstruction may be associated with organic and functional lesions of the nervous system (TBI, mental trauma, spinal cord injury, ischemic stroke, etc.), as well as circulatory disorders (thrombosis and embolism of mesenteric vessels, dysentery, vasculitis), Hirschsprung's disease.

Paralytic intestinal obstruction is caused by intestinal paresis and paralysis, which can develop as a result of peritonitis, surgical interventions in the abdominal cavity, hemoperitonium, poisoning with morphine, salts of heavy metals, food toxic infections, etc.

With various types of mechanical intestinal obstruction, there are mechanical obstacles to the movement of food masses. Obstructive intestinal obstruction can be caused by fecal stones, gallstones, bezoars, and accumulation of worms; intraluminal intestinal cancer, foreign body; removal of the intestine from the outside by tumors of the abdominal organs, pelvis, kidney.

Strangulated intestinal obstruction is characterized not only by compression of the intestinal lumen, but also by compression of the mesenteric vessels, which can be observed with strangulated hernia, intestinal volvulus, intussusception, nodulation - overlapping and twisting of intestinal loops among themselves. The development of these disorders may be due to the presence of a long intestinal mesentery, scar cords, adhesions, adhesions between intestinal loops; sudden loss of body weight, prolonged fasting followed by overeating; sudden increase in intra-abdominal pressure.

The cause of vascular intestinal obstruction is acute occlusion of mesenteric vessels due to thrombosis and embolism of the mesenteric arteries and veins. The development of congenital intestinal obstruction, as a rule, is based on anomalies in the development of the intestinal tube (duplication, atresia, Meckel's diverticulum, etc.).

Classification

There are several options for classifying intestinal obstruction, taking into account various pathogenetic, anatomical and clinical mechanisms. Depending on all these factors, a differentiated approach to the treatment of intestinal obstruction is used.

For morphofunctional reasons, they distinguish:

1. dynamic intestinal obstruction, which, in turn, can be spastic and paralytic.

2. mechanical intestinal obstruction, including forms:

• strangulation (volvulus, strangulation, nodulation)
• obstructive (intraintestinal, extraintestinal)
• mixed (adhesive obstruction, intussusception)

3. vascular intestinal obstruction caused by intestinal infarction.

According to the level of location of the obstacle to the passage of food masses, high and low small intestinal obstruction (60-70%) and colonic obstruction (30-40%) are distinguished. According to the degree of obstruction of the digestive tract, intestinal obstruction can be complete or partial; according to the clinical course - acute, subacute and chronic. Based on the time of formation of intestinal obstructions, congenital intestinal obstruction associated with embryonic intestinal malformations is differentiated, as well as acquired (secondary) obstruction due to other reasons.

There are several phases (stages) in the development of acute intestinal obstruction. In the so-called “ileus cry” phase, which lasts from 2 to 12-14 hours, pain and local abdominal symptoms prevail. The stage of intoxication that replaces the first phase lasts from 12 to 36 hours and is characterized by “imaginary well-being” - a decrease in the intensity of cramping pain, weakening of intestinal peristalsis. At the same time, non-passage of gases, stool retention, bloating and asymmetry of the abdomen are noted. In the late, terminal stage of intestinal obstruction, which occurs 36 hours after the onset of the disease, severe hemodynamic disturbances and peritonitis develop.

Symptoms of intestinal obstruction

Regardless of the type and level of intestinal obstruction, severe pain, vomiting, stool retention and failure to pass gas occur.

Abdominal pain is cramping and unbearable. During a contraction that coincides with a peristaltic wave, the patient’s face is distorted with pain, he groans, and takes various forced positions (squatting, knee-elbow). At the height of a painful attack, symptoms of shock appear: pale skin, cold sweat, hypotension, tachycardia. The subsidence of pain can be a very insidious sign, indicating intestinal necrosis and death of nerve endings. After an imaginary lull, on the second day from the onset of intestinal obstruction, peritonitis inevitably occurs.

Another characteristic symptom of intestinal obstruction is vomiting. Especially profuse and repeated vomiting, which does not bring relief, develops with small intestinal obstruction. Initially, the vomit contains food debris, then bile, and in the later period - intestinal contents (fecal vomit) with a putrid odor. With low intestinal obstruction, vomiting, as a rule, is repeated 1-2 times.

A typical symptom of low intestinal obstruction is retention of stool and gas. Digital rectal examination reveals the absence of feces in the rectum, distension of the ampulla, and gaping of the sphincter. With high obstruction of the small intestine, there may be no stool retention; emptying of the lower parts of the intestine occurs independently or after an enema.

With intestinal obstruction, attention is drawn to bloating and asymmetry of the abdomen, peristalsis visible to the eye.

Diagnostics

Percussion of the abdomen in patients with intestinal obstruction reveals tympanitis with a metallic tint (Kivul's symptom) and dullness of percussion sound. Auscultation in the early phase reveals increased intestinal peristalsis and “splashing noise”; in the late phase - weakening of peristalsis, the sound of a falling drop. With intestinal obstruction, a distended intestinal loop is palpated (Val's symptom); in the later stages – rigidity of the anterior abdominal wall.

Of great diagnostic importance is rectal and vaginal examination, which can be used to identify obstruction of the rectum and pelvic tumors. The objectivity of the presence of intestinal obstruction is confirmed by instrumental studies.

A survey X-ray of the abdominal cavity reveals characteristic intestinal arches (gas-swollen intestine with fluid levels), Kloiber's cups (dome-shaped clearings above the horizontal fluid level), and a symptom of pennation (the presence of transverse striations of the intestine). X-ray contrast examination of the gastrointestinal tract is used in difficult diagnostic cases. Depending on the level of intestinal obstruction, radiography of the passage of barium through the intestines or irrigoscopy may be used. Colonoscopy allows you to examine the distal parts of the large intestine, identify the cause of intestinal obstruction and, in some cases, resolve the phenomena of acute intestinal obstruction.

Carrying out an ultrasound of the abdominal cavity with intestinal obstruction is difficult due to severe pneumatization of the intestine, but the study in some cases helps to detect tumors or inflammatory infiltrates. During diagnosis, acute intestinal obstruction should be differentiated from intestinal paresis - drugs that stimulate intestinal motility (neostigmine); Novocaine perinephric blockade is performed. In order to correct the water-electrolyte balance, intravenous administration of saline solutions is prescribed.

If, as a result of the measures taken, intestinal obstruction does not resolve, one should think about mechanical ileus, requiring urgent surgical intervention. Surgery for intestinal obstruction is aimed at eliminating mechanical obstruction, resection of a non-viable section of the intestine, and preventing recurrent obstruction.

