Intestinal obstruction - symptoms and treatment
Correct diagnosis and physician tactics play a big role in the treatment of intestinal obstruction. Treatment involves:
- timeliness of infusion therapy;
- identifying the cause of the pathological process;
- choosing a compression relief method;
- determining the scope of surgical intervention;
- prevention of postoperative complications and patient rehabilitation.
Objectives and content of surgical intervention
Intestinal decompression (surgical removal of its compression) is divided into closed and open methods.
The closed method consists of inserting an 80-100 cm nasogastric tube with many side holes with a diameter of 0.3-0.4 cm - intestinal intubation. The duration of intestinal drainage is 2-5 days.
Open decompression methods include enterotomy, jejunostomy, and colonostomy.
Less effective methods of decompression are:
- intestinal intubation (70-80 cm below the Treitz ligament) through a microgastrostomy;
- end ileostomy - should be performed at a distance of 25-30 cm from the cecum;
- hanging enterostomy;
- cecostoma;
- transcecal retrograde intubation of the small intestine;
- contranatural anus.
If there is colonic obstruction of the left intestine, then Hartmann's operation . If the site of occlusion is located in the rectum, then the tactics change: extirpation of the rectum is performed and, if the intestine is long enough, a coloanal anastomosis is performed.
To correct fecal incontinence, anal ring plastic surgery is performed using the adductor magnus muscle of the thigh or a magnetic sphincter.
Performing surgical intervention in patients with acute insufficiency at a late stage and in conditions of developed peritonitis has its own characteristics. They are associated, first of all, with the need for thorough sanitation of the abdominal cavity during surgery.[16]
Treatment and observation of patients in the postoperative period is of great importance.[3][5] For this purpose the following is carried out:
- correction of hypohydration - introduction of polyionic solutions;
- restoration of water-electrolyte and colloid-osmotic functions;
- restoration of acid-base relationships.
An important aspect in the treatment of acute infusion is infusion therapy . A patient with OKN is prescribed crystalloids, protein, glycosylated and colloidal drugs. Antibiotic therapy should also be carried out .
In the treatment of acute insufficiency, broad-spectrum antibiotics are used - third generation cephalosporins, fluoroquinolones, carbapinems and metronidazole. The duration of antibacterial treatment is 7-9 days.
All postoperative treatment tactics should be aimed at eliminating intoxication, restoring water-electrolyte balance and maintaining gastrointestinal motility. Patients are prescribed:
- sodium bicarbonate solution;
- 5% glucose solution;
- Ringer's solution.
In the absence of contraction of the intestinal walls, proserine derivatives or neuromidin are added. As an analgesic measure, a paraumbilical blockade is performed (if the initial cause was pancreatic pathology).[15]
In the postoperative period, a mandatory measure is to rinse the intestines with antiseptic solutions through a probe, which remains until intestinal motility is restored, gases begin to escape and the amount of discharge through the intestinal tube decreases.
Is it possible to cure intestinal obstruction without surgery?
Therapeutic methods for treating intestinal obstruction are usually ineffective and are not used, since lost time can lead to complications and death.
If a patient sees a doctor with intestinal obstruction that is just developing, and its cause is constipation or decreased intestinal tone, then cleansing siphon enemas (a solution of magnesium sulfate and magnesium sulfate) and laxatives are used. These methods are effective in treating constipation and developing intestinal obstruction.
It is important to understand that only a doctor can judge whether intestinal obstruction has formed after diagnosis. It is impossible to treat yourself, since the patient can suffer serious complications if intestinal obstruction has already formed and caused a persistent block of the intestinal lumen.
Physical exercise
In case of intestinal obstruction, physical exercise is strictly prohibited . The basic rule: “cold, hunger and peace” and contact a specialist.
Can I use a laxative?
Laxatives can be used only in case of developing intestinal obstruction and under the supervision of a doctor, since it is impossible to independently determine the stage of the disease.
Can I use an enema?
Enemas are effective if you consult a doctor before intestinal obstruction has formed, and this is confirmed by diagnostic methods. When the disease has developed, the use of enemas is dangerous and can lead to serious complications.
Clinic.
· Abdominal pain. The pain is paroxysmal, cramping in nature. Patients have cold sweat, pale skin (with strangulation). Patients await the next attacks with horror. The pain may subside: for example, there was a volvulus, and then the intestine straightened, which led to the disappearance of pain, but the disappearance of pain is a very insidious sign, since with strangulation CI necrosis of the intestine occurs, which leads to the death of nerve endings, therefore, the pain disappears.
· Vomit. Repeated, first with the contents of the stomach, then with the contents of 12 p.c. , then vomit appears with an unpleasant odor. The tongue with CI is dry.
Bloating, abdominal asymmetry
· Retention of stool and gases is an ominous symptom indicating CI.
Bowel sounds may be heard, even at a distance, and increased peristalsis is visible.
Causes of intestinal obstruction
Each form of the condition is provoked by certain reasons. Spastic obstruction is formed when the intestine spasms of a reflex nature. The spasm itself is caused by the following reasons:
- helminthic infestations;
- foreign objects in the intestines;
- injury to the abdominal area;
- acute form of inflammation of the pancreas;
- biliary colic;
- colic of renal localization, nephrolithiasis, nephroptosis;
- pneumonia, pleurisy, pneumothorax;
- rib fractures;
- acute infarction conditions;
- pathologies of the nervous system (trauma, acute cerebrovascular accidents, dyscirculatory encephalopathy).
