Obstruction is a condition in which the movement of food through the intestines is disrupted.

According to clinical symptoms, acute and chronic course of the disease is distinguished. According to the development of pathology in medicine, there are also two types of it - dynamic and mechanical.

general information

In childhood, NC accounts for about 2% of all surgical diseases.

There is a congenital and acquired condition, accounting for 25% and 75%, respectively.

Among adults, the disease occurs in 1.5-2 cases per 10 thousand people, which is 1.38% of all surgical pathologies.

Among acute diseases of surgical diseases, the percentage of the disease among adults is 4.50%.

NK affects middle-aged people, especially men, in a ratio of 3:1.

In medicine, the types of disease are divided into:

• etiology - congenital or acquired form of the disease;
• the cause of occurrence - mechanical and dynamic, which, in turn, is spastic and paralytic;
• factors of violation of the functions of the root of the mesentery, the vessels of which feed the intestine. They are squeezing (strangulation), not squeezing (obstructive) and combined;
• clinical development - acute, subacute, complete, partial and chronic forms.

Causes

The causes of the mechanical form in adults include the following disorders:

• volvulus of the intestine;
• nodal education;
• Adhesive disease;
• The entrance of one gut to another;
• Strangulated hernia;
• Blockage of the intestine with feces, a ball of ascaris, a neoplasm or a foreign body.

The dynamic stage develops for the following reasons:

• Reflex disorders of the digestive tract, affecting the motor function of the intestine;
• Violation of the functioning of the central nervous system;
• Violations of acid-base and electrolyte balance.

May cause intestinal obstruction adhesions or adhesions after abdominal operations, inflammatory processes.

The disease can develop in case of malnutrition, increased peristalsis, compression of the intestine with increased pressure inside the abdominal cavity.

CI in children is more likely to develop due to mechanical obstacles. Less commonly, this surgical disease is associated with impaired intestinal motility.

In children, the disease can be of two types - congenital or acquired. The causes of congenital pathology include abnormalities in the development of the esophagus.

The reasons for the acquired form are much more diverse. Depending on the causes, the disease has two forms - mechanical and dynamic.

The latter develops in two forms, when there is a prolonged tension of the organ, or vice versa, paralytic, when the walls are completely relaxed.

The key causes of bowel obstruction are:

• Postoperative complications;
• Consequences or complications after taking medications;
• Complications after inflammation of the appendix.

The main reasons for the development of the mechanical form include:

• adhesive process;
• Squeezing of the organ by the tumor;
• Ingress of a foreign body;
• Blockage with a lump of food or worms;
• Prolonged fasting, eating a large amount of food after;
• Integration of one intestine into another due to the underdevelopment of the mechanism of peristalsis (occurs in children under 10 months).

In children, the acute course of the disease is more common, in addition to variants of congenital pathology.

Pregnant women have all forms intestinal obstruction, but most often there is an acute form, expressed in volvulus of the small intestine.

Causes that contribute to the development of intestinal obstruction include:

• Adhesions after abdominal operations or inflammatory processes;
• Long mesentery;
• Internal hernia;
• Pathologies in the development of the digestive tract;
• Neoplasms;
• Growing uterus.

In pregnant women, the disease develops in the second trimester or during childbirth.

Disease classification

Causes of CI, the variety of its forms creates some difficulties in the diagnosis of surgical disease.

Based on the clinical manifestations of the disease, two types of its course are distinguished in medicine - acute obstruction, which is the most common form, and a chronic form, which is quite rare.

The mechanism of the development of the disease determines all its varieties.

Dynamic intestinal obstruction often occurs in the elderly, patients with acute myocardial infarction, with acute pancreatitis, after undergoing abdominal surgery.

Dynamic disease is spastic and paralytic forms.

KN is divided into obstructive, when there is a blockage of the passage to the intestine by fecal masses with gallstones or a foreign body, and strangulation, which occurs when infringement, volvulus, nodes and squeezing vessels of the mesentery.

Complete CI - expressed by the completeness of symptoms;

Partial - with less severe symptoms, since the organ is not completely clogged and continues to function.

In the dynamics of the development of the disease, three stages are distinguished, in the event that help is not possible at the first or second stages.

