Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents.
This disruption can occur at any point along the gastrointestinal tract , and clinical symptoms often vary according to the level of obstruction.
It has been said that ileus is when the intestine stops functioning properly, the food does not pass, which leaves a bowel obstruction.
Intestinal obstruction is most commonly caused by intra-abdominal adhesions, malignancy or intestinal hernia.
Clinical presentation usually includes nausea and vomiting, colicky abdominal pain and lack of approval of flatus or bowel movements. The classic findings of the physical examination of abdominal distension, percussion tympany, and acute bowel sounds suggest the diagnosis.
Radiological images can confirm the diagnosis and can also serve as useful adjuvant investigations when the diagnosis is less certain.
Although the radiograph is often the initial study, a CT scan without contrast is recommended if the index of suspicion is high or if the suspicion persists despite the negative radiography.
The treatment of uncomplicated obstructions includes fluid resuscitation with correction of metabolic disorders, intestinal decompression and bowel rest. Evidence of vascular compromise or perforation, or lack of resolution with adequate intestinal decompression is an indication for surgical intervention.
Intestinal obstruction accounts for approximately 15 percent of all emergency department visits for acute abdominal pain Complications of intestinal obstruction include intestinal ischemia and perforation.
The morbidity and mortality associated with bowel obstruction have decreased since the advent of more sophisticated diagnostic tests, but the condition remains a challenging surgical diagnosis.
Physicians who are treating patients with intestinal obstruction should weigh the risks of surgery with the consequences of inadequate conservative management.
Causes and risk factors
The most common causes of intestinal obstruction include adhesions, neoplasms and hernia. Adhesions resulting from previous abdominal surgery are the predominant cause of small bowel obstruction, accounting for approximately 60 percent of cases.
Lower abdominal surgeries, which include appendectomies, colorectal surgery, gynecological procedures and hernia repair, confer an increased risk of small bowel adhesive obstruction.
Less common causes of obstruction include intestinal intussusception, volvulus, intra-abdominal abscesses, gallstones, and foreign bodies.
Causes of intestinal obstruction
- Adverse disease (60 percent).
- Neoplasm (20 percent).
- Hernia (10 percent)
- Inflammatory bowel disease (5 percent).
- Intussusception (5 percent)
- Volvulus (5 percent).
- Other (5 percent).
What are the symptoms of intestinal obstruction?
The most common symptoms are:
- Not being able to pass the gas.
- Not being able to have a bowel movement
- He retched.
- Swelling and abdominal swelling
- Abdominal pain.
The treatment of intestinal obstruction is aimed at correcting physiological disorders caused by obstruction, bowel rest and elimination of the source of obstruction. The first is approached through intravenous fluid resuscitation with isotonic fluid.
The use of a bladder catheter to closely control the production of urine is the minimum requirement to measure the adequacy of resuscitation; Other invasive measures may be used, such as arterial cannulation or monitoring of central venous pressure, as justified by the clinical situation.
Antibiotics are used to treat intestinal overgrowth of bacteria and translocation through the wall of the intestine. The presence of fever and leukocytosis should prompt the inclusion of antibiotics in the initial treatment regimen.
Antibiotics should be covered against gram-negative and anaerobic organisms, and the choice of a specific agent should be determined by susceptibility and local availability. Aggressive electrolyte replacement is recommended after confirming adequate renal function.
The decision to perform surgery for intestinal obstruction can be difficult. Peritonitis, clinical instability or unexplained leukocytosis or acidosis are of concern for abdominal sepsis, intestinal ischemia or perforation; These findings require immediate surgical exploration.
Patients with an obstruction that resolves after the reduction of a hernia should be scheduled for elective hernia repair, whereas immediate surgery is required in patients with an irreducible or strangulated hernia.
Stable patients with a history of abdominal malignancy or high suspicion of malignancy should be thoroughly evaluated for optimal surgical planning. Abdominal malignancy can be treated with primary resection and reconstruction or palliative bypass, or placement of ventilation and feeding tubes.
The treatment of stable patients with intestinal obstruction and a history of abdominal surgery presents a challenge. Conservative treatment of a high-grade obstruction should be attempted initially, using intestinal intubation and decompression, aggressive intravenous rehydration and antibiotics.
The inclusion of oral magnesium hydroxide, simethicone and probiotics decreased the duration of hospitalization in a randomized controlled trial of 144 patients with partial small bowel obstruction (number needed to treat = 7).
Caution should be used when clinical and radiological evidence suggests obstruction, because the use of intestinal stimulation may exacerbate the obstruction and precipitate intestinal ischemia.