INTESTINAL OBSTRUCTION

Introduction :
Intestinal obstruction is a mechanical or functional obstruction of the intestines, preventing the
normal transit of the products of digestion. It can occur at any level distal to the duodenum of the
small intestine and is a medical emergency. Although many cases are not treated surgically, it is
a surgical problem. It may be small bowel obstruction or large bowel obstruction.

Definition

Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of
the intestinal contents to pass through.

Causes:
Obstruction of the bowel may due to:

 A mechanical cause, which simply means something is in the way

 Ileus, a condition in which the bowel doesn't work correctly but there is no structural
problem

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction
in infants and children. Causes of paralytic ileus may include:

 Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)

 Complications of intra-abdominal surgery
 Decreased blood supply to the abdominal area)
 Injury to the abdominal blood supply
 Intra-abdominal infection
 Kidney or lung disease
 Use of certain medications, especially narcotics

In older children, paralytic ileus may be due to bacterial, viral, or food poisoning
(gastroenteritis), which is sometimes associated with secondary peritonitis and appendicitis.
Mechanical causes of intestinal obstruction may include:

 Abnormal tissue growth

 Adhesions or scar tissue that form after surgery
 Foreign bodies (ingested materials that obstruct the intestines)
 Gallstones
 Hernias
 Impacted feces (stool)
 Intussusception
 Tumors blocking the intestines
 Volvulus (twisted intestine)

Symptoms
Signs and symptoms of intestinal obstruction include:
 Crampy abdominal pain that comes and goes (intermittent)
 Nausea
 Vomiting or diarrhea
 Inability to have a bowel movement or pass gas
 Swelling of the abdomen (distention)
 Abdominal tenderness
 Fever

Diagnosis
 Blood tests
 X-rays of the abdomen
 CT scanning and/or ultrasound.
 If a mass is identified, biopsy may determine the nature of the mass.
 Radiological signs of bowel obstruction include bowel distension and the presence of
multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs.
 Contrast enema or small bowel series or CT scan can be used to define the level of
obstruction, whether the obstruction is partial or complete, and to help define the cause of
the obstruction.
 According to a meta-analysis of prospective studies by the Cochrane Collaboration, the
appearance of water-soluble contrast in the cecum on an abdominal radiograph within 24
hours of oral administration predicts resolution of an adhesive small bowel obstruction
with a pooled sensitivity of 96% and specificity of 96%. PMID 15674958
 Colonoscopy, small bowel investigation with ingested camera or push endoscopy, and
laparoscopy are other diagnostic options.

Treatment
Treatment for intestinal obstruction requires hospitalization.
This includes
 Giving fluids through an intravenous (IV) line
 Putting a nasogastric (NG) tube through nose and into stomach to suck air and fluid out
to allow the intestines to decompress
 Placing a thin, flexible tube (catheter) into your bladder to drain urine.
 In mechanical obstruction in some food and fluid can still get through (partial
obstruction), decompressing intestine with an NG tube may improve the condition, and
 no further treatment is necessary. If the obstruction does not clear within a day or so, you
may need surgery to relieve the obstruction.
 Complete obstruction, in which nothing can pass through intestine, is a medical
emergency that requires immediate surgery to relieve the blockage.

Complications
If left untreated, intestinal obstruction can cause serious, life-threatening complications. As your
intestine becomes congested, its ability to absorb food and fluids decreases.
 Decreased absorption may cause vomiting, dehydration and, eventually, can result in
shock, which may cause kidney failure.
 Intestinal obstruction can also cut off the blood supply to the affected portion of your
intestine. If left untreated, lack of blood causes the intestinal wall to die. Tissue death can
result in a tear (perforation) in the intestinal wall, which can lead to peritonitis, an
infection of the lining of your abdominal cavity.
 Peritonitis is a life-threatening condition that requires immediate medical and surgical
attention.
Signs and symptoms of peritonitis include:
 Abdominal pain or tenderness
 Abdominal swelling
 Nausea
 Vomiting
 Fever
 Chills
 Thirst
 Low urine output
 Fluid in the abdomen
 Inability to have a bowel movement or pass gas
Peritonitis may cause you to go into shock. Signs and symptoms of shock include:
 Cool, clammy skin that may be pale or gray
 A weak and rapid pulse
 Abnormal breathing that may be either slow and shallow or very rapid
 Dilated pupils in the eyes
 Lackluster eyes that seem to stare

Prevention

Prevention depends on the cause. Treatment of conditions (such as tumors and hernias) that are
related to obstruction may reduce risk.
Some causes of obstruction cannot be prevented.