In case of obstruction of the small intestine, resection of the small intestine can be performed with enteroenteroanastomosis or enterocoloanastomosis; deintussusception, unwinding of intestinal loops, dissection of adhesions, etc. In case of intestinal obstruction caused by a colon tumor, hemicolonectomy and temporary colostomy are performed. For inoperable tumors of the large intestine, a bypass anastomosis is performed; If peritonitis develops, transversostomy is performed.

In the postoperative period, BCC replacement, detoxification, antibacterial therapy, correction of protein and electrolyte balance, and stimulation of intestinal motility are carried out.

Prognosis and prevention

The prognosis for intestinal obstruction depends on the start date and completeness of the treatment. An unfavorable outcome occurs with late recognized intestinal obstruction, in weakened and elderly patients, and with inoperable tumors. With a pronounced adhesive process in the abdominal cavity, relapses of intestinal obstruction are possible.

Prevention of the development of intestinal obstruction includes timely screening and removal of intestinal tumors, prevention of adhesions, elimination of helminthic infestations, proper nutrition, avoidance of injuries, etc. If intestinal obstruction is suspected, immediate consultation with a doctor is necessary.

Acute intestinal obstruction (AIO) is a syndrome characterized by impaired passage of contents through the digestive tract due to mechanical obstruction or inhibition of intestinal motor function. The first works on intestinal obstruction that have survived to this day are the works of Hippocrates. In his writings, the name ileus appears for the first time, which served as a collective term for various diseases of the abdominal cavity, including obstruction.

Currently, in terms of frequency of occurrence, the disease ranks fifth among the main forms of “acute abdomen.” OKN occurs in all age groups, but most often between the ages of 30 and 60 years. Obstruction due to intussusception is more often observed in children, strangulation - in middle-aged patients, obstruction - in patients over 50 years of age. An important feature noted recently is the redistribution in frequency of occurrence of individual forms of OKN. Thus, forms such as nodulation, intussusception and volvulus have become much less common. At the same time, the frequency of obstructive colonic obstruction of tumor etiology has increased. In 75-80% of cases, the cause of mechanical intestinal obstruction is the adhesive process of the abdominal cavity. Despite the evolution of views on the etiology and pathogenesis of acute insufficiency, the development of modern diagnostic methods, improvement of surgical technologies and resuscitation and anesthesia, postoperative mortality ranges from 10% to 25%. The highest percentage of postoperative mortality in ACI occurs at ages under 5 years and over 65 years.

Classification

Back in the first half of the 19th century, two types of intestinal obstruction were identified - mechanical and dynamic. Subsequently, Wahl proposed dividing mechanical intestinal obstruction into strangulation and obstruction. The simplest and most appropriate classification at present can be considered in which OKN is divided according to its morphofunctional nature:

1. Dynamic (functional) obstruction (12%):
2. Spastic, occurring with diseases of the nervous system, hysteria, intestinal dyskinesia, helminthic infestation, etc.
3. Paralytic (infectious diseases, thrombosis of mesenteric vessels, retroperitoneal hematoma, peritonitis, diseases and injuries of the spinal cord, etc.
4. Mechanical intestinal obstruction (88%):
5. Strangulation (volvulus, nodulation, internal entrapment)
6. Obstructive:

a. intraorganic (foreign bodies, fecal and gallstones, helminthic infestation located in the intestinal lumen)

b. intramural (tumor, Crohn's disease, tuberculosis, cicatricial stricture affecting the intestinal wall)

V. extraorgan (cysts of the mesentery and ovary, tumors of the retroperitoneal space and pelvic organs, causing compression of the intestine from outside).

1. Mixed:

A. Adhesive obstruction

b. Intussusception

By origin:

1. Congenital.
2. Acquired.

By level of obstruction:

1. Small intestine: a. high b. low
2. Colon - According to the dynamics of the development of the pathological process

(using the example of adhesive intestinal obstruction)

Stage I. Acute violation of intestinal passage - stage of “ileus cry” - the first 12 hours from the onset of the disease)

Stage II. Acute disturbance of intramural intestinal hemocirculation

(intoxication phase) - 12-36 hours.

Stage III. Peritonitis - more than 36 hours from the onset of the disease.

Significant disagreements are found in the literature on the issue of determining the severity of colonic obstruction. This circumstance has given rise to many classifications of the clinical course of the disease. The most frequently used in urgent coloproctology is the classification developed at the Research Institute of Coloproctology of the Russian Academy of Medical Sciences. According to the proposed classification, there are 3 degrees of severity of colonic obstruction:

I degree (compensated). Complaints of periodic constipation, lasting 2-3 days, which can be eliminated with diet and laxatives. The general condition of the patient is satisfactory, periodic bloating is noted, there are no symptoms of intoxication. The results of colonoscopy and irrigography indicate that the tumor narrows the intestinal lumen to 1.5 cm, and a small accumulation of gases and intestinal contents is detected in the colon.

II degree (subcompensated). Complaints of persistent constipation, lack of independent stool. Taking laxatives is ineffective and gives a temporary effect. Periodic bloating, difficulty passing gas. The general condition is relatively satisfactory. Symptoms of intoxication are noticeable. The tumor narrows the intestinal lumen to 1 cm. On X-ray examination, the colon is dilated and filled with intestinal contents. Individual liquid levels (Kloiber cups) can be determined.

III degree (decompensated). Complaints about the absence of stool and the passage of gas, increasing cramping pain in the abdomen and bloating, nausea, and sometimes vomiting. Severe signs of intoxication, impaired water-electrolyte balance and CBS, anemia, hypoproteinemia. On X-ray examination, the intestinal loops are dilated and inflated with gas. Many liquid levels are determined. As a rule, the majority of patients admitted to an urgent hospital due to obstructive colonic obstruction of tumor etiology have a decompensated degree of the disease, which ultimately determines the high rate of postoperative complications and mortality.

In recent years, the so-called false obstruction syndrome of the colon, first described by N. Ogilvie in 1948, has been increasingly mentioned. This syndrome most often manifests itself in the form of a clinic of acute dynamic intestinal obstruction due to a violation of sympathetic innervation. Often this condition is observed in the early postoperative period, which leads to repeated laparotomies. Most authors note diagnostic difficulties in establishing Ogilvy syndrome. Bilateral perinephric novocaine blockade according to A.V. has a positive effect. Vishnevsky.

When the clinical manifestations of the disease are accompanied by mildly expressed symptoms, we do not make a diagnosis of “partial intestinal obstruction”, considering it unjustified in tactical terms. In this case, we are most often talking about incomplete closure of the intestinal lumen by a growing tumor, adhesive obstruction, or recurrent volvulus. Such a diagnosis disorients the surgeon and leads to delayed operations.

