Intestinal Obstruction (Bowel Obstruction)
Intestinal obstruction is the complete or partial blockage of the intestines, interfering with the smooth transit of their contents.
- Abdominal bloating and pain, accompanied by loss of appetite, and occasionally fever, are the common symptoms.
- Intestinal tumors, hernias and scar tissue formations in the intestines caused by surgeries are the usual causes of obstructions.
- Physical examination followed by x-rays help diagnose the condition.
- Surgical intervention may be necessary if the obstruction is not resolved by the suctioning out of stomach contents and enemas.
Complete or partial intestinal obstruction can develop at any point, not only in the small intestine, but in the large intestine also. The normal functioning of the intestinal segment above the blockage continues for some time till food and stomach secretions get accumulated there. Eventually, the area swells up with gas, and the accumulated contents, leading to inflammation. Without timely medical treatment, the condition can worsen leading to rupture of the intestine and spilling of its contents into the abdominal cavity. A rupture can result in peritonitis or the infection and inflammation of the peritoneum which lines the abdomen.
Causes
In infants and newborn babies there may be several reasons for intestinal obstruction such as:
- Congenital abnormalities of the digestive tract
- Accumulation of meconium forming a hard mass in the intestine
- Volvulus or a twisted loop in the intestine
- Intestinal atresia or a narrowed or undeveloped area of the intestine
- Intussusception in which one part of the intestine telescopes into the adjacent portion
When a person has undergone an abdominal surgery, bands and webs of scar tissue may form across the lumen of the intestine. Adhesions or scar tissue formations between tissues and organs can also develop. These are a major cause of intestinal obstructions in people who have had surgeries previously. Intestinal tumors, as well as hernias in which a portion of the intestine protrudes through a small opening in the abdominal wall, are the other usual reasons.
Pancreatic cancer, Crohn’s disease and scarring from peptic ulcer are causes of obstructions in the duodenum, the part of intestine which leads from the stomach. Blocks in the rest of the small intestine may result from worms, undigested food or gall stones.
Fecal impaction, diverticulitis, and colon cancer may cause blockage in the large intestine. Twisting of the intestine called volvulus, and adhesions resulting from earlier surgeries, are some of the other reasons of obstruction.
Strangulation: A severe obstruction may deprive the intestine of adequate blood supply, resulting in a condition called strangulation. It is a very common occurrence when intestinal hernias get stuck tightly in an opening of the abdominal wall. Telescoping of one part of the intestine into its adjacent portion, called intussusception, and volvulus, or narrowing of a portion of the intestine are other reasons for strangulation. It is a serious condition occurring in up to 20% of cases with obstruction in the small intestine. If gangrene sets in, bowel death may occur within a short span of time. It may result in rupture and associated complications such as inflammation of the peritoneum, septic shock, and even death.
Intestinal Obstruction Symptoms and Diagnosis
Pain and abdominal cramps are the usual symptoms of obstruction. Bloating of the abdomen and loss of appetite are very common intestinal obstruction symptoms. If the obstruction is in the small intestine, nausea and vomiting may be present. Constipation results from total obstruction, but in case the obstruction is partial, fecal matter and mucus secretions may leak from around the obstruction resulting in diarrhea. Severe constant pain may indicate strangulation of the intestine. Fever may be present, especially if intestinal rupture has occurred.
When the doctor conducts a physical examination, swelling and tenderness in an area may indicate an intestinal obstruction. The bowel sounds, made by the natural movements of the digestive tract, can be heard through a stethoscope and if they are abnormally high-pitched and loud, it may be an evidence of intestinal obstruction. Absence of bowel sounds also is indicative of obstruction. Significant tenderness may be present only if peritonitis has resulted from a ruptured intestine.
When an x-ray is taken, the intestine may be seen having dilated areas where the obstruction has occurred. Presence of air under the diaphragm, and around the intestine, also may be detected. It is an abnormal condition usually indicating a ruptured intestine. It can also indicate bowel death, when a portion of the intestinal tissue dies due to lack of blood supply.
Treatment
Intestinal obstructions have to be treated with the patient admitted in the hospital. The location of the obstruction is identified and a long suction tube is inserted into the stomach via the nose to draw out the contents above the block. If the patient had diarrhea or vomiting, the loss of fluid and minerals such as potassium and sodium is compensated by intravenous administration of an electrolyte solution.
If the cause of the blockage is adhesions or scar tissue bands, emptying out of some of the intestinal contents may relieve the obstruction without any further intervention. When barium enema is given, it eases out the large intestine and helps in inflating and straightening a twisted segment. A flexible endoscope inserted into the large intestine via the anus may help in removing an obstruction in the last segment of the large bowel.
If there is a possibility of strangulation, immediate surgical intervention is required to prevent complications such as bowel death and rupture. Adhesions and cross bands in the intestines due to scar tissue formation may be treated by removing them surgically, but the chances of recurrence are high. Sometimes, a portion of the intestine may have to be removed. Occasionally, an alternate route for excretion may be created by a surgery called colostomy in which the colon is attached to an opening created in the abdominal wall.
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Yasser Elnahas
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