• non-reflex stage. It lasts from 6 to 12 hours. Manifested by cramping pains, rumbling, increased peristalsis, vomiting, stool retention;
• intoxication stage. The form is characterized by a change in symptoms - a decrease in pain, but their character becomes constant, increased vomiting, tachycardia, lowering blood pressure;
• stage of peritonitis. It occurs after 24 hours and is manifested by severe intoxication. The patient begins to vomit, the masses of which have the smell of feces, there is a painful swollen abdomen, an increased reduction in heart rate, and an aggravation of facial features.

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Specific and non-specific symptoms

It is quite difficult to independently determine the symptoms of intestinal obstruction, since they are the same for diseases of the abdominal organs.

Specific symptoms of the disease include:

Along with classic symptoms The following additional symptoms may be observed:

• Lack of appetite;
• Aversion to food;
• Pallor;
• High or low temperature;
• Tongue covered with gray coating;
• hiccups;
• Belching.

There are a number of symptoms and signs of intestinal obstruction in adults and children, which are detected by the surgeon when probing and listening to the abdominal cavity, the treatment of which is urgently required.

What to do: first aid, which doctor to go to

If you suspect this dangerous condition, you urgently need to call an ambulance. Disease develops quite quickly, and the time of admission of the patient to a medical institution determines the outcome of the disease.

Tactics of treatment of NK depends on the causes that caused the condition. Most cases are not without urgent abdominal intervention.

But with the dynamic development of the disease, conservative methods of treatment are used.

Anyway If symptoms are severe, see a doctor who will prescribe the appropriate therapy.

Diagnostic measures

The diagnosis is based on the following criteria:

• Medical history;
• Clinical symptoms;
• inspection data;
• Laboratory tests.

Of great importance in establishing the diagnosis are diseases that could contribute to the occurrence of obstruction.

These include hernias, abdominal operations, adhesive processes, gallbladder diseases, helminthic invasion, tumors, etc.

During the examination, rectal and vaginal examination, allowing to determine the inflammatory site, tumor or blockage of the rectum.

A separate place is given x-ray examination of the abdominal cavity. Usually primary x-rays are sufficient to establish the diagnosis.

In some cases, additional diagnostic measures are applied, which include:

• Observation under the x-ray machine;
• X-ray contrast examination of the small intestine with barium sulfate;
• Irrigoscopy.

Surgical intervention

After confirmation of the diagnosis, the patient is transferred to the hospital. The operation is performed only with the onset of peritonitis.

In other cases, conservative treatment is prescribed, which is aimed at:

• Removal of pain syndrome;
• Fight against intoxication;
• Restoration of electrolyte balance;
• Removal of stagnant feces.

The patient is prescribed hunger and rest, after which they spend urgent measures:

• Entering a flexible probe through the nose to free the upper parts of the digestive system from stagnant masses, thus it is possible to stop vomiting;
• Intravenous administration of solutions to restore electrolyte balance;
• Appointment of painkillers and antiemetics;
• With increased peristalsis, antispasmodics are prescribed;
• To stimulate intestinal motility, prozerin is administered subcutaneously.

With paralytic obstruction, drugs are prescribed that stimulate muscle contraction, which helps to move food.

The paralytic form is a temporary condition, with proper treatment her symptoms may disappear.

If conservative treatment fails, surgery is performed. It is aimed at eliminating the blockage, removing the affected segment and preventing a recurrence.

If a child has severe pain in the abdominal region, it is urgent to go to a consultation with a doctor.

It is dangerous to engage in self-medication, since the lost time will only aggravate the condition and it will be much more difficult to treat intestinal obstruction.

The choice of treatment method depends on the timing of treatment in a medical institution. When diagnosing congenital pathology, surgical intervention.

The operation is also performed when adhesive processes are detected. In case of late treatment, intestinal necrosis begins to develop, which is subject to urgent removal.

With the development of peritonitis, complex treatment is prescribed:

• Antiseptic preparations;
• Painkillers;
• Vitamins.

In addition, there is detoxification therapy. The whole complex is aimed at eliminating symptoms.

In case of early treatment, conservative treatment of intestinal obstruction without surgery and, accordingly, consequences is prescribed.

Air is forced into the intestines with a special device to straighten the bend of the intestine.

The procedure is done under an x-ray machine. Excess air is removed through the gas outlet tube.

If a dynamic form is diagnosed, then conservative treatment.

For this, the following manipulations are carried out:

• Stimulation of peristalsis;
• Enemas;
• Electrical stimulation of the intestine;
• Compensation for the lack of potassium;
• Reducing the load on the gastrointestinal tract;
• bowel intubation;
• Introduction of a permanent probe.