Paralytic intestinal obstruction is caused by paralysis and intestinal paresis. They also develop due to conditions such as:
- peritonitis;
- surgical manipulations on the abdominal organs;
- hemoperitoneum;
- intoxication with metal compounds, morphine derivatives;
- food poisoning.
Obstructive, or mechanical, intestinal obstruction is caused by the presence of obstacles along the movement of chyme through the intestinal lumen. Obstacles may include:
- fecal stones;
- bezoars;
- gallstones;
- accumulation of helminthic organisms;
- neoplasms, intestinal cancer;
- foreign object;
- neoplasms of nearby organs (kidneys, reproductive organs and others).
Strangulated intestinal obstruction in adults is provoked by compression of the intestinal lumen and compression of the mesenteric vessels. This condition is observed in the following cases:
- strangulated hernia;
- intestinal volvulus;
- formation of nodes (intestinal loops overlap and twist together);
- intussusception.
Such disorders develop with a large length of the mesentery, the presence of adhesions between intestinal loops, weight loss, fasting and subsequent overeating, and a sharp increase in pressure inside the abdominal cavity.
Vascular intestinal obstruction is provoked by acute blockage of blood vessels caused by thrombotic conditions, embolism of the vascular elements of the mesentery.
Congenital intestinal obstruction is based on anomalies in the formation of the intestinal tube (diverticula, atresia).
Classification of intestinal obstruction
There are several classifications of the condition that take into account clinical mechanisms, pathogenesis and anatomical features. Based on these factors, you can make a correct diagnosis and select the correct methods of therapy that are suitable in a particular case.
Based on morphofunctional reasons, the following types of obstruction are distinguished:
- Dynamic. Its subtypes include paralytic and spastic.
- Mechanical. There are three forms here, these include strangulation (strangulation, torsion, formation of nodes), obstructive (extra- and intraintestinal), and mixed (intussusception, adhesions).
- Vascular. It is provoked by infarction of the intestine.
The level of localization of the obstacle during the movement of digested food determines the division of obstruction into such conditions as:
- high small intestinal obstruction;
- low small bowel obstruction;
- colonic obstruction.
The degree of disturbance in the movement of digested food determines the division of the condition into complete or partial obstruction.
Clinical forms of obstruction are acute, subacute and chronic. There is also a division of the condition into congenital (provoked by developmental defects) and acquired, or secondary.
Therapeutic correction of intestinal obstruction
In case of intestinal obstruction, the patient should be immediately hospitalized in a surgical inpatient department. Before a medical examination, it is prohibited to give enemas, give the patient analgesics, laxatives, or wash the stomach.
If there is no peritonitis, then in stationary conditions decompression of the digestive tract is carried out using aspiration of the contents of the digestive system through a thin nasogastric tube, as well as a siphon enema.
In case of pronounced peristaltic movements and cramping pain syndrome, antispasmodics (platiphylline, drotaverine) are administered. In case of paresis, drugs are administered that stimulate intestinal motility (proserin), and a perinephric blockade is also performed using novocaine. To correct the imbalance of water and electrolytes, saline solutions are administered intravenously.
If the listed measures do not bring a visible positive result, a conclusion is made about the mechanical nature of the ileus, after which urgent surgical intervention is performed.
During the operation, mechanical obstruction is eliminated, the affected area of the intestine is resected, and measures are taken to prevent recurrent cases of intestinal obstruction.
If intestinal obstruction is caused by a tumor process in the area of the large intestine, then the operation involves a hemicolonectomy, as well as a colostomy. In case of inoperable tumor, surgeons perform a bypass anastomosis. For peritonitis, transversostomy is performed.
After surgery, the following measures are necessary:
- restoration of circulating blood volume,
- detoxification,
- administration of antibiotics,
- restoration of the balance of proteins, water and electrolytes.
ICD-10 and ICD-9 code
ICD 10 code:
- K31.5 - Duodenal obstruction;
- K56.0 - Paralytic ileus;
- K56.1 - Intussusception;
- K56.3 - Ileus caused by gallstone;
- K56.7 - Ileus, unspecified;
- P75* - Meconium ileus in cystic fibrosis (E84.1+);
- P76.1 - Transient ileus in the newborn.
ICD 9 code:
- 537.2 - Chronic duodenal obstruction;
- 560.1 - Paralytic intestinal obstruction;
- 560.31 - Gallstone intestinal obstruction;
- 777.1 - Meconium ileus in a fetus or newborn;
- 777.4 - Temporary ileus in a newborn.
Prevention
Preventive measures regarding intestinal obstruction include timely detection and removal of tumor formations, preventing the development of adhesions, and getting rid of helminthic pathologies. It is equally important to eat right and avoid injury.
If you notice symptoms of intestinal obstruction, you should immediately contact a specialist. Timely diagnosis is the key to correctly prescribed therapeutic measures and their effectiveness, that is, the patient’s recovery.
