The symptoms of intestinal obstruction (ileus) are caused by the partial or complete blockage of the intestinal transit, which hinders the transport of food.
Contents
Causes of mechanical intestinal obstruction
Adhesions
Adhesions (so-called brides or adhesions) are the cause of 50-70% of all intestinal obstructions. They can be congenital, but also develop after abdominal surgery.
Adhesion consists of hard gebewestern ranks that can connect the intestine with the adjacent organs.
Sometimes this fibrous, tight tissue pulls the intestine out of position, which can cause blockages or rotation of the intestine.
Intestinal hernia (hernia)
Fractures occur when the muscle wall that holds the internal organs in place gives way or tears, and part of the intestine protrudes through this hernial gate.
If the hernia is pinched (incarcerated), the blood supply to the intestine is reduced and causes a blood deficiency or death of the tissue (necrosis). Perforation of the intestines and gangrene (formerly called gangrene) are serious complications that can lead to infection and death.
Intestinal rotation (volvulus) Volvulus is the rotation of the intestine around its own axis, whereby arteries are constricted and the blood supply is interrupted, resulting in necrosis (gangrene)
and reduced blood flow to the intestines.
This process has rapid development, gangrene can develop within 6-12 hours.
Intussusception (strangulation ileus) The invagination of one section of the intestine into another (intussusception or intussusception)
typically occurs in newborns. The prognosis for this disease is good, especially if surgery is performed immediately after diagnosis.
If intussusception is not treated within 24 hours, a fatal outcome is likely.
Crohn’s
disease Crohn’s disease is an inflammatory bowel disease. Medications are effective in some cases in the remission of Crohn’s disease, the majority of patients eventually need surgery.
In response to the inflammation, the intestinal wall thickens and the inside of the intestine (lumen) narrows, which can lead to occlusion of the intestine.
Mechanical blockage caused by foreign bodies
If a foreign body is swallowed unintentionally, it can enter the digestive tract (intraluminal intestinal obturation).
This foreign body must be removed before it pierces the intestine and stops the normal flow of digestion.
Benign or malignant tumors Colon tumors
can block the intestine. Tumors that originate from other areas, such as the liver, pancreas or pelvic organs, can squeeze part of the intestine from the outside and cause a blood deficiency (ischemia) (extraintestinal occlusion).
Functional intestinal obstruction
If the intestinal obstruction has no mechanical causes, it is called functional or paralytic ileus. Here is a disturbance of the intestinal muscle activity (peristalsis), because the inside of the intestine is actually continuous for the digested food.
Peristalsis refers to the rhythmic contraction of the gastrointestinal muscles, which is responsible for the transport of intestinal contents.
A standstill of the half-digested food or a lack of locomotion can lead to inflammation and infection up to rupture.
peritonitis, blood poisoning and death can be an immediate consequence.
The causes of functional intestinal obstruction include:
Medications: Opioids, antipsychotics, antidepressants, and antihistamines slow muscle activity. Those who undergo chemotherapy treatment should drink a lot and consume a lot of fiber, because chemotherapy can lead to constipation.
Heroin can cause the formation of quite large feces.
An intestinal obstruction can also arise as a complication as a result of abdominal surgery.
Cold water
If the abdominal temperature drops during digestion, digestion can block.
A digestive blockage caused by cold occurs mainly in two cases:
drinking very cold liquids (water or other drinks),
swimming in cold water (swimming pool or sea).
The symptoms are abdominal pain, diarrhea, vomiting, fever and fatigue.
After a day or two of rest, the problem should resolve itself.
First symptoms of intestinal obstruction
The following symptoms typically occur with intestinal obstruction. However, they can also have more harmless causes, such as a temporary indigestion. However, if they last for a long time, this is an indication of a blocked intestine.
If 3 days pass without defecation, there is a suspicion of intestinal obstruction, accompanying symptoms include:
Abdominal pain The occlusion of the small intestine usually produces abdominal cramps and pain around the navel.
If the colon is blocked, the pain occurs below the navel.
Bloating The accumulation of intestinal gases and solid components leads to bloating and abdominal bloating.
Diarrhea and constipation
Frequent attacks of diarrhea can be caused by incomplete intestinal obstruction.
Recurrent diarrhoea can lead to dehydration.
Constipation or constipation and the inability to leak gas indicate complete blockage of intestinal transit. Some patients have alternating episodes of diarrhea and constipation.
Dehydration and imbalance in electrolyte balance
The intestinal obstruction causes increased secretion formation in the intestine, which leads to a stretching of the intestinal section lying before the occlusion.
The loss of fluid caused by vomiting and reduced fluid intake in the intestine leads to dehydration.
Vomiting causes a loss of potassium, chlorine and hydrogen ions in the stomach, in addition, dehydration causes the reabsorption of bicarbonate, resulting in alkalosis (an excess of alkaline substances, which means an increased pH in the blood).