Since acute CI is more often observed in pregnant women, the treatment is carried out in conjunction with the surgeon.

Therapeutic measures begin with conservative treatment:

• Stimulation of intestinal motility;
• Fight against paresis;
• Detoxification therapy.

If there is no improvement within two hours, then an operation is performed to remove the blockage and empty the intestines.

After the operation is given antibiotic therapy, drainage is inserted. Constant suction of intestinal contents is carried out and intravenous administration of restorative drugs is prescribed.

The well-known doctor of medical sciences Elena Malysheva tells about the symptoms of intestinal obstruction, the features of the manifestation of a congenital disease in newborns:

Forecast and prevention

A favorable outcome of the disease depends on the timing of medical care.

To the question "what to do with the first symptoms of intestinal obstruction?" there is a simple answer - need to see a doctor since an unfavorable prognosis is noted in cases of late diagnosis, in elderly or debilitated patients, as well as in patients with an inoperable malignant tumor.

In the presence of adhesive processes in the abdominal cavity, relapses occur.

Prevention measures include the timely detection and removal of neoplasms, the removal of worms, the prevention of adhesive processes and injuries.

Don't forget to eat right.

Bowel problems are common in today's population. One of the most dangerous pathologies affecting the intestines is its obstruction. When manifestations of this disease are detected, emergency assistance from surgeons is required. In the absence of treatment, various complications are possible, up to a fatal outcome. The first symptom of obstruction is cramping intensifying pain. In rare cases, the pain syndrome increases gradually.

Etiology of the pathological condition

Intestinal obstruction is a kind of blockage of the intestine, when the contents cannot move to the anus. This provokes a difficulty in the process of emptying the intestines, the discharge of gases, as a result of which they are formed. The clinical picture becomes clearer when the patient's condition deteriorates sharply. The main source of such malaise is irregular emptying. Within the normal range, a person should defecate at least once a day. If the patient suffers from constipation, there are signs of obstruction, you should visit a doctor without delay.

Intestinal obstruction develops due to the influence of various factors. The reasons for its occurrence are mechanical and functional. Mechanical causes include adhesions, mobile caecum, pockets in the peritoneum, lengthening of the sigmoid colon. Functional bowel obstruction occurs against the background of overeating after dietary nutrition, a sudden increase in fresh vegetables and fruits in the diet, as well as the transfer of an infant to formula under the age of one year.

Complete or partial intestinal obstruction of the mechanical type occurs for the following reasons:

• helminthic invasions;
• inflammatory processes;
• the presence of a hematoma;
• oncology;
• hernia and adhesive process;
• changes in the structure of the abdominal cavity;
• improper formation of the intestine;
• fecal, gallstones;
• intestinal obstruction;
• cases of intussusception;
• reduction in the size of the intestinal lumen;
• volvulus of some parts of the intestine;
• congenital strands of the abdominal cavity.

The following factors can provoke functional obstruction: intestinal motility disorders, Hirschsprung disease, spasms and paralytic processes.

Clinical picture of obstruction

If there is suspicion of intestinal obstruction, the patient must be urgently taken to surgery. Timely assistance is the key to a positive prognosis. In some cases, the problem can be eliminated without surgical intervention by surgeons. The main symptom indicating obstruction is the problematic discharge of gases, feces. With partial obstruction or damage to the upper part of the organ, a slight discharge of flatus and scanty stools are observed. Basically, vomiting, nausea, severe cramping pains in the abdomen, bloating and asymmetry of the abdomen are manifested.

In addition to the listed symptoms, there are specific signs that only a doctor can identify. Therefore, urgent hospitalization is a necessary measure. In case of complications, the risk of death, the development of renal and hepatic insufficiency, as well as disorders in the functioning of the heart muscle, increase.

Particular attention should be paid to suspected obstruction in infants. If at least one manifestation of the disease is detected, it is urgent to seek medical help. Symptoms associated with intestinal obstruction:

• gray color of the skin;
• bloating in the upper abdomen of the child;
• weight loss;
• bilious vomiting, especially after feeding;
• elevated body temperature.

The child becomes whiny, capricious and restless, refuses food. In this case, immediately call an ambulance.

Classification of intestinal obstruction

Pathology is complete and partial, proceeds in acute or chronic form.

