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Intestinal Obstruction

Definition


Disease: Intestinal Obstruction Intestinal Obstruction
Category: Digestive diseases
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Disease Definition:

Intestinal obstruction is a blockage of the small intestine or colon that prevents food and fluid from passing through. This obstruction can result from several condition, but it’s most frequently the outcome of fibrous bands of tissue in the intestine (adhesions), hernias or tumors.

Intestinal obstruction can cause an array of uncomfortable signs and symptoms, such as swelling, vomiting, nausea and abdominal pain. Intestinal obstruction can result in the blocked parts of the intestine to die (become necrotic) when it isn’t promptly treated.

This tissue death can lead to perforation of the intestine, shock and severe infection. However, with prompt medical care, intestinal obstruction can usually be successfully treated.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The following are signs and symptoms of intestinal obstruction:

 

 

  • Nausea
  • Fever
  • Abdominal tenderness
  • Crampy abdominal pain that appears and disappears (intermittent)
  • Inability to have a bowel movement or pass gas
  • Swelling of the abdomen (distention)
  • Vomiting or diarrhea


Due to the serious complications that can develop from intestinal obstruction, one should seek medical care right away when there are any signs or symptoms of the previous mentioned list.

Causes:

Several conditions can result from intestinal obstruction. The causes usually vary, yet, depending on whether the obstruction occurs in the small intestine or in the colon.
“Mechanical” obstruction occurs when something like tumor or hernia is physically blocking the intestine. Blockage of the intestine can either be complete or partial. Paralytic ileus (pseudo-obstruction), a condition in which the intestines don’t function properly, may have the same signs and symptoms as mechanical obstruction, but no physical obstruction is apparent.


Mechanical obstruction of the small intestine
Common reasons behind mechanical obstruction in the small intestine include the following:


Intestinal adhesions: These bands of fibrous tissue in the abdominal cavity may be present at birth (congenital). But, more often, they form after abdominal surgery. Intestinal adhesions can bind parts of the intestine, resulting in blocking the passage of food and fluids.
Hernias: Hernias occur when part of the intestine protrudes into another section of the body. When a loop of intestine becomes trapped because of a hernia, it will result in intestinal obstruction.
Tumors: A tumor within the small intestine may block the passage of the food and fluids, resulting in obstruction.
Hernias, tumors and adhesions account for about 90% of cases of mechanical small intestine obstruction.

The following are other reasons:

 

 

  • Narrowing of the outlet from the stomach (stricture)
  • Inflammation of scarring from Crohn’s disease
  • Telescoping of a portion of the intestine into another part (intussusception)
  • Twisting of the intestine (volvulus)

 

Mechanical obstruction of the colon
Mechanical intestinal obstruction is less likely to occur in the colon that in the small intestine. Only 10 to 15 % of mechanical obstruction cases occur in the colon. Adhesions and hernias seldom result in obstruction in the colon. The most common reasons behind the occurrence of mechanical colonic obstruction include the following:

 

 

  • Twisting of the colon (volvulus)
  • Cancer
  • Diverticulitis, a condition in which small, bulging pouches (diverticula) in the digestive tract become infected or inflamed

 

The following are less common causes of intestinal obstruction in the colon:

 

  • Impacted feces
  • Foreign bodies, swallowed objects that block the colon.
  • Telescoping of a part of the colon into another part (intussusception)
  • Narrowing of the colon (stricture)


Paralytic ileus
Paralytic ileus can result in signs and symptoms of intestinal obstruction. In such a case, the intestines do not function properly, even though there isn’t any blockage; movement of the intestines is either immensely reduced or absent. The intestines are unable to move food and fluid smoothly through the digestive system.
Paralytic ileus can affect any part of the intestine.
Abdominal surgery is the most common cause of paralytic ileus. The intestines do not function normally right after abdominal surgery. A nasogastric (NG) tube and intravenous fluid are usually necessary until the intestines begin to function again. Postoperative paralytic ileus is not a form of mechanical obstruction.

One is at a greater risk of developing intestinal obstruction when they have had abdominal surgery of any kind, previous surgery for obstruction, remove part of the intestine (bowel resection) or other pelvic surgery, or surgery to remove the appendix (appendectomy). These surgeries can result in adhesions that are one of the most common reasons for intestinal obstruction to occur.
The following are conditions that raise the risk of intestinal obstruction:

 

 

  • A history of constipation
  • Malrotation, a condition present at birth (congenital) in which one’s intestine doesn’t develop correctly
  • Abdominal or pelvic surgery
  • Cancer within the abdomen, particularly when one has had surgery to remove an abdominal tumor or radiation therapy
  • Chrohn’s disease, an inflammatory condition that can result in the intestine’s walls to thicken, narrowing its passageway.

Complications

Complications:

Intestinal obstruction when isn’t promptly treated can result in serious, life-threatening complications. As one’s intestine becomes congested, it’s ability to absorb food and fluids decreases. Reduced absorption may result in vomiting, dehydration and finally in shock that may result in kidney failure.


Intestinal obstruction can additionally cut off the blood supply to the affected portion of the intestine. Lack of blood causes the intestinal wall to die when it isn’t promptly treated. Tissue death can cause a tear (perforation) in the intestinal wall that can contribute to peritonitis, an infection of the lining of abdominal cavity.
Peritonitis is a life-endangering condition that needs medical and surgical attention right away. The following are signs and symptoms of peritonitis:

 

 

  • Fever
  • Low urine output
  • Abdominal pain or tenderness
  • Chills
  • Fluid in the abdomen
  • Nausea
  • Abdominal swelling
  • Inability to have a bowel movement or pass gas
  • Thirst
  • Vomiting
  •  

Peritonitis may result in one to go into shock. The following are signs and symptoms of shock:

 

 

  • Dilated pupils in the eyes
  • Cool, clammy skin that may be pale or gray
  • Lackluster eyes that appear to stare
  • Abnormal breathing that may be either slow and shallow or very rapid
  • A weak and rapid pulse


A person who is in shock may either be unconscious or conscious. Shock is an emergency condition that requires medical care right away.

Treatments:

Hospitalization is required for the treatment of intestinal obstruction. When one arrives at the hospital, the doctors will first stabilize the medical condition. This includes giving the fluids through an intravenous (IV) line, putting a nasogastric (NG) tube through the nose and into the stomach to suck air and fluid out to allow the intestines to decompress, and placing a thin, flexible tube (catheter) into the bladder to drain urine.


Depending on the cause of the condition, specific treatment can be determined. When the doctor determines that the signs and symptoms are resulted from paralytic ileus, they may monitor the condition for a day or two in the hospital. Paralytic ileus is usually a temporary condition that gets better on its own. When paralytic ileus doesn’t get better within several days, the doctor may prescribe medication that results in muscle contractions that can help move food and fluids through the intestines.


When experiencing a mechanical obstruction in which some food and fluid can still get through (partial obstruction), decompressing the intestine with an NG tube may improve the condition, and no further treatment is required. When the obstruction doesn’t clear within a day or so, they may need surgery to relieve the obstruction.


Complete obstruction, in which nothing can pass through the intestine, is a medical emergency that needs immediate surgery to relieve the blockage.

Prognosis:

Not Available

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