Causes of acute intestinal obstruction

OKN can be caused by multiple causes, which are identified as predisposing and producing factors. The first include anomalies in the development of the intestine and its mesentery, the presence of adhesions, cords, pockets in the abdominal cavity, pathological formations in the intestinal lumen (tumor, polyps), defects of the anterior abdominal wall, inflammatory infiltrates, hematomas emanating from the intestinal wall or surrounding organs. The second includes reasons that, in the presence of predisposing factors, can cause the development of OKN. These are, first of all, acutely developing disorders of intestinal motor function in the form of hyper- or hypomotor reactions or a combination thereof. This condition may be caused by increased food load, a disorder of the nervous regulation of intestinal motor activity, irritation of the receptors of internal organs by an emerging pathological process, drug stimulation, or a sudden increase in intra-abdominal pressure during physical activity.

The form of the resulting OKN will depend both on the nature of the predisposing causes and on the type of disturbances in intestinal motor function.

Pathogenesis of acute intestinal obstruction

The pathogenesis and causes of death in acute intestinal failure, not complicated by intestinal necrosis and peritonitis, undoubtedly belong to one of the most complex and difficult sections of surgical pathology. A large number of experimental and clinical studies carried out both in our country and abroad are devoted to the study of these issues. Table 1 schematically presents the main components of the pathogenesis of OKN, the development and significance of which is directly proportional to the duration of the disease. The initial manifestations of OKN (stage I) are associated with impaired passage through the intestines. The severity of their occurrence and the intensity of development depend on the morphological and functional characteristics of the disease. Thus, in cases of dynamic, strangulation and obstructive obstruction, the duration of stage I will be different. It is known that an obstruction along the gastrointestinal tract does not cause any serious consequences if a bypass route is created for the evacuation of intestinal contents. The exception is the strangulation form of intestinal obstruction, when the intestinal mesentery is involved in the pathological process from the very beginning and the pathogenesis of the disease is dominated not so much by evacuation as by vascular disorders.

In stage I, there are no gross morphofunctional changes in the intestinal wall, no disturbances in water-electrolyte balance and endogenous intoxication syndrome. For such patients, with the exception of cases of strangulation intestinal obstruction, conservative therapy is indicated. The second stage of OKN is characterized by an acute disorder of intramural intestinal hemocirculation. This is no longer just a reaction of the body to the cessation of intestinal passage, but profound pathological changes, which are based on tissue hypoxia and the development of rapid autocatalytic processes. It has been established that with an increase in intraintestinal pressure to 30 mm. rt. Art. capillary blood flow in the intestinal wall completely stops. All of the above gives grounds to interpret the second stage of OKN as a process of acute disturbances of intramural intestinal hemocirculation. Taking into account its progressive nature, at this stage it is no longer possible to adhere to the tactics of dynamic monitoring of the patient and persistent conservative treatment. It is necessary to establish indications for urgent surgical intervention.

The identification of stage III OKN from a clinical and pathophysiological point of view is associated with the development of peritonitis due to the penetration of microorganisms through the intestinal wall into the free abdominal cavity and the progressive syndrome of multiple organ failure.

Symptoms of acute intestinal obstruction

Clinical picture acute intestinal obstruction consists of 2 groups of symptoms. The first group is directly related to the changes occurring in the gastrointestinal tract and abdominal cavity during acute intestinal tract. The second group reflects the body’s general reaction to the pathological process.

Group I. The earliest and one of the most persistent signs of the disease is pain. The occurrence of cramping pain is characteristic of acute obstruction of the intestinal lumen and is associated with its peristalsis. Sharp, constant pain often accompanies acutely developed strangulation. If OKN is not diagnosed in a timely manner, then on days 2-3 from the onset of the disease, intestinal motor activity is inhibited, which is accompanied by a decrease in pain intensity and a change in its nature. In this case, symptoms of endogenous intoxication begin to prevail, which is a poor prognostic sign. The pathognomonic symptom of ACI is stool retention and non-passage of gas. However, with high small-intestinal obstruction at the beginning of the disease, the passage of gases and stools may be observed due to emptying of the distal parts of the intestine, which do not bring relief to the patient, which often disorients the doctor. One of the early clinical signs of OKN is vomiting. Its frequency depends on the level of obstruction in the intestine, the type and form of obstruction, and the duration of the disease. Initially, vomiting is of a reflex nature, and subsequently occurs due to overflow of the proximal parts of the gastrointestinal tract. The higher the intestinal obstruction, the more severe the vomiting. In the initial stage of colonic obstruction, vomiting may be absent. With low small intestinal obstruction, vomiting is observed with large intervals and an abundance of vomit, which takes on the character of intestinal contents with a “fecal” odor. In the later stages of acute insufficiency, vomiting is a consequence not only of stagnation, but also of endotoxicosis. During this period, it is not possible to eliminate vomiting even by intestinal intubation.

One of the local signs of OKN is bloating. “Oblique abdomen” (Bayer’s symptom), when bloating leads to asymmetry of the abdomen and is located in the direction from the right hypochondrium through the navel to the left iliac region, characteristic of volvulus of the sigmoid colon. Intestinal obstruction caused by obstruction of the lumen of the proximal jejunum leads to bloating in the upper parts of the abdomen, while obstruction in the ileum and colon leads to bloating of the entire abdomen. In order to diagnose the mechanical form of intestinal obstruction, a triad of clinical signs (Wal's symptom) was described: 1. Asymmetry of the abdomen; 2. Palpable swollen intestinal loop (elastic cylinder) with high tympanitis; 3. Peristalsis visible to the eye. To identify a possible strangulated hernia accompanied by clinical acute intestinal obstruction, it is necessary to carefully examine and palpate the epigastric, umbilical and inguinal areas, as well as existing postoperative scars on the anterior abdominal wall. When examining patients with acute intestinal obstruction, it is very important to remember about the possible parietal (Richter) strangulation of the intestine, in which the “classical” clinical picture of complete intestinal obstruction, as well as the presence of a tumor-like formation characteristic of a strangulated hernia, are absent.

On palpation, the abdomen remains soft and painless until peritonitis develops. However, during the period of active peristalsis, accompanied by an attack of pain, tension occurs in the muscles of the anterior abdominal wall. For cecal volvulus, the Schiemann-Dans symptom is considered pathognomonic, which is defined as a feeling of emptiness on palpation in the right iliac region due to intestinal displacement. With colonic obstruction, flatulence is detected in the right iliac region (Anschutz's symptom). The symptom described by I.P. has significant diagnostic value. Sklyarov (“splashing noise”) in 1922, detected with a slight concussion of the anterior abdominal wall. Its presence indicates an overflow of liquid and gases into the adductor colon, which occurs with mechanical intestinal obstruction. This symptom should be reproduced before performing a cleansing enema. Percussion of the anterior abdominal wall reveals areas of high tympanitis with a metallic tint (Kivul's symptom), as a consequence of developing pneumatosis of the small intestine. This is always a warning sign because gas does not normally accumulate in the small intestine.

