Intestinal Obstruction

Definition and Causes

Intestinal obstruction is a disorder characterized by the impairment of food passage through the digestive system. If the condition progresses to an acute stage, it becomes life-threatening.
These disorders can result from or be compounded by various diseases. Complete or partial obstruction of food passage can occur, and the higher the obstruction, the more serious the condition becomes.

Classification:
Intestinal obstruction can be classified into different types:

1. Dynamic (paralytic and spastic): Occurs due to increased muscle tension in the intestinal wall. Major causes include irritation due to worms, acute pancreatitis, foreign body ingestion, as well as intestinal muscle paralysis resulting from food poisoning, surgical interventions, or medications containing morphine or heavy metal salts.
2. Mechanical (occlusive and incarcerative): Appears in various forms due to the presence of an obstacle in the path of food movement, such as gallstones, foreign bodies, tumors, and cysts in other organs pressing on the intestinal cavity. Bowel twisting or looping is considered a serious condition.

Symptoms of Intestinal Obstruction in Children
There is no difference in symptoms between children and adults, but children may have difficulty expressing their discomfort. Therefore, parents should note the main symptoms of indigestion: abdominal pain, absence of bowel movements and passing gas for three to four days, belching, and foul-smelling breath. If these symptoms are present, immediate referral to a gastroenterologist or surgeon is necessary.

Distinguishing Between Symptoms of Indigestion and Constipation
Indigestion and constipation are often confused, with the subtle difference between these two conditions lying in the fact that acute indigestion can lead to complications in the presence of constipation.
Constipation is a functional obstruction of the intestines, where stool is irregular, but over time or with the use of laxatives, it eventually occurs. Patients mainly suffer from a feeling of incomplete bowel emptying, the need to strain, and pain during defecation. If there is a previous history of constipation in the patient, and bowel movements are delayed longer than usual with the appearance of indigestion symptoms, this is considered a reason to immediately seek medical attention.

Symptoms of Intestinal Obstruction

Symptoms of intestinal obstruction vary and depend on the type and severity of the problem. Generally, intestinal obstruction may include:

• Severe pain that can be continuous or episodic. The pain occurs independently of food intake and is not localized to a specific area.
• Delay in defecation and passing gas. In cases of high intestinal obstruction, bowel emptying may occur without passing the site of the obstruction.
• Continuous vomiting that persists for a long time, and if the intestinal obstruction is in the upper part, vomiting is more forceful.
• Abdominal swelling and bowel sounds.
  In complex cases such as intestinal twisting, there is continuous and severe pain that sometimes becomes intolerable.
  When such symptoms of intestinal obstruction are discovered, immediate medical care should be sought, otherwise, the patient may begin to experience fever, increased breathing rate, dehydration, and disturbances in urine output.

Causes of Intestinal Obstruction

1. Presence of cancerous diseases in the intestines or adjacent organs.
2. Pressure on the intestines by fibrous scars formed after surgical procedures.
3. Contraction or pressure resulting from hernias.
4. Obstruction caused by the formation of fecal stones, worm masses, or foreign bodies.
5. Poisoning.
6. Peritonitis (inflammation of the peritoneum).

Diagnosis of Intestinal Obstruction
For diagnosis, necessary tests and analyses must be performed. The doctor may recommend:

1. Blood tests – can be determined based on complaints, and may be general blood tests or chemical analysis.
2. Ultrasound (ultrasound imaging) – performed on the entire abdominal cavity to determine the size of intestinal loops, presence of fluids in the cavity, and peristaltic movements.
3. X-ray examination – the doctor examines the intestinal loops and the extent of their filling with fluids and gases.
4. Colonoscopy – primarily determined in cases of large bowel obstruction.

Treatment of Intestinal Obstruction

Proper diagnosis and the physician’s tactics play a significant role in treating intestinal obstruction. Treatment includes:

• Timely intravenous therapy.
• Identifying the cause of the pathological process.
• Selecting a method to relieve pressure.
• Determining the extent of surgical intervention.
• Preventing post-operative complications and patient rehabilitation.

Tasks and content of surgical intervention:

Relieving intestinal pressure (surgical decompression) is divided into closed and open methods.

• Closed method involves inserting a nasogastric tube, about 80-100 cm long with multiple side holes with a diameter of 0.3-0.4 cm – intestinal intubation. Bowel drainage typically lasts for 2-5 days.
• Among the open methods for relieving pressure are: enterostomy, intestinal perforation, and creating an opening in the colon.
• Less effective methods include: colonoscopy (70-80 cm below the Treitz ligament) via microgastrotomy, terminal ileostomy – which should be performed 25-30 cm from the blind intestine, and perforation of the looping intestines or the transversely coursing intestines from behind.
• If there is non-transit in the large section of the intestines to the left, a Hartmann’s operation is usually performed. If the obstruction is in the rectum, the tactics change: where the rectum is excised and if sufficient length of intestines is available, a straight connection to the anus is formed.

Managing treatment and monitoring patients in the post-operative period is of great importance. To achieve this, the following are done:

• Correcting fluid loss – injecting multi-ion solutions.
• Restoring fluid, colloid, and osmotic pressure functions.
• Restoring acid-base balance.

An important aspect in treating intestinal obstruction is intravenous therapy. Patients are assigned multi-ion solutions, proteins, glucose solutions, and colloidal solutions. Antibiotic therapy is also administered.

In treating intestinal obstruction, broad-spectrum antibiotics are used, such as third-generation cephalosporins, fluoroquinolones, carbapenems, and metronidazole. The duration of antibiotic therapy is 7-9 days.

Each post-operative treatment plan should be aimed at removing intoxication, restoring fluid and electrolyte balance, and supporting gastrointestinal motility. Patients are prescribed:

• Sodium bicarbonate solution.
• 5% glucose solution.
• Ringer’s solution.

In cases of intestinal wall non-constriction, derivatives of proserin or neostigmine are added. As an anesthetic measure, a block injection above the navel is performed (if the primary problem is due to pancreatic malformation).

In the post-operative period, intestinal lavage with antiseptic solutions through a tube is considered necessary and remains until bowel movement is restored, gas is released, and secretion volume from the intestinal tube decreases.

Prevention:

To avoid the occurrence of intestinal obstruction, it is preferable to adopt a healthy lifestyle, adhere to a healthy diet, and maintain body water balance. Doctors recommend regular exercise several times a week and increasing movement. Additionally:

1. Regular check-ups to diagnose any potential disease development early and initiate treatment immediately.
2. Avoid introducing any foreign bodies into the intestines.
3. After surgical procedures, take preventive measures to avoid adhesion formation.
4. Undergo treatment to prevent worm infestation.

If any signs of intestinal obstruction are discovered, immediate medical attention should be sought.

Sources:

• The first text is titled “Diagnosis and Treatment Tactics for Patients with Acute Intestinal Obstruction” by T.I. Tamm et al., published in Kharkov in 2003.
• The second text is by A.G. Zemlyanoy and N.I. Glushkov, discussing how to reduce mortality in cases of acute intestinal obstruction. It’s part of the materials from the All-Russian Conference of Surgeons on Relevant Issues in Abdominal Surgery, held in Pyatigorsk in 1997.