Intestinal obstruction, intestinal occlusion, intestinal pseudo -object, intestinal volvulus or intestinal ileus is a total or partial blockage of intestinal transit which prevents feces, gases and digestive secretions from being evacuated. If it is not treated, intestinal perforation can produce with consequences, even fatal. It is a very frequent cause in the income of surgical emergency.
Causes of intestinal obstruction
Scar tissue, strangulation and others
There are several causes that have been identified in the appearance of intestinal obstruction such as:
– Intestinal adhesions formed by fibrous or scar tissue that is formed after abdominal or pelvic surgery.
– Colon cancer.
– Invagination of a bowel segment within another.
– Congenital defect
– A hernia.
– Having received radiotherapy.
– Intestinal strangulation. Blood contribution to the intestine is interrupted.
– narrowing or absence of a part of the intestine (intestinal atresia).
– Inflammatory intestinal diseases such as Crohn’s disease.
– Intestinal volvulus (colon torsion).
– Fecal retention.
– Diverticulitis. Inflammation or infection of balloon -shaped bags (diverticula) that are formed in the intestine.
There are three basic types of intestinal occlusion:
– Mechanical occlusion (hernias, flanges, volvulus, invaginations, tumors, inflammatory diseases, biliary ileus, fecalomas, bezoar and foreign bodies).
– Paralytic ileus (postciruge, peritonitis, metabolic alterations, medullary lesion, lead poisoning and porphyrias). Pseudo -Obstruction paralytic ileus causes symptoms of intestinal obstruction but does not imply total blocking. What happens is that the coordinated muscle contractions are interrupted in the intestines stopping or reducing the traffic of food, liquids, feces and intestinal secretions.
– Vascular (arterial embolism, venous thrombosis and mesenteric ischemia).
Symptoms of intestinal obstruction
Abdominal pain and others
The main symptoms of intestinal obstruction are:
– Colic type abdominal pain. It is usually intermittent.
– Loss of appetite.
– Constipation.
– Nausea and vomiting.
– Inability to evacuate or eliminate gases.
– Inflammation of the abdomen.
Diagnosis of intestinal obstruction
Physical exam and radiographs
The physical exam and abdomen radiographs are usually the basic tests to confirm the obstruction. You can also perform abdominal computerized tomography (TC), opaque enema (colon and rectum radiography), and traffic radiographs esophagostroduodenal (radiographs of the esophagus, stomach and small intestine). If there is a strangulation, an exploratory laparathomy (surgical exploration of the abdomen) will be necessary. In the case of children, it is usual to perform an ultrasound.
Treatment and medication of intestinal obstruction
Hospitable
Intestinal obstruction requires hospital admission with the placement of an intravenous path to administer fluids and electrolytes (sodium, chloride and potassium) to rehydrate and replenish salts after vomiting. Intravenous via antibiotics will be administered if there is risk of ischemia or intestinal infarction.
A nasogastric probe will be placed to extract air and fluids with the aim of relieving swelling in the abdomen. If the cause is an adherence or a scar, surgery may not be necessary. In children with invagination, a barium or air enema may be necessary.
If the obstruction is total there are several possible techniques such as:
Place a self -expandable metallic ‘stent’ in the colon. It is inserted with an endoscopy through the mouth or colon and is used in cases of colon cancer or when surgery can present other complications.
Intestine resection. Repair or removal of the damaged part of the intestine.
Colostomy or ileostomy. An end of the intestine is taken through an opening on the abdominal wall and the colon or ileus content is evacuated to an external bag. It can be temporary.
Prevention of intestinal obstruction
Good dietary guidelines
A healthy and balanced diet rich in fiber, avoiding alcohol and tobacco and exercising regular in addition to making a correct fluid intake are prevention measures against intestinal transit block. However, if an intestinal obstruction has been suffered, it is recommended to follow during the first days after traffic recovery, a diet of liquids with broths and jelly. Then you can incorporate milk, yogurts, purés and fruit smoothies.
The following phase, and as a usual dietary measure, must include a dietary guideline that reduces residual volume in intestines such as cooked fruits and vegetables (spinach, pumpkin, carrots, asparagus and potatoes); and meats and cooked fish. You have to avoid fat, fried, sausages, spicy and sweet.
This article was published at La Vanguardia on November 7, 2020
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