When auscultating the anterior abdominal wall at the onset of the disease, intestinal sounds of varying height and intensity are heard, the source of which is the small intestine that is swollen, but has not yet lost motor activity. The development of intestinal paresis and peritonitis marks a weakening of intestinal sounds, which appear in the form of separate weak bursts, reminiscent of the sound of a falling drop (Spasokukotsky's symptom) or the noise of bursting bubbles (Wilms' symptom). Soon these sounds are no longer detectable. The condition of a “silent abdomen” indicates the development of severe intestinal paresis. Due to changes in the resonating properties of the contents of the abdominal cavity, against the background of an increased abdominal volume, heart sounds begin to be clearly heard (Bailey's symptom). At this stage the clinical picture acute intestinal obstruction increasingly combined with the symptoms of widespread peritonitis.

Diagnosis of acute intestinal obstruction

In diagnostics acute intestinal obstruction A carefully collected anamnesis, scrupulous identification of clinical symptoms of the disease, and critical analysis of radiological and laboratory data are of great importance.

The examination of a patient with acute intestinal tract must be supplemented with a digital examination of the rectum, which allows one to determine the presence of feces (“coprostasis”), foreign bodies, a tumor or the head of the intussusception. Pathognomonic signs of mechanical intestinal obstruction are balloon-like swelling of the empty ampulla of the rectum and decreased tone of the anal sphincters (“anal gaping”), described by I.I. Grekov in 1927 as a “symptom of the Obukhov hospital.”

Group II. The nature of general disorders in acute insufficiency is determined by endotoxicosis, dehydration and metabolic disorders. Thirst, dry mouth, tachycardia, decreased diuresis, and blood thickening, determined by laboratory parameters, are noted.

A very important diagnostic step is an X-ray examination of the abdominal cavity, which is divided into:

1. Non-contrast method (panoramic radiography of the abdominal cavity). Additionally, a survey x-ray of the chest cavity is performed.
2. Contrast methods for studying the movement of barium suspension through the intestines after oral administration (Schwartz test and its modifications), its administration through a nasoduodenal tube and retrograde filling of the colon with a contrast enema.

Abdominal imaging may reveal direct and indirect symptoms acute intestinal obstruction. Direct symptoms include:

1. Accumulation of gas in the small intestine is a warning sign, since under normal conditions gas is observed only in the stomach and large intestine.

1. The presence of Kloiber cups, named after the author who described this sign in 1919, is considered a classic x-ray sign of mechanical intestinal obstruction. They represent horizontal fluid levels located in distended intestinal loops, which are detected 2-4 hours after the onset of the disease. Attention is drawn to the ratio of the height and width of gas bubbles above the liquid level and their localization in the abdominal cavity, which is important for the differential diagnosis of types of OKN. However, it should be remembered that Kloiber cups can also form after cleansing enemas, as well as in weakened patients who have been in bed for a long time. Horizontal levels are visible not only when the patient is in a vertical position, but also in the later position.

1. A symptom of transverse striation of the intestinal lumen, referred to as Case's symptom (1928), “stretched spring”, “fish skeleton”. This symptom is considered as a manifestation of edema of the kerkring (circular) folds of the small intestinal mucosa. In the jejunum, this symptom manifests itself more prominently than in the ileum, which is due to the anatomical features of the relief of the mucous membrane of these parts of the intestine. Clearly visible folds of the small intestine are evidence of the satisfactory condition of its wall. The wear of the folds indicates a significant disruption of intramural hemodynamics.

In cases where the diagnosis of OKN is very difficult, the second stage of X-ray examination using contrast methods is used.

X-ray contrast method. Indications for its use can be formulated as follows:

• Reasonable doubts about the presence of a mechanical form of OKN in the patient.
• Initial stages of adhesive intestinal obstruction, when the patient’s condition is not alarming and there is hope for its conservative resolution
• Dynamic monitoring of the progress of the contrast mass must be combined with a clinical study of the patient’s condition and the implementation of conservative therapeutic measures aimed at resolving intestinal obstruction. If local signs of acute insufficiency worsen and endotoxemia increases, the study is stopped and the question of emergency surgery is raised.

When performing oral contrast and interpreting the data obtained, it is necessary to take into account the timing of the passage of the contrast agent through the intestines. In a healthy person, a barium suspension, drunk per os, reaches the cecum after 3-3.5 hours, the right flexure of the colon - after 5-6 hours, the left flexure - after 10-12 hours, the rectum - after 17-24 hours. The use of oral radiopaque methods is not indicated for colonic obstruction due to their low information content. In such cases, an emergency colonoscopy is performed.

Ultrasound scanning of the abdominal organs is complemented by x-ray examination, especially in the early stages of acute insufficiency. It allows you to repeatedly observe the nature of peristaltic movements of the intestine without exposing the patient to radiation, determine the presence and volume of effusion in the abdominal cavity, and examine patients in the early postoperative period. The most important signs in assessing the stage of OKN are the diameter of the intestine, which can range from 2.5 to 5.5 cm and the thickness of its wall, ranging from 3 to 5 mm. the presence of free fluid in the abdominal cavity. With the development of destructive changes in the intestinal loops, the thickness of the wall can reach 7-10 mm, and its structure becomes heterogeneous with the presence of inclusions in the form of thin echo-negative stripes.

Laparoscopy. The development of endoscopic research methods in emergency surgery has made it possible to use laparoscopy in the diagnosis of acute insufficiency. A number of domestic and foreign authors point out the possibilities of the method for differential diagnosis of mechanical and dynamic forms of acute intestinal obstruction, for dissection of single adhesions. However, as our experience in using laparoscopy shows, using it in conditions of severe intestinal paresis and adhesions in the abdominal cavity in most cases is not only uninformative, but also dangerous due to the possible occurrence of severe complications. Therefore, the main indication for the use of laparoscopy in acute insufficiency is the objective difficulties in the differential diagnosis of acute surgical pathology.

Treatment of acute intestinal obstruction

Conservative therapy. Based on ideas about the vascular genesis of disorders in strangulation acute insufficiency and the rapidity of their development, the only way to treat it is emergency surgery with corrective therapy on the operating table and in the postoperative period. In all other cases, treatment of OKN should begin with conservative measures, which in 52%-58% of cases give a positive effect, and in other patients they are a stage of preoperative preparation.