As for the origin, the disease is congenital or acquired. The cause of the congenital form is the blockage of the intestine with meconium of a dense consistency, as well as the abnormal development of the organ. Given the causes of malaise, the character is dynamic and mechanical.

With partial intestinal obstruction, the symptoms are chronic. The patient from time to time has vomiting, there is a delay in stool and gases, periodic pain. Basically, the clinical picture is not acute. In some cases, the symptoms subside on their own. The disease can last for several decades. If the cause of the pathology is a tumor growing inside, the signs appear and intensify gradually. There is flatulence, constipation, pain and vomiting.

As for the stages of partial blockage, they are replaced by periods of resolution that occur against the background of diarrhea. During this period, the feces become plentiful and liquid, have a putrid odor. The main feature of the partial form of pathology is that over time it can become complete and acute.

Another form of pathology is adhesive obstruction. This type of obstruction is characterized by impaired passage through the organ caused by adhesions in the abdominal cavity. Adhesions and strands are the result of acute, limited peritonitis, injuries of the abdomen, hemorrhage. This type of obstruction can affect any part of the intestine. Most often, adhesions occur in the omentum with a postoperative scar. The basis of the pathology is the incorrect and disturbed peristalsis of this organ, caused by the formation of adhesions. There are several types:

• Obstructive - the onset and course of the disease is acute, sudden. In some cases, chronic obstruction develops into an acute stage.
• Strangulation - manifests itself against the background of infringement of part of the intestine, the mesentery is involved in the process. The course of pathology is stormy, acute. Hemodynamic disorders are manifested, provoking the development of peritonitis and.
• Mixed - pathology combines the features of mechanical and dynamic obstruction.

The next variety is obstruction of the small intestine. Pathology can affect any part of this intestine. At the same time, the part of the intestine, which is located above the site of the lesion, does not stop working, therefore it begins to swell. As for the cause of the malaise, then, most often, it is intestinal obstruction. The main signs of obstruction: vomiting, the presence of severe pain in the epigastric region, aversion to food, flatulence, and dehydration.

The pathology of the large intestine occurs against the background of a violation of the passage through the intestine, accompanied by swelling, cramping pains, difficult passage of flatus, lack of stool, vomiting and flatulence. The disease can be partial or complete. In most cases, the lesion is organic. If the pathology progresses, signs of intoxication increase markedly, metabolism is disturbed, diarrhea is replaced by constipation.

Medical therapy

First of all, it is necessary to perform a diagnosis in order to confirm the diagnosis. Urgent measures are taken to help relieve pain shock and quickly replenish the lost fluid. X-ray and ultrasound are required. With the help of a probe, the upper part of the organ is released, with the help of a siphon enema, the lower part. It is mandatory to introduce antispasmodics to relax the muscles of the intestine, to stop the increased peristalsis. In some cases, these measures are enough to restore the work of the digestive tract. If this treatment approach does not help, emergency surgery is required.

Surgery is mandatory in the following situations:

• intussusception;
• volvulus of the small intestine;
• blockage by stones from the gallbladder;
• winding one gut on another.

Depending on how the pathology proceeds, the patient is prescribed an appropriate diet therapy. After the operation, it is forbidden to drink and eat for twelve hours. Nutrition is carried out parenterally: nutrient solutions are administered intravenously. After some time, baby food, fermented milk products are added to the diet. Then the patient is transferred to dietary table number 4, which should be followed for at least 3 months.

Intestinal obstruction is a dangerous disease that requires emergency medical attention. If you notice suspicious symptoms, call an ambulance.

Stool and gas retention, nausea and vomiting. At the very beginning of the disease, intestinal motility may be increased, but over time, intestinal motor activity disappears completely. These symptoms of acute intestinal obstruction are characteristic of all patients, and do not depend on the form of obstruction. In this case, the severity of symptoms is determined by the level of the obstacle and the time elapsed from the onset of the disease. An attack of pain with mechanical obstruction begins at the time of the passage of the peristaltic wave, so the pain is cramping in nature. If the cause of obstruction is strangulation, the intensity of pain is so pronounced that patients characterize them as "unbearable". With dynamic intestinal obstruction, the pain is dull, bursting in nature and spread throughout the abdomen. For high obstruction, multiple is characteristic, for low - rare, which may be completely absent at the onset of the disease. A high level of obstruction is characterized by the presence of an independent stool and gas discharge at the very beginning of the disease, with a low obstruction, there is no stool. Symptoms of acute intestinal obstruction gradually increase, such as bloating, anxiety, body temperature may increase and blood pressure may decrease.

