Intestinal obstruction – causes, symptoms & therapy

An intestinal obstruction is a disruption in the intestinal passage. This can result from an obstruction blocking the bowel, leading to “mechanical ileus.”

In so-called “paralytic ileus”, the muscles of the intestinal wall are paralyzed and are therefore no longer able to transport the intestinal contents further. An intestinal obstruction can develop in all parts of the intestine, but it occurs much more often in the small intestine than in the large intestine. An intestinal obstruction can be fatal if left untreated.

causes

The most common cause of a mechanical intestinal obstruction is adhesions in the abdomen, which can occur after an operation. Scarring thickening of the intestinal wall, so-called “brides”, can form and narrow the intestinal lumen. Scarring can also develop after peritonitis and then lead to an intestinal blockage. Abdominal tumors, swallowed foreign bodies, faeces or gallstones or worms are also possible causes of an intestinal obstruction.In the case of paralytic ileus, the cause is not the obstruction of the intestine, but paralysis of the intestinal muscles. This can happen through exposure to toxins or medications. The most common cause of paralytic intestinal obstruction is peritonitis. But severe pain, such as that caused by a heart attack, can also paralyze the intestines as a reflex. Abdominal injuries, bleeding into the abdomen or circulatory disorders in the abdominal vessels can also lead to an intestinal obstruction.

When to the doctor?

An intestinal obstruction only manifests itself through non-specific symptoms, which then quickly become more severe and clearer. Then it is high time to see a doctor. Depending on what the symptoms say about the progress of the intestinal obstruction, you should not only go to the family doctor, but ideally to the emergency room. In the case of vomit, for example, the patient does not have much time to act and in the next step he would have to be admitted to the hospital anyway.

With some underlying diseases, it may be that an intestinal obstruction is a likely side effect or consequence. The patient has then usually already been informed of telltale symptoms and can therefore consult a doctor in good time for clarification if there are indications of an intestinal obstruction. He is thus spared the unpleasant effects of the incident and he does not even put himself in danger because he can be treated promptly.

Of course, there is nothing to be said against a previously completely healthy person turning to the doctor with the suspicion of an intestinal blockage, because a timely examination is always better than when an emergency occurs. Furthermore, the initial symptoms of a suspected intestinal obstruction can also have other causes, which can be quickly found and eliminated by visiting a doctor in good time before they cause further symptoms unnecessarily.

symptoms and course

Typical symptoms of intestinal obstruction:

• stomach pain

• dehydration

• gas

• Vomit

• Diarrhea

• constipation

• sweats

• fainting

Pain or severe flatulence that does not go away are often the first symptoms that a patient with an intestinal obstruction notices. If a passage obstacle is the cause, it is possible that the affected person still has a bowel movement. In the case of intestinal paralysis, however, there is usually complete stool retention. While in mechanical ileus the intestine is still trying to overcome the obstacle with violent contractions and to transport the digested material further, in the case of paralytic intestinal obstruction no intestinal noises can be heard. In the course of a mechanical intestinal obstruction, colicky abdominal pain and vomiting of feces can become increasingly severe.

In both forms of ileus, digestive juices accumulate in the intestines and are not reabsorbed by the intestinal wall. The result is a lack of fluids with a drop in blood pressure and even shock. If the intestinal obstruction persists for a long time, the intestinal wall may start to digest itself. The intestinal contents can then empty into the abdominal cavity and lead to life-threatening peritonitis.

Diagnose

The diagnosis of intestinal obstruction (ileus) is not easy to make. It is difficult to detect in older people and children. If the signs of an intestinal obstruction are not entirely clear, the doctor should still consider it. During the conversation, the doctor asks about the current symptoms before performing a physical examination. An X-ray is important to diagnose an ileus . It provides the doctor with important information as to where the intestinal obstruction is, what the cause is and whether there are any complications.

If there is a mechanical intestinal obstruction, the section of intestine in front of the obstruction is expanded accordingly and filled with gas and/or liquid. The accumulation of fluid appears on the x-ray as a mirror formation in the loops of the intestine. The part of the intestine behind it is empty.

If there is a functional ileus, the entire intestine is dilated and enriched with gas and/or liquid. If a contrast medium ] is injected into the intestine, the X-ray image shows where the obstruction is. An ultrasound examination can also be used to diagnose the presence of an ileus and determine exactly where in the intestine it is. If both examination methods are not sufficient to make the diagnosis with certainty, there is the possibility of having spiral computed tomography performed.

complications

Serious complications can occur as a result of an intestinal obstruction. A life-threatening course of the ileus is possible without medical treatment. A serious consequence of the intestinal obstruction is the lack of volume. Fluid is withdrawn from the affected person, since there is no reabsorption of secretions such as bile, gastric juice, small intestine and pancreatic secretion, which are released into the intestinal lumen. Another loss of fluid occurs through vomiting. As a result, there is a volume deficiency, which in turn can lead to consequences such as reduced urine production, thickening of the blood and even shock.

In the case of a mechanical intestinal obstruction, peristalsis exceeds normal levels in the early stages. However, if the intestinal muscles tire, peristalsis increasingly loses its strength. After some time, it finally comes to a complete standstill. Breathing is also hampered by the intestinal obstruction. The ileus results in increased pressure on the abdomen, which also affects the diaphragm. As the lungs can no longer expand properly because of this, this leads to breathing difficulties. If the breathing difficulties persist, there is a risk of pneumonia .

One of the most dangerous complications of ileus is the permeability of the intestinal wall for bacteria and toxins. The accumulated intestinal contents get into the abdominal cavity through the resulting holes and tears, which in turn triggers peritonitis. Because the patient’s condition deteriorates dramatically, an immediate operation is necessary.

treatment and therapy

As a first measure in the case of an intestinal obstruction, a stomach tube is usually placed so that the intestinal contents can drain out. The patient is not allowed to eat or drink anything. Infusions are intended to stabilize the patient’s circulation.

Surgery is indicated for mechanical intestinal obstruction. This is the only way to remove the causative adhesions or foreign bodies. If the intestinal wall is already damaged, it may be necessary to remove parts of the intestine. Sometimes it is necessary to create an “artificial exit” after an intestinal obstruction. If there is a suspicion of a paralytic ileus, the doctor will not operate immediately. Drugs can stimulate the intestines to start working again. Enemas are also a means of treating this form of bowel obstruction.If these measures are unsuccessful, however, surgical intervention may also be necessary. If peritonitis has already occurred, the administration of antibiotics is indicated after an intestinal obstruction.

prevention

In order to prevent intestinal obstruction, abdominal operations should be avoided as far as possible. In addition, measures for intestinal care are useful. This includes plenty of exercise, drinking enough water and a high-fiber diet. Those who tend to have constipation can stimulate their digestion with special herbal teas or linseed. Laxatives damage the intestines and can contribute to intestinal obstruction.