Conservative therapy is based on the “drip and suck” principle. Treatment begins with the introduction of a nasogastric tube to decompress and flush the upper digestive tract, which reduces intracavitary pressure in the intestine and the absorption of toxic products. The perirenal novocaine blockade according to A.V. has not lost its therapeutic value. Vishnevsky. The administration of enemas has independent significance only in case of obstructive colonic obstruction. In other cases, they are one of the methods of stimulating the intestines, so there is no need to place high hopes on their effectiveness. Carrying out drug stimulation of the gastrointestinal tract is justified only when there is a decrease in intestinal motor activity, as well as after eliminating the obstacle to intestinal passage. Otherwise, such stimulation can aggravate the course of the pathological process and lead to rapid depletion of neuromuscular excitability against the background of increasing hypoxia and metabolic disorders.

An obligatory component of conservative treatment is infusion therapy, with the help of which blood volume is restored, cardiohemodynamics are stabilized, protein and electrolyte imbalances are corrected, and detoxification is carried out. Its volume and composition depends on the severity of the patient’s condition and averages 3.0-3.5 liters. In case of a serious condition of the patient, preoperative preparation should be carried out by the surgeon together with the anesthesiologist-resuscitator in the intensive care ward or resuscitation department.

Surgical treatment. Conservative therapy should be considered effective if, in the next 3 hours from the moment the patient was admitted to the hospital after enemas, a large amount of gas passed and there was abundant stool, abdominal pain and bloating decreased, vomiting stopped and the general condition of the patient improved. In all other cases (with the exception of dynamic intestinal obstruction), conservative therapy should be considered ineffective and indications for surgical treatment should be given. In case of dynamic intestinal obstruction, the duration of conservative treatment should not exceed 5 days. The indication for surgical treatment in this case is the ineffectiveness of conservative measures and the need for intestinal intubation for the purpose of its decompression.

Success in the treatment of acute insufficiency is directly dependent on adequate preoperative preparation, the correct choice of surgical tactics and postoperative management of patients. Various types of mechanical acute intestinal obstruction require an individual approach to surgical treatment.

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 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.

Such a common symptom as abdominal pain should always be treated with caution, because it can be a manifestation of a serious surgical pathology, in which the movement of food contents through the digestive tube is disrupted. This condition can lead to serious consequences, so it is important to recognize it in time and promptly seek medical help.

This condition is characterized by a violation (complete or partial) of the movement of contents through the intestinal sections.

This is an acute surgical pathology that is more common in the male population aged 30-60 years. But women and children with such a diagnosis are not at all uncommon in hospitals and clinics. Among all “acute abdomen”, this diagnosis is established in 5-9% of cases.

This pathology is classified according to anatomical principles into colonic (if the process affects the final sections of the gastrointestinal tract) and small intestinal (with lesions of the duodenum, jejunum and ileum). By origin - congenital and acquired.

But more informative is the classification, which reveals the mechanism of the disease, according to which dynamic and mechanical obstruction are distinguished.

Reasons for the development of the mechanical form

This pathology is called obstructive. The term comes from Lat. obturatio - blockage.

• Pinching, twisting of intestinal loops behind each other or around their axis, the formation of nodes, which results in a disruption of the blood supply to the vessels and blocking of blood flow in the areas of the loops. This is the situation that people call “volvulus.” The medical name for this phenomenon is strangulated intestinal obstruction.
• Combination of obstruction and entrapment. This is a situation in which one loop is inserted and pressed into another, being both a mechanical obstacle and a source of compression of blood vessels and cessation of normal blood flow.

Reasons for the development of dynamic form

It is based on functional disorders of motor activity of the gastrointestinal tract, namely:

• persistent spasm
• paresis
• paralysis

Based on the mechanism of motor disorders, this form is divided into paralytic and spastic.

Defects in muscle tone and peristalsis in the form of paralysis and paresis can be observed both throughout the intestine and in its individual areas. The following conditions can provoke motor-evacuation dysfunction and cause paralytic obstruction:

1. injuries, operations on the abdominal cavity and gastrointestinal tract
2. inflammatory processes: appendicitis, peritonitis, ileitis, cholecystitis
3. pathological conditions occurring outside the peritoneum: myocardial infarction, spinal and skull injuries, pneumonia
4. retroperitoneal hematomas, as well as thrombosis of mesenteric vessels, splenic infarctions
5. metabolic diseases (diabetic precoma, cystic fibrosis)

Persistent spasm of the intestinal muscles is possible with:

1. ascariasis
2. hepatic and renal colic
3. diseases of the nervous system (hysteria, neurasthenia)
4. intoxication of the body both by products of internal metabolism (in case of severe renal and liver failure) and substances coming from outside (alcohol, heavy metals)

Adhesions as an etiological factor

Adhesions can deform the structure of the organ, tighten, and disrupt the anatomical location of the intestinal loops.

Some practicing surgeons distinguish separately the adhesive form of disruption of the passage of contents through the intestine, thereby emphasizing the role of the causative factor: the presence of adhesions - connective tissue fibers formed as a result of an inflammatory process or trauma to the organ.

Other authors believe that it is more convenient to consider the adhesive process not as a separate form, but as one of the causes of obstructive and strangulation obstruction, since these structures can cause both circulatory disorders and block the intestinal lumen.

Both opinions are justified and have the right to exist.

Mechanism of damage development

What is the cause of a dangerous surgical pathology is clear, but what happens inside the intestine when the normal movement of food through it stops?

In general terms, the pathogenesis can be represented as follows:

The contents in the form of food gruel encounter an obstacle on its way, and stagnation occurs. The intestinal wall is subject to excessive stretching, and excess digestive juices, bile, pancreatic secretions, and gases accumulate in it due to the activity of microorganisms and the breakdown of organic acids.

The altered wall is unable to fully carry out absorption, the pressure in it increases, the intestinal loops increase in volume, swell, change color, become purple or bluish, or are completely absent.

The pathogenesis of the process and its speed depends on the form of obstruction. In the strangulation form, due to a sharp disruption of blood circulation, pathological changes in the intestinal wall increase extremely quickly: its vessels are compressed, blood clots form, and death - necrosis - develops.

All processes lead to disruption of the functioning of a part of the intestine or its part. Through a non-functioning organ, pathogenic microorganisms, part of the liquid contents, and bacterial toxins can penetrate into the abdominal cavity. Peritonitis develops.

Such changes in the body cannot but affect the patient’s well-being. And if in the initial stages the process is local, limited in nature, albeit with a clear clinical picture. Then, as the disease progresses, peritonitis develops, followed by sepsis (blood poisoning) and multiple organ failure.

At the stage of systemic damage to the body, without highly qualified medical care, the disease ends in death.

Symptoms of intestinal obstruction

You can suspect a disease if you know the main signs and symptoms that are characteristic of it. Most often, patients with a confirmed diagnosis complain of:

1. Abdominal pain

The earliest, most frequent and widespread symptom. They can be characterized as cramping, increasing in intensity, like colic with “light” pain-free intervals during obstruction, or as unbearable, constant with ischemic disorders.