Fatigue
The closure and the consequent inability to digest hinder the absorption of vitamins and other nutrients. This leads to weakness.
Other symptoms
- Abdominal bloating (distension)
- Halitosis
- Inability to release gas
- Vomit
- Hypotension
Diagnosis of intestinal obstruction
First, the doctor analyzes the patient’s medical history and conducts a physical examination.
The occlusion can be diagnosed by listening to the abdomen with the stethoscope. The doctor can see if there is a strong bloating of the abdomen.
Diagnostic imaging techniques include: CT and X-ray examination of the abdomen to determine the location and cause of the intestinal obstruction.
If the colon is occluded, the doctor may perform a colonoscopy (colonoscopy) to inspect the intestine. A clear image of the colon is obtained by a colon contrast stone, which is an X-ray fluoroscopy with contrast medium (barium).
Differential diagnosis
Abdominal pain and vomiting can be caused by a stomach flu, but if the abdomen is bloated and there is no urge to defecate, intestinal obstruction should be considered.
Diarrhea and vomiting cause numerous bowel sounds and can be confused with the typical sounds of intestinal obstruction.
Reduced blood flow (ischemia) to the intestine can cause pain and stretching, but usually it leads to hemorrhagic diarrhea.
The pain of acute inflammation of the pancreas often radiates to the back.
A high level of amylase is typical in intestinal obstruction, but also in pancreatitis.
An intestinal rupture can lead to an acute abdomen, with fever and vomiting.
Peptic ulcer, acute perforated diverticulitis and perforated carcinoma are other possible causes.
Intussusception should be considered in children.
Tuberculosis can manifest itself with gastrointestinal symptoms.
In non-gastrointestinal diseases, heart attack and ovarian cancer should be considered.
Treatment of intestinal obstruction
In the case of an intestinal obstruction (ileus), the therapy depends on the cause of the interruption of normal intestinal transit and is usually carried out in a hospital.
Treatment of an incomplete mechanical intestinal obstruction
In the case of a mechanical partial closure of the intestine, in which part of the food pulp and fluids still pass through the intestine, it may already be sufficient to suck out the stomach contents with a nasal gastric tube and thus reduce the flatulence of the abdomen.
An occlusion of the colon can be treated by an enema with warm water, glycerine and laxatives.
The doctor may prescribe a low-fiber diet, which is easier for the intestines to digest. If the intestinal obstruction does not dissolve, surgery may have to be performed.
Treatment of a complete mechanical intestinal obstruction If the intestine is completely blocked, surgery is usually required to loosen the occlusion
. The procedure depends on the cause of the constipation and where in the intestine the occlusion exists.
The surgical procedure usually involves the removal of the occlusion and the dead or severely damaged intestinal sections.
Alternatively, the blockage can be treated with a metallic autoextension stent. A stent is a cylindrical metal mesh structure that is inserted into the colon through the mouth or anus with the help of an endoscope.
In a stenosis caused by a tumor (intestinal constriction), the stent allows the expansion of the intestinal lumen and thus the passage of the stool.
Before positioning this device, the doctor makes an enema to free the section of intestine located below the occlusion.
Normally, stents are used for colon tumors or to provide temporary relief to patients at high risk of emergency surgery. The surgery may still be necessary if the patient is stable.
Treatment of functional ileus
If the doctor believes that the signs and symptoms are caused by paralytic intestinal obstruction, the patient may stay in the hospital for observation for a day or two. Often, paralytic ileus is a temporary disorder that improves on its own.
If there is no improvement after a few days, the doctor may prescribe a drug that triggers muscle contractions to favor the transport of food and fluid in the intestine. If the paralytic intestinal obstruction is caused by a disease or medication, the doctor must cure the underlying disease or stop taking the drug.
Complications
All carcinomas that cause intestinal obstruction are at an advanced stage and can form metastases.
Perforation and ischemia of the intestine can lead to peritonitis and blood poisoning.
Blood poisoning, vitamin deficiency (hypovitaminosis) and electrolyte imbalance can cause circulatory collapse and acute kidney failure.
In acute pseudo-structure of the colon, the mortality rate is 40% if perforation or ischemia occurs.
Prognosis
In patients with occlusion of the small intestine, mortality is 25% if surgery is performed no earlier than 36 hours after onset; if the operation is performed within 36 hours, the mortality rate drops to 8%.
The prognosis for advanced colon cancer is poor.
The majority of patients with occlusion have distant metastases.
In 50% of cases of volvulus of the sigmoid colon, recurrence occurs within 2 years.
60% of artificial bowel outlets have no relapses.
Elderly patients, patients with hypoalbuminaemia and those with a primary tumor that is not gastrointestinal in nature have a worse prognosis.