Forms of acute intestinal obstruction

Depending on the cause that caused intestinal obstruction, mechanical and dynamic obstruction are isolated. In the first case, there is a mechanical obstruction either in the intestinal cavity (obstruction by a tumor, gall or fecal stone), or outside (strangulation - volvulus of intestinal loops, constriction by postoperative adhesions). A feature of strangulation obstruction is the compression of blood vessels and nerves and the associated violation of the blood supply to the intestinal loops. Dynamic obstruction is associated with a violation of the contractile activity of the smooth muscle of the intestine and most often occurs against the background of intoxication, after undergoing abdominal surgery or with a traumatic brain injury, as a result of which there was a violation of the central regulation of intestinal motility. If the obstruction occurs at the level of the small intestine, the obstruction is small bowel, the occurrence of an obstruction to normal passage at the level of the colon leads to the development of colonic obstruction. If the intestinal lumen is completely closed, the obstruction is called complete, if only part of the lumen is closed - partial.

Causes of acute intestinal obstruction

The following can lead to the development of acute intestinal obstruction: tumor lesions of the intestine and other abdominal organs (in this case, the intestinal lumen can be blocked from the outside); cholelithiasis; adhesions and strands in the abdominal cavity (as a consequence of operations or inflammatory processes); thrombosis of the vessels of the mesentery; intoxication; tuberculosis of the abdominal organs; infringement of a hernia of the abdomen.

Complications of acute intestinal obstruction

With progressive obstruction, it is possible to develop necrosis of the intestinal wall with its subsequent perforation, the ingress of intestinal contents into the abdominal cavity and the occurrence of diffuse peritonitis.

Diagnostics

The diagnosis of acute intestinal obstruction is made on the basis of specific complaints of the patient, examination data and instrumental methods of examination, the leading of which is X-ray examination. First of all, a survey radiography is performed, and if necessary, a study with a water-soluble contrast agent. With a low level of obstruction, irrigoscopy or can be prescribed. Additional information is obtained by ultrasound and computed tomography. Data from laboratory studies indicate dehydration and hemoconcentration, which is associated with fluid loss.

Treatment

Treatment of acute intestinal obstruction begins after clarifying the form of the disease. The main treatment for mechanical intestinal obstruction is surgery. If a strangulation obstruction is suspected, the operation is performed on an emergency basis. In some cases of obstructive obstruction, conservative therapy is performed. This is possible if patients can pass the probe beyond the level of the obstacle during colonoscopy. All patients are shown gastric lavage and infusion therapy to replenish the volume of circulating blood and combat the loss of fluid and electrolytes. Conservative treatment of acute intestinal obstruction includes: removal of contents from the stomach, colon cleansing with a siphon enema, administration of antispasmodic drugs. If the complex of the above measures does not give an effect within 2 hours, a decision is made on the operation. Dynamic intestinal obstruction is mainly treated conservatively. Apply drugs that enhance peristalsis, use the method of electrical stimulation of the intestine.

Content

Bowel problems are very common these days. One of them is intestinal obstruction - a serious condition, in the acute stage of which the intervention of surgeons is necessary. The earliest harbinger of the disease is pain: it begins suddenly, at any time, for no apparent reason. Less often, the pain increases little by little, and after a certain period of time becomes intense.

What is intestinal obstruction

Intestinal obstruction is the impossibility of the physiological nature of the passage of stool to the anus. The process of natural emptying of the rectum becomes difficult, the discharge of gases stops, and fecal blockages form. Symptoms become more pronounced as the condition worsens. The source of problems is irregular stools: it is correct if a person empties once a day. In case of constipation, the appearance of signs signaling obstruction, you should consult a doctor.

Causes of obstruction

Obstruction in the intestine develops under the influence of various reasons, which are divided into two categories: functional and mechanical. The development of a disease of a mechanical type is facilitated by factors such as an increase in the length of the sigmoid colon, the presence of pockets of the peritoneum, a mobile caecum, and adhesions. Functional obstruction develops against the background of overeating after fasting, a sharp increase in fresh fruits, the transfer of newborns to adapted mixtures up to a year.