2. Vomiting

Occurs in more than 75% of patients. It is typical that when pathology occurs in the high small intestinal sections, vomiting is quite common, occurs repeatedly, and does not bring relief. Reflex incessant vomiting is very characteristic of the strangulation form.

Disturbances in the passage of food in the lower intestinal sections rarely cause this symptom. If vomiting does occur, it is in the later stages of the disease, in advanced cases it has an unpleasant smell of feces due to the decomposition of the contents of the vomit.

3. Lack of stool, impaired passage of gases

These symptoms appear when the lumen of the organ is completely blocked, with partial obstruction, and in the early stages they may be absent.

Stool may be partially present during emptying of the sections below the site of the obstruction, but if the focus of the pathology is located in the sigmoid colon and more distally, then the patient cannot recover at all “by and large.”

4. Bloating

A characteristic sign that allows us to make an assumption about the level of obstruction. If the changes affect the high intestinal sections, bloating is uncharacteristic, since almost all the loops are in a collapsed state.

If the passage is disrupted in the lower small intestinal sections, symmetrically.

Colon pathology is characterized by asymmetry: the right half of the abdomen may be enlarged, corresponding to damage to the right colon, or the left half, where the opposite sections are located.

Sometimes, with obvious obstruction, peristaltic waves and swelling of the loops can be visually observed. Paralytic processes are characterized by a symmetrical accumulation of gases without distortions of the abdomen in any part of it.

5. Peristaltic noises

Rumbling, gurgling, transfusion - these signs actively appear in the first stages of the disease, and indicate disturbances in motility and gastrointestinal function.

In the later stages, with the development of necrosis and peritonitis, all noises subside. This is a prognostically unfavorable sign; “deathly silence” indicates irreversible changes in the organ.

Stages of the disease

There are three successively replacing stages of obstruction, each of which corresponds to certain manifestations.

Knowing the features of the clinical picture step by step, the doctor can quickly navigate, determine exactly how much medical care the patient needs, guess from the clinic how long the disease lasts and what condition the intestines are in.

Stage 1 – early

Lasts up to 12 hours. The main complaint of patients is pain. In case of a mechanical obstruction in the gastrointestinal tract - cramping, with light intervals; in case of circulatory disorders - unbearable, extremely pronounced (sometimes of such intensity that it can provoke a painful shock)

Stage 2 – intermediate

From 12 to 24 hours. The clinic is accompanied by vomiting and bloating. Repeated profuse vomiting leads to dehydration and thirst.

After drinking liquid, the patient feels a deterioration in health: increased pain or re-vomiting. The condition progressively worsens from moderate to severe.

The patient is agitated, takes a forced position or cannot find a position that would alleviate his condition, and rushes around the bed. The pulse is frequent, weak filling, tachycardia, the skin is pale and cold.

When examined by a surgeon, specific symptoms are revealed: the sound of splashing, falling drops, Valya, Kivulya, which will reliably indicate to the surgeon that there is an obstruction.

Stage 3 – late

At this stage, the patient’s condition is assessed as extremely serious, consistent with the clinical picture of peritonitis.

There is an increase in body temperature, pulse, respiratory rate, and tests show signs of severe inflammation.

There are no bowel sounds. The body refuses to work, decompensation and multiple organ failure sets in.

Without treatment, the patient at this stage has no chance of survival.

How to diagnose pathology

In recognizing pathology, an important role is played by the qualifications of the surgeon, his ability to correctly conduct an examination, palpate the abdomen, collect anamnesis, quickly find his bearings and decide on the tactics for managing the patient.

This diagnosis does not tolerate slowness and does not allow long thinking and waiting. As soon as possible, if obstruction is suspected, the patient should undergo the following diagnostic tests:

• X-ray examination of the abdomen in a vertical position and a horizontal position on the left side. Radiography can be performed with barium suspension contrast.

The diagnosis will be confirmed by visualized accumulations of gas in the small intestine (normally there is gas only in the colon), “inverted bowls” - gas above the liquid level, “organ pipes” - swollen loops with gas and liquid. This is how radiologists describe confirmed intestinal obstruction.

• colonoscopy
• irrigoscopy

These methods are used to clarify pathology in the final sections of the gastrointestinal tract; they will help identify the mechanical cause of closure of the lumen and more accurately determine the localization of the process.

• laparoscopy

It is used more and more often in modern surgery. Through small incisions on the anterior abdominal wall, the doctor inserts an endoscopic device with a camera into the abdominal cavity; on the monitor screen, which is connected to the endoscope, organs and pathological changes are visualized with high accuracy.

In addition to diagnostic, the method can be used for therapeutic purposes: some manipulations can be performed laparoscopically to cut adhesions, remove foreign bodies, and perform detorsion.

• Ultrasound of OBP (due to increased accumulation of gases, it may be difficult to perform)

Both methods are very informative in determining fluid in the abdominal cavity, tumors, and infiltrates.

Treatment of intestinal obstruction

All patients with a presumptive diagnosis should be urgently hospitalized in a surgical hospital.

The doctor, after a thorough interview, examination, and diagnosis, determines the type of obstruction and, taking into account the patient’s condition, chooses treatment tactics.

Patients with an established diagnosis are subject to urgent surgical intervention if:

• signs of peritonitis
• strangulation form of the disease

Surgical intervention for this form is necessary, since developing blood flow disturbances and ischemia very quickly lead to necrosis and necrosis of the organ wall.

• severe obstructive form
• severe intoxication syndrome
• in a state of shock

For other forms of obstruction (paralytic, spastic), if the patient’s condition is stable, therapy begins with conservative methods. In more than half of the cases, such methods are effective and allow one to avoid surgery.

Such methods include:

• Cleansing or siphon enema.
• Removing the contents of the gastrointestinal tract through continuous aspiration - suction with a special device that is inserted through the pharynx and esophagus. This is necessary to unload and reduce pressure inside the hollow organ.
• Novocaine blockade in the lumbar region on both sides. Allows pain relief.
• Colonoscopy when the process is localized in the distal parts. This method allows, in some cases, to eliminate sigmoid torsion, as well as endoscopically install a small stent - a metal frame that expands the wall from the inside and eliminates the phenomenon of stagnation, and removes a mechanical obstacle in the form of a foreign body.
• Drug treatment. Intravenous administration of antispasmodics, non-narcotic analgesics, ganglion blockers, anticholinesterase substances. With the help of drip infusions, the water and electrolyte balance is corrected and intoxication is combated.

