What is obstruction?
Mechanical obstruction occurs when there is a physical obstruction. The most common cause in adults is adhesions after abdominal surgery, followed by strangulated hernias and colon tumors. Separately, there is a strangulation form, in which the vessels of the mesentery are compressed along with the lumen: this is the most dangerous option, the clock counts. Dynamic, or functional, obstruction develops without obstacles: the intestine stops contracting after surgery, with peritonitis, pancreatitis, severe infections and disturbances in electrolyte metabolism.
- Adhesive obstruction after surgery
- Strangulated hernia
- Colon tumor
- Twist and knotting
- Intussusception, most often in children
- Coprostasis with severe constipation
- Paralytic form after operations and with peritonitis
Symptoms
The disease usually begins with cramping pain that comes in waves at intervals of several minutes as the intestine tries to push through the contents. Then vomiting occurs - first with food eaten, later with bile, and with a high obstruction it is repeated and does not bring relief. The abdomen swells, gases and feces stop passing. With low colonic obstruction, bloating is severe, and vomiting appears late. An alarming turn - when cramping pain gives way to constant pain, the abdomen becomes hard and the temperature rises: this is a sign of intestinal necrosis and peritonitis.
- Cramping abdominal pain in waves
- No stool or gas
- Abdominal bloating, sometimes asymmetrical
- Vomiting, repeated if there is a high obstruction
- Feeling of transfusion and rumbling in the stomach
- Constant pain and a hard stomach are a sign of complications
Who's at risk
Most often, obstruction develops in people who have undergone operations on the abdominal cavity and pelvis: adhesions form in many people, and can appear years later. Patients with hernias, especially irreducible ones, are also at risk, as well as people over sixty years of age with colon tumors, in which the lumen gradually narrows. In children, intussusception plays a special role, when one part of the intestine is pushed into another. Additional factors include chronic constipation, inflammatory bowel disease, radiation therapy to the abdominal area, and taking medications that slow down peristalsis.
- Surgeries on the abdomen and pelvis in the past
- Hernias of the anterior abdominal wall and inguinal
- Tumors and polyps of the colon
- Crohn's disease and consequences of radiation therapy
- Chronic constipation
- Old age and inactivity
Diagnostics
The diagnosis is made in the hospital. The surgeon examines the abdomen, assesses bloating, peristaltic sounds, and necessarily examines the sites of typical hernias and the rectum. Plain x-ray of the abdomen shows characteristic fluid levels and distended loops. Ultrasound helps to see dilated loops, pendulum-like movements of the contents and free fluid. Computed tomography is the most informative: it shows the level and cause of the obstruction and signs of impaired blood supply. Blood tests reflect dehydration and inflammation. If a colonic cause is suspected, barium enema or colonoscopy is performed.
- Examination by a surgeon, examination of the hernial orifice and rectum
- Plain radiography of the abdominal cavity
- Abdominal ultrasound
- Computed tomography of the abdomen
- General and biochemical blood test, electrolytes
- Irrigoscopy or colonoscopy for colonic obstruction
Treatment and prevention
Treatment begins immediately after admission: the patient is prohibited from eating and drinking, a nasogastric tube is placed to unload the stomach, fluids and electrolytes are replenished intravenously. In case of early adhesive obstruction without signs of blood flow disturbance, such tactics with observation often make it possible to do without surgery. If the obstruction is mechanical, the condition worsens, or there is a suspicion of intestinal necrosis, an operation is performed: adhesions are cut, the volvulus is eliminated, the hernia is reduced, and in case of a tumor, a section of the intestine is removed, sometimes with a stoma. Prevention - timely treatment of hernias, bowel cancer screening and stool control.
- Fasting, nasogastric tube, intravenous infusions
- Observation of a surgeon in early adhesive form
- Surgery for mechanical obstruction and deterioration
- Dissection of adhesions, elimination of volvulus, bowel resection
- Planned treatment of hernias before strangulation
- Colon cancer screening from 45–50 years of age
- Checking regular bowel movements and drinking enough fluids