Mechanical

The mechanical causes of the disease, which noticeably poisons the existence of the patient:

• accumulation of worms;
• hematoma;
• failures in the formation of the intestine;
• failures in the structure of the peritoneum;
• gall and fecal stones;
• vascular ailments;
• inflammation;
• neoplasms (cancer or benign);
• oncology;
• bowel obstruction;
• adhesions;
• hernia;
• volvulus of the intestine;
• cords of the peritoneum of the congenital type;
• the entry of foreign elements into the intestines;
• decrease in the intestinal lumen.

Functional

Functional reasons for the development of obstruction are also known. Their list usually depends on the associated problems, but a short version of it looks like this:

• paralytic phenomena;
• spasms;
• disruptions in intestinal motility.

Symptoms and signs of bowel obstruction

According to doctors, if an intestinal obstruction is suspected, the patient should be taken to the hospital as soon as possible. So the prognosis will be favorable. Violation can be corrected without surgical intervention in some cases. Obvious signs of the onset of the disease are the impracticability of the discharge of feces and gases. In the case of partial obstruction or obstruction of the upper intestines, scanty stools and a slight discharge of flatus are observed. Symptoms such as repeated vomiting, irregular shape and bloating occur.

There are also specific symptoms that can only be detected by a specialist, which is why the patient's early hospitalization is so important. If you do not start treating the patient on time, then the risk of developing dangerous consequences increases, including cardiac disorders, liver and kidney failure, and death. In the case of squeezing of the vessels, necrosis of the intestine develops. Even an operation (if the case is advanced) may not save the patient.

The most dangerous conditions include intestinal obstruction in infants. Therefore, it is important for moms and dads to know the symptoms that should cause concern:

• significant weight loss due to fluid loss,
• vomiting with an admixture of bile that appears after eating,
• grayish skin tone of a child,
• temperature,
• swelling of the upper abdomen.

A calm baby may refuse to eat, become restless and moody. Then you need to immediately call a doctor.

Video: How to get rid of intestinal obstruction at home

The topic of the video below is a symptom of constipation and what it can threaten. Constipation can be indicative of many serious illnesses, including obstruction or Hirschsprung's disease.

Photo of intestinal obstruction

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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How to identify and treat bowel obstruction

Intestinal obstruction- this is a complete or partial violation of the movement of contents through the intestines, refers to diseases of mechanical origin.

Most often, obstruction of the small intestine is associated with the formation of adhesions and hernias.
The main cause of colon obstruction is colon cancer.

For intestinal obstruction of all types, the main pathological signs are characteristic:

• bowel expansion,
• loss of fluid and electrolytes,
• dyspnea,
• tachycardia.

Violation of blood circulation in the intestinal wall significantly complicates intestinal obstruction. The result is bleeding. In this regard, the success of treatment depends entirely on the duration of the operation and the amount of blood replacement therapy.

With intestinal obstruction, peristalsis appears visible to the eye. It is accompanied by high-pitched metallic sounds, often gurgling, reminiscent of the sound of water pouring out of a bottle. Simultaneously with peristaltic waves, pain in the abdomen occurs or intensifies.

Peristaltic noises are absent in peritonitis, in the postoperative period and in paralytic ileus.

Types of intestinal obstruction

All types of intestinal obstruction can be divided into two main groups:

• mechanical, which in turn is obstructive (blockage of the intestine) and strangulation (with impaired blood circulation in the intestine),
• dynamic or physiological.

Mechanical obstruction

Causes of mechanical obstruction can be:

• blockage of the intestinal lumen,
• twisting (torsion) of the intestine,
• intestinal entrapment.

The earliest symptom of mechanical obstruction is a sharp expansion of the middle sections of the intestine.

Obturation obstruction (blockage)

In the case of obstruction (blockage) of the intestinal lumen, a violation of the promotion of intestinal contents is its main manifestation. Distinguish between high (small intestinal) and low (colonic) obstructive obstruction.

The main symptoms of any obturation (blockage) of the intestine:

• pain,
• vomit,
• no chair.

Types of pain. Pain is the earliest characteristic sign of intestinal obstruction. Usually she is very strong, cramping. Periodic cramping pain is the result of the expansion of the intestine and its contractions.

If the pain is chronic, then this may indicate a gradual narrowing of the intestinal lumen.

Constant severe pain can be a sign of the development of strangulation (squeezing of blood vessels), perforation, peritonitis.

Pain in small bowel obstruction is more often localized in the upper or middle part of the abdomen.

Colonic obstruction is manifested by pain in the lower abdomen or in the projection of the colon.