Important rule: If the surgeon’s choice (for certain indications) is on conservative therapy, but after 2 hours from its start the patient does not feel relief, there is no positive dynamics, or the condition worsens, it is necessary to change the treatment tactics in favor of surgery.

Surgical treatment

Before the operation, the patient must be prepared in a short time, which includes catheterization of the bladder, injection of saline and plasma-substituting solutions into the vein. This preparation is aimed at stabilizing the patient's vital functions so that he can tolerate surgery well.

Depending on the cause that caused the obstruction, the surgeon performs one or another action aimed at eliminating it. This can be resection - removal of part of the intestine due to developed necrosis or due to tumor damage, straightening of loops, twists or nodes, dissection from rations.

Sometimes situations in the abdominal cavity are so serious that it is difficult to manage with one operation. In such cases, interventions are performed delayed, in two or three stages.

Any operations are aimed at preserving the organ as much as possible, but if the doctor sees that the intestine is not viable (it is gray in color, does not peristalt, the vessels do not pulsate), it is removed.

Any interventions on the intestines are quite traumatic and require careful monitoring and observation in the postoperative period.

Patency restored - what next?

If the cause of the disease has been managed surgically, it is very important to stabilize the patient’s condition and return him to normal life as quickly as possible through proper management of the postoperative period.

This period includes:

• getting rid of toxins and breakdown products

Infusion drugs, saline solutions, and blood plasma analogues are prescribed. Forced diuresis can be used: the prescription of large volumes of plasma replacement drugs, and then a diuretic drug that stimulates diuresis. Increased urine output “flushes” all toxins from the body.

• prevention of possible infection

It is mandatory to prescribe broad-spectrum antibiotics intravenously, as well as through drainage tubes into the postoperative wound if necessary.

• prevention of thromboembolism and thrombosis

It is necessary to tightly bandage the lower extremities and prescribe aspirin, warfarin or heparin, which have a thinning effect on the blood. It is important not to let the patient “lie down”: perform verticalization as early as possible.

• normalization of intestinal function

For several weeks, they continue to aspirate the contents of the gastrointestinal tract through a probe, administer prokinetics that stimulate motor skills, and prescribe sessions of physiotherapeutic procedures with electrical stimulation.

Success in the treatment of this pathology depends on timely diagnosis, so you should listen to your body. If it gives signals of trouble in the form of abdominal pain, bloating or vomiting, you should not self-medicate, it is better to consult a specialist as soon as possible!

Intestinal obstruction can occur for various reasons. There are mechanical and dynamic causes of its occurrence. A mechanical cause is a physical obstacle that has formed (or entered) into the lumen and clogged it. The dynamic reason is the physiological state of the intestine, in which its walls are unable to evacuate feces out.

Let's list what can be a mechanical obstacle to the path of feces:

• Fecal stones– are formed inside the large intestine during prolonged stagnation and compaction of feces. As a rule, in old age.
• Balls of worms(more often - elongated types of helminths, for example - roundworms). Balls of worms can form in other human cavities - for example, in blood vessels or the heart.
• Hairballs– enter the esophagus through the mouth due to the harmful habit of gnawing or sucking hair. Over time, they accumulate and form balls of various sizes.
• Foreign bodies- enter the intestines through the mouth, esophagus and stomach. In 60% of cases in children, pathology occurs precisely for this reason. Ingestion of foreign objects can cause obstruction of any part of the digestive tract (esophagus, thin or thick sections). The localization of the process in the intestinal cavity is determined by weakened intestinal peristalsis. Poor movement of feces occurs due to excessively high-calorie and fatty foods, insufficient mobility, and also while taking certain medications. Thus, intestinal obstruction in a child after swallowing a foreign body may be a consequence of slow movement of feces.
• Tumors of neighboring organs– compress the intestines inside the abdominal cavity.

The listed causes of obstruction are called obstructive. In addition to them, there are strangulation reasons. These are physiological changes in the location of the intestine, during which acute intestinal obstruction is formed.

These include:

• Wrapping intestinal loops around yourself.
• Intertwining several loops, “tying” them with a “knot”.
• Intestinal strangulation in a hernia.
• Compression of the intestinal cavity by adhesions (which may be on neighboring abdominal organs). In this case, adhesive intestinal obstruction is formed. It can be complete or partial.
• Inflammatory processes leading to tumors and edema of the intestinal wall.

Dynamic intestinal obstruction forms without a physical obstruction (stone or lump). It is determined by the condition of the intestinal walls. Therefore, sometimes it can be cured without surgery. For example, if dynamic obstruction is caused by excessive tension (spasm of the intestinal muscles), then the movement of feces can be normalized with an antispasmodic.

In addition to the listed mechanical reasons, doctors identify dynamic causes of obstruction. There are two of them - muscle spasm in the walls or their paralysis. Intestinal obstruction in older people often occurs precisely for this reason.

Signs and symptoms of intestinal obstruction

The process of obstruction formation develops over the course of a day. Doctors distinguish several periods of its development, which are distinguished by characteristic symptoms. The stages of formation were called the early, middle and late periods.

Signs of intestinal obstruction in adults and children at an early stage are as follows:

• The first signs of pathology appear in the form of pain. If the intestinal lumen is blocked by a physical body (stone, ball), then the pain is paroxysmal in nature, then appears and then disappears. If a torsion of the intestinal loop has occurred, the pain will be constantly present, but will change its intensity (it hurts stronger, sometimes weaker). The localization of pain corresponds to the site of obstruction formation. At the same time, over time, the pain will intensify, getting worse every hour.
• Vomiting is possible already in the first early period if an obstruction has formed at the beginning of the small intestine.
• Cessation of stool and formation of gases (occurs at the beginning of the pathology - if an obstruction has formed in the lower parts of the large intestine).

The early period lasts up to 12 hours. Medium – starts 12 hours after the first signs appear and lasts until the end of the day (24 hours).

Signs of intestinal obstruction in the middle period:

• Persistence of pain. They stop strengthening and weakening and acquire a permanently sharp character. The food has stopped completely, there is no peristalsis.
• Bloating– a physical increase in the volume of the abdominal cavity, visible to the naked eye.
• Severe and frequent vomiting– is formed due to a constant flow of toxins that flows from the zone of stagnation into the blood, and then into the liver.
• Stopping stool(if the obstacle is located in the upper parts of the intestine, then the urge to defecate does not stop immediately, but only in the middle period). A blockage in the upper part is called small intestinal obstruction. It is in the small section that blockages form more often (due to the relatively small diameter of the lumen, in the human small intestine its diameter can be only 2.5 cm).

After 24 hours after the onset of painful symptoms, extensive pathology of the late period is formed.

