Intestinal Obstruction: Definition, Causes, Symptoms, Diagnosis And Treatment

Intestinal Obstruction: Definition, Causes, Symptoms, Diagnosis And Treatment.

What is Intestinal Obstruction?

Intestinal obstruction is a medical condition that keeps food or liquid from passing through small intestine or large intestine (colon). Causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery, hernias, Colon cancer, Crohn's disease (an inflamed intestine ), infected pouches in your intestine (diverticulitis).

Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated.

Digested food particles must travel through 25 feet or more of intestines as part of normal digestion. These digested wastes are constantly in motion. However, intestinal obstruction can put a stop to this. An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food.

If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage. If enough pressure builds up, your intestine can rupture, leaking harmful intestinal contents and bacteria into your abdominal cavity. This is a life-threatening complication.

There are many potential causes of intestinal obstruction. Often, this condition can’t be prevented. Early diagnosis and treatment are crucial. An untreated intestinal obstruction can be fatal.

  Causes of intestinal obstruction.

An obstruction can be partial, which may resolve without surgery. A complete blockage is more likely to need intestinal surgery.

1. Mechanical obstructions

This occurs when something physically blocks your intestine. 

In the small intestine, this can be due to:

adhesions, which consist of fibrous tissue that can develop after any abdominal or pelvic surgery or after severe inflammation

volvulus, or twisting of the intestines

intussusception, a “telescoping,” or pushing, of one segment of intestine into the next section

malformations of the intestine, often in newborns, but can also occur in children and teens

tumors within your small intestine

gallstones, although they rarely cause obstructions

swallowed objects, especially in children

hernias, which involve a portion of your intestine protruding outside of your body or into another part of your body

inflammatory bowel disease, such as Crohn’s disease.

Although less common, mechanical obstructions can also block large intestine. This can be due to:

impacted stool

adhesions from pelvic infections or surgeries

ovarian cancer

colon cancer

meconium plug in newborns (meconium being the stool babies first pass)

volvulus and intussusception

diverticulitis, the inflammation or infection of bulging pouches of intestine

stricture, a narrowing in the colon caused by scarring or inflammation.

2. Non mechanical obstruction

Small and large intestines normally work in a coordinated system of movement. If something interrupts these coordinated contractions, it can cause a functional intestinal obstruction. This is generally known as a nonmechanical obstruction. If it’s a temporary condition, it’s referred to as an ileus. It’s called a pseudo-obstruction if it becomes chronic, or long term.

  Causes for ileus include:

abdominal or pelvic surgery

infections, such as gastroenteritis or appendicitis

some medications, including opioid pain medications

electrolyte imbalances.

  Intestinal pseudo-obstruction can be caused by:

Parkinson’s disease, multiple sclerosis, and other nerve and muscle disorders

Hirschsprung’s disease, a disorder in which there is a lack of nerves in sections of the large intestine

disorders that cause nerve injury, such as diabetes mellitus

hypothyroidism, or an underactive thyroid gland

What are the signs and symptoms of intestinal obstruction?

Signs and symptoms of intestinal obstruction include:

Relapsing crampy abdominal pain

Abdominal swelling

Constipation

Vomiting

Loss of appetite

Inability to have a bowel movement or pass gas.

Some of the symptoms may depend on the location and length of time of the obstruction. For example, vomiting is an early sign of small intestine obstruction. This may also occur with an obstruction of your large intestine, if it is ongoing. A partial obstruction can result in diarrhea, while a complete obstruction can result in an inability to pass gas or stool.

Intestinal obstruction may also cause serious infection and inflammation of your abdominal cavity, known as peritonitis. This occurs when a portion of your intestine has ruptured. It leads to fever and increasing abdominal pain. This condition is a life-threatening emergency requiring surgery.

How intestinal obstruction is diagnosed?

Firstly, a medical practitioner may push on your abdomen to examine it. They then listen with a stethoscope to any sounds being made. The presence of a hard lump or particular kinds of sounds, especially in a child, may help determine whether an obstruction exists.

Other tests include:

blood tests for blood counts, liver and kidney function, and levels of electrolytes

X-rays

CT scan

colonoscopy, a flexible lighted tube that your doctor uses to look at your large intestine

enema with contrast.

  Potential complications of intestinal obstruction.

Treatment is needed to reduce complications such as:

dehydration

electrolyte imbalances

perforation, or a hole that forms in your intestines, which leads to infections

kidney failure.

If the obstruction is preventing blood from getting to a segment of intestine, this can lead to:

intestinal perforation

sepsis, a life-threatening blood infection

tissues death

multiple organ failure

infections

death.

For some people with a chronic obstruction due to a stricture or narrowing of their intestine, a doctor may place a metal stent that expands inside the intestine using a long tube called an endoscope. The stent, a wire mesh, holds open the intestine. The procedure may not require cutting into the abdomen, and it’s usually used if a person isn’t a candidate for traditional surgery.

How to treat Intestinal Obstruction?

Treatment for intestinal obstruction depends on the cause of your condition, but generally requires hospitalization.

I. Hospitalization to stabilize your condition

When you arrive at the hospital, the doctors will first work to stabilize you so that you can undergo treatment. This process may include:

II. Placing an intravenous (IV) line into a vein in your arm so that fluids can be given

Putting a nasogastric tube through your nose and into your stomach to suck out air and fluid and relieve abdominal swelling

Placing a thin, flexible tube (catheter) into your bladder to drain urine and collect it for testing.

III. Treating intussusception

A barium or air enema is used both as a diagnostic procedure and a treatment for children with intussusception. If an enema works, further treatment is usually not necessary.

IV. Treatment for partial obstruction

If you have an obstruction in which some food and fluid can still get through (partial obstruction), you may not need further treatment after you've been stabilized. Your doctor may recommend a special low-fiber diet that is easier for your partially blocked intestine to process. If the obstruction does not clear on its own, you may need surgery to relieve the obstruction.

V. Treatment for complete obstruction

If nothing is able to pass through your intestine, you'll usually need surgery to relieve the blockage. The procedure you have will depend on what's causing the obstruction and which part of your intestine is affected. Surgery typically involves removing the obstruction, as well as any section of your intestine that has died or is damaged.

VI. Alternatively, your doctor may recommend treating the obstruction with a self-expanding metal stent. The wire mesh tube is inserted into your colon via an endoscope passed through your mouth or colon. It forces open the colon so that the obstruction can clear.

Stents are generally used to treat people with colon cancer or to provide temporary relief in people for whom emergency surgery is too risky. You may still need surgery, once your condition is stable.

VII. Treatment for pseudo-obstruction

If your doctor determines that your signs and symptoms are caused by pseudo-obstruction (paralytic ileus), he or she may monitor your condition for a day or two in the hospital, and treat the cause if it's known. Paralytic ileus can get better on its own. In the meantime, you'll likely be given food through a nasal tube or an IV to prevent malnutrition.

If paralytic ileus doesn't improve on its own, your doctor may prescribe medication that causes muscle contractions, which can help move food and fluids through your intestines. If paralytic ileus is caused by an illness or medication, the doctor will treat the underlying illness or stop the medication. Rarely, surgery may be needed to remove part of the intestine.

In cases where the colon is enlarged, a treatment called decompression may provide relief. Decompression can be done with colonoscopy, a procedure in which a thin tube is inserted into your anus and guided into the colon. Decompression can also be done through surgery.

Sources:

www.mayoclinic.org

www.healthline.com