The nature of vomiting. Vomiting is another important sign of intestinal obstruction. The time of onset of vomiting depends on which part of the intestine the obstruction occurs. The lower it is (closer to the rectum), the later vomiting appears. With colonic obstruction, vomiting may be absent or appear late, depending on the normal functioning of the ileocecal valve.

Features of vomit are determined by the localization of obstruction, the degree of cessation of motility, bacterial growth, and putrefactive processes in the intestine. The nature of the vomit is important for preliminary diagnosis.

The lower the pathological process is, the more often the vomit has a fecal odor.

Lack of stool. The persistent absence of stools and gases is a sign of the cessation of bowel function. Depending on the level of obstruction and the amount of content in the distal part of the intestine, constipation can be partial or complete.

Obstructive small bowel obstruction

Symptoms of high intestinal obstruction are manifested in the form of early severe vomiting of gastric contents and bile. Since the rest of the intestine is practically empty, there is no bowel movement.

With obstruction of the small intestine, the absorption of water and electrolytes worsens and secretion increases at the same time. As a result, peristalsis is disturbed, all functions of the intestine are violated. It accumulates a large amount of fluid coming from the blood. The intestine is stretched, absorption from the stretched segment stops. The contents are quickly infected with microbial flora and become a source of toxins.

If the intra-intestinal pressure reaches the level of arterial pressure, then there is a violation of the microcirculation of the intestinal wall and gangrene of the intestinal wall occurs. Through the wall affected by gangrene, the fluid rushes into the abdominal cavity. In order to prevent peritonitis and reduce intoxication, it is very important to quickly remove this fluid from the abdominal cavity.

Obstructive colonic obstruction

Symptoms - progressive constipation, abdominal pain and flatulence, vomiting with the smell of feces or fecal matter.

The cause of this type of obstruction in most cases is carcinoma.

The diagnosis is established on the basis of sigmoidoscopy data.

strangulation obstruction

Strangulation intestinal obstruction is a combination of obstruction with impaired blood supply in the intestinal loop as a result of infringement or volvulus of the intestine.

The main causes of this type of obstruction are:

• hernia infringement,
• intussusception,
• spikes,
• inversion,
• tumor,
• gall stone.

Mechanical obstruction can be caused by foreign bodies. It can be caused by food lumps that form after a heavy meal, especially sauerkraut, pasta, or ingestion of fruit seeds, orange, etc.
Often such a foreign body is gallstones if they reach a size of 2-2.5 cm.

Gallstones are formed during gallstone disease. This disease develops more often in middle-aged and elderly women if they have had bouts of hepatic colic or exacerbation of cholecystitis in the past. In this case, an attack of obstruction is similar to another biliary colic, which makes it difficult to diagnose. Therefore, with such attacks, you should immediately consult a doctor.

Strangulation symptoms

During strangulation, a significant amount of fluid moves into the abdominal cavity along with the blood. As a result, the pulse rate increases as peritonitis or other complication increases.

With obstructive obstruction, blood pressure and respiratory rate in the early stages do not change, there is no tension in the abdominal muscles and pain during palpation. If these symptoms appear in combination with fever, tachycardia, and leukocytosis, strangulation should be assumed.

Intestinal volvulus

In this case, the intestine twists around itself.

The reason for this may be the anatomical features of the mesentery, chronic constipation, the use of coarse food in large quantities. This disease is more common in men than in women.

Symptoms begin to appear abruptly:

• sudden abdominal pain
• rapid increase in bloating,
• vomiting is uncommon
• There may be a small amount of blood in the stool.

In the case of volvulus of the small intestine, gangrene quickly sets in, so early diagnosis and emergency surgery are of great importance.

When the sigmoid colon is torn, an attempt is made to straighten it with a colonoscope. If this can be done, then there is a rapid improvement in the condition.
If this does not work, then an immediate operation is needed.

Intussusception

Invagination is the introduction of one section of the intestine into another.

Most intussusceptions (85-89%) occur in infants aged 4 to 10 months. Boys get sick more often.

There are the following types:

1. Small intestinal intussusceptions. The introduction of the small intestine into the small (20-25% of all cases).
2. Small-colonic intussusceptions. The introduction of the small intestine into the blind (50-65%), and in children - 85%.
3. Colonic intestinal intussusceptions. The introduction of the colon into the colon (10%).

In most adults, intussusception is caused by a benign or malignant tumor of the intestine.