It is characterized by general disorders of the vital functions of organs and systems:

• The temperature rises - this indicates the addition of a bacterial infection. Against the background of stagnation of feces, the protective function of the mucous membrane of the intestinal wall decreases. Pathogenic bacteria penetrate inside and cause widespread inflammation followed by a rise in temperature. A blood test at this moment shows a large number of leukocytes (more than 10 million units).
• The urge to go to the toilet gradually stops, urine stops being produced due to general dehydration of the body. The tongue becomes dry, the pressure decreases - which are also signs of dehydration.
• Respiratory and heart rate increases (due to decreased blood pressure).
• Signs of damage (inflammation) of the peritoneum (the medical name for inflammation is peritonitis) - severe pain and a hard, tense abdomen.
• Sepsis develops - a purulent infection or blood poisoning.

Why is intestinal obstruction dangerous?

Intestinal obstruction in adults or children creates a number of pathological processes that lead to death. How lethal complications develop:

1. In the obstructed part of the intestine, waste products - feces - accumulate.
2. Stagnation of feces becomes a source of toxins. They penetrate the wall into the blood and spread throughout the body.
3. Severe intoxication occurs (general poisoning of the body - sepsis, peritonitis). It is accompanied by the traditional symptoms of poisoning - nausea, vomiting, headache, weakness.
4. The intestinal walls in the bend zone are deprived of normal blood supply. When the blood flow is completely blocked, they die quickly, within a few minutes. With partial overlap, toxins from their own vital activity accumulate in the cells. As a result, inflammation, swelling, and pain are formed.
5. When the intestinal wall becomes necrotic or inflamed, the absorption process stops. Toxins stop entering the blood. But at the same time, nutrients and water stop entering the blood. Restricted water intake and vomiting lead to general dehydration of the body.

The processes described above lead to death within 24 hours after the first signs of blockage (feeling unwell, nausea) appear.

Intestinal obstruction in children

Intestinal obstruction in newborns is formed due to congenital defects in the development of the abdominal organs. In this case, the intestinal cavity can be compressed by neighboring organs, or pinched in the opening of the intestinal wall (hernia). Or intestinal asthenia or spasm (obstruction) may develop.

If such disorders are accompanied by thick, dense meconium (which is also a pathology), then the intestinal contents stop moving along the passage. A newborn baby does not pass original feces (meconium). This leads to necrosis of intestinal tissue, as well as intestinal perforation, blood poisoning, and death.

Most intestinal defects in newborns develop in the early period of intrauterine development (before the 10th week). Abnormalities can cause complete bowel obstruction. In the presence of congenital pathology, the following signs of intestinal obstruction in children are formed:

• Vomiting after feeding.
• Lack of bowel movements and meconium passage within 24 hours after birth.

Intestinal obstruction in infants is accompanied by pain and crying.

Partial intestinal obstruction occurs when the intestinal lumen is not completely blocked. In this case, part of the feces may move towards the exit.

The cause of partial blockage is tumors and adhesions. They narrow the lumen of the intestine, and over time, they can block it completely.

The symptoms in this case are as follows:

• Pain (not as severe as with complete obstruction).
• Nausea, possible vomiting.
• Abdominal bloating (not as severe as with a complete blockage of the intestines).

Treatment of partial obstruction can be conservative and non-surgical.

What to do if you have intestinal obstruction

In most cases, treatment of intestinal obstruction is an emergency operation. Sometimes conservative therapy is possible (if the process has just begun or the blockage of the lumen is not yet complete).

Conservative treatment and “golden” 6 hours

The first 6 hours of pathology development are called “golden”. During this period, the obstruction can be treated without surgery.

What to do if there is a partial blockage of the intestines:

• When there is spasm of the intestinal walls, antispasmodics are needed to facilitate the passage of feces.
• Colonoscopy is probing the colon through the anus with a probe (endoscope). The use of colonoscopy in some cases allows you to break through an obstruction in the intestine.
• Enemas. Partial intestinal obstruction can be cleared with frequent (every 20 minutes) enemas.

In most cases, the “golden time” turns out to be missed (and not always through the fault of the patient; sometimes the doctor does not understand the ongoing process and mistakenly refers the sick woman to the gynecological department). Surgery is required to treat and save the life of the patient.

When is surgical treatment required?

What kind of surgery is necessary for intestinal obstruction is determined by the cause of the disease. Sometimes part of the dead intestine is removed, and the remaining edges are sewn together immediately during surgery. Sometimes the edges of the cuts are brought out, connected with a temporary tube and stitched together after a few weeks. In medical practice, such a resection is called stoma removal.

If the cause is a hernia, the intestine is reduced and the hernia is sutured. In this case, it is possible that there will be no need to remove part of the intestinal wall (if its tissue is not dead). The same is done for intestinal volvulus - the loop is straightened and the condition of the intestinal wall is assessed. If there is no tissue necrosis, the intestine is not cut.

If there is a foreign body, the intestine must be opened to remove the existing clot, lump or stone. In parallel with the surgical intervention, the person is given injections of antibiotics (if an infection process was present) and anti-inflammatory drugs.

What can be the consequences of surgery for intestinal obstruction?

The need for diet and nutrition control

The main consequence of the operation is the need for diet and strict nutritional control for a long time after surgical treatment. This is necessary to improve digestion and restore intestinal activity.

Throughout the acute period, when there is a blockage of the intestine, food is generally contraindicated for a person. There is also no food for the first 24 hours after the operation. The person is fed with a drip (a glucose solution is administered through a vein). After 24 hours, the patient is allowed liquid food.

What diet is prescribed for intestinal obstruction?

• Fractional meals - up to 8 times a day, in small portions.
• All food is ground into a liquid pulp and consumed warm (it is better to abstain from hot and cold food).
• What you can: jelly, mucous decoctions, jelly, juices, low-fat broths (from poultry), grated oatmeal, curd soufflé, sour milk. Later (after a few days) steamed meatballs, various pureed porridges, and omelet are added.
• Caloric intake is limited to 1000 kcal per day (during the first days after surgery) and up to 1800 kcal per day (one week after surgery).

Important: Every fourth case of this pathology is associated with poor nutrition. Therefore, monitoring your diet and food choices is not a whim of billionaires. This is the key to the health of every person.

The menu for intestinal obstruction after surgery should be gentle. For twelve months, a person should not eat food that causes fermentation - pickles, carbohydrates (sweets), citrus fruits, soda. Salt intake is also limited to a minimum.

Intestinal obstruction is a dangerous pathology. The possibility of its successful treatment is determined by the time when the patient is taken to the doctor. Medical statistics confirm the fact that surgery within the first 6 hours of blockage almost always leads to recovery. Late surgery (one day after the first symptoms appear) has a 25% mortality rate. Therefore, at the slightest suspicion of obstruction (bloating, lack of stool, pain), immediately consult a doctor.