In children, intussusception occurs when switching from breastfeeding to mixed feeding, but the specific cause remains unknown.

Symptoms of acute intussusception

In acute intussusception, three main symptoms appear:

• sudden severe pain of a cramping nature,
• bleeding from the rectum with the development of collapse,
• a tumor-like formation of a spherical or sausage-shaped shape, determined by palpation of the abdomen.

Chronic intussusception

Chronic intussusception is rare, but can develop at any age. When a part of the intestine is inserted, the lumen does not close completely and food continues to move through the narrow opening.

Obstruction is manifested by seizures, which can end on their own.

Treatment of chronic intussusception

In adults, the treatment is surgical.

In children under 5 years of age, you can try to eliminate the intussusception with a barium enema. If this fails, then surgical treatment is necessary.

Dynamic (functional) intestinal obstruction

Dynamic intestinal obstruction develops due to paralysis or a sharp spasm of the muscular membrane of the intestinal wall. Depending on this, paralytic (adynamic), spastic obstruction and motor dysfunction with an unidentified cause (intestinal pseudo-obstruction) are distinguished.

Dynamic intestinal obstruction develops reflexively with severe pain of various origins, stress, metabolic disorders.

It is characterized by an increase in the abdomen, the absence of peristaltic noises and abdominal pain. Treatment depends on the cause of the obstruction.

There are many reasons for the development of dynamic obstruction.

Causes of paralytic obstruction

• peritoneal injury,
• peritonitis,
• acute pancreatitis, early,
• pneumonia,
• diabetes,
• infection,
• myocardial infarction,
• injuries and diseases of the spine,
• hepatic and renal colic.

Paralytic ileus can develop as a result of severe abdominal pain of any origin.
The main symptom is an increase in the abdomen and the absence of peristaltic noises. Bloating can be very pronounced, the abdomen is symmetrical. On palpation, the abdominal wall is soft and painless.

The elimination of obstruction can be facilitated by electrical stimulation of the intestine with special devices.

Spastic intestinal obstruction

Spastic obstruction occurs due to a strong prolonged spasm of the intestine. This type of obstruction is much less common than paralytic ileus.

Causes of spastic obstruction:

• hysteria,
• nicotine overdose,

Treatment in this case is to eliminate the spasm and the cause of the spasm.

Intestinal pseudo-obstruction

Intestinal pseudo-obstruction is a violation of patency associated with impaired intestinal motility, the causes of which have not been established.

There are hereditary pseudo-obstruction and its secondary forms.

Secondary pseudo-obstruction develops in various diseases that can lead to muscle damage not only of the intestines, but also of internal organs.

Diagnostics

During the interview, the doctor needs to obtain information about previous diseases and operations, the presence of blood in the stool, previous diagnoses (Crohn's disease, tuberculosis), as well as the use of drugs that can affect intestinal motility.

The most important symptoms on examination are bloating, the intensity of peristaltic noises, and the degree of dehydration of the patient. Hernias and adhesions of the abdominal cavity account for 50% of the causes of all cases of intestinal obstruction.

The main diagnostic method is X-ray examination.

An overview image of the abdominal cavity allows you to:

• confirm obstruction,
• establish its localization in the small and large intestine,
• distinguish mechanical obstruction from paralytic.

To clarify the diagnosis in some cases, an irrigoscopy is performed.

• digital examination of the rectum,

Before the colonoscopy, preparation is carried out - 3 ordinary enemas of 1.5 liters each are given, with an interval of 30 minutes.

Treatment

Acute intestinal obstruction refers to urgent diseases, strangulation obstruction indicates an even more urgent situation. In these cases, surgical treatment is necessary.

Treatment goals:

• correction of water and electrolyte deviations
• elimination of obstruction
• constant suction from the intestine of the contents and the prevention of its overstretching.

The main goal is the prompt elimination of intestinal obstruction. An exception may be adhesive obstruction and partial obstruction in Crohn's disease. In these cases, it can be restored using intranasal intrubation with a special probe.

Forecast

Due to early diagnosis, improvement of complex therapy and timely operations, mortality has decreased in recent decades. The success of treatment is influenced by factors such as:

• patient's age,
• causes,
• localization of obstruction,
• complications.

Attention!

Intestinal obstruction is a very formidable sign. The life of the patient depends on the speed of diagnosis and surgical treatment. At the first sign, you should immediately consult a doctor.