Intestinal obstruction is a disease that combines a complex of symptoms that are characterized by absolute or partial disability of the intestine, both large and thin. For him, the absence of movement of any type of food, including solid and liquid masses, as well as the presence of intense inflammation in the abdominal cavity is inherent. Intestinal obstruction is dynamic and mechanical.
Features of the disease
Dynamic intestinal obstruction is a separate type of the aforementioned disease and occurs in 10% of patients with bowel obstruction. To this diagnosis of doctors often pushes the need to exclude mechanical obstruction, which has the need for urgent surgery.
The difficulty in diagnosing this disease is that the pathogenesis of dynamic intestinal obstruction is not characterized by the presence of a unique obstacle to the movement of juices and food fragments along the intestinal tract. In this case, inherent only a short reduction in the processes of this body.
However, the danger of the disease lies in the fact that it can provoke neurohormonal dysfunction in the patient’s body, as well as disrupt the functionality of the small and large intestines. Consider what factors affect the occurrence of a disease such as dynamic intestinal obstruction.
Causes of the disease
Although modern science is distinguished by great achievements and achievements in medicine, it has not yet been able to unravel the specific mechanisms that provoke the appearance of the disease in question. The appearance of a problem such as dynamic intestinal obstruction can be caused by the following factors:
- peritonitis, which can provoke appendicitis or pancreatitis;
- acute mesenteric infarction;
- toxic megacolon (Crohn’s disease, Hirschsprung ’s disease, ulcerative colitis);
- reflex circumstances (postoperative condition, colic, bleeding, trauma of the abdominal cavity, spinal fractures, as aggravation of mechanical intestinal obstruction);
- neurogenic diseases;
- hormonal changes (e.g., pregnancy);
- metabolic diseases (hypokalemia, ketoacidosis, uremia, intoxication).
Classification of dynamic intestinal obstruction
In medicine, each diagnosis has its own individual code, name and generally accepted standards for the provision of medical care. A disease such as dynamic intestinal obstruction is no exception. ICD 10 (International Classification of Diseases) classifies the disease in question as follows:
- class XI "Diseases of the digestive system" (K00-K93);
- section "Other bowel diseases" (K55-K63);
- diagnosis code - K56.6;
- the name is “Other and unspecified intestinal obstruction”.
In medical practice, it is customary to distinguish between two main types of dynamic intestinal obstruction:
Spastic bowel obstruction
In clinical practice, it is infrequent, usually it is met in conjunction with another disease. Often the cause of the disease is infection of the body with worms or pylorospasm, as a consequence of birth injury. Also among the other causes of this type of disease can be noted: diseases of the nervous system, neurosis, dyskinesia.
You can get rid of this problem exclusively using conservative methods, since it does not make sense to resort to surgical intervention in this case.
Spastic bowel obstruction: symptoms
In adults, this disease occurs much more often than in children, but its symptoms are the same at any age. This disease is characterized by a sudden onset. The patient complains of short bouts of pain in the abdomen, which do not have a specific location.
Patients with this diagnosis note the following symptoms:
- cramping pains in the abdomen;
- uneven bloating and fullness;
- nausea, possible vomiting, constipation.
On palpation of the abdomen, a diseased segment of the small intestine is felt, the abdomen itself remains soft. Violations from other systems are not observed. The general condition of the patient is not critical.
Pseudoileus
It is determined by paralysis of intestinal motility, accompanied by a sudden regression of the functional revitalization of neuromuscular formations. Distinguish between reflex and postoperative paralytic bowel obstruction.
With the reflex form of the disease, irritation of the sympathetic compartment of the autonomic nervous system is observed. Postoperative obstruction has a more complex genesis and is more common after various operations carried out on the abdominal organs.
The following factors provoke the formation and development of the disease:
- inflammatory processes in the abdomen;
- bruising (phlegmon) of the retroperitoneal region;
- the overall picture observed after an operation such as laparotomy;
- the consequences of pathological diseases such as pleurisy, pneumonia, myocardial infarction;
- thrombosis of mesenteric vessels;
- transferred infectious diseases, including toxic paresis.
There are several stages of this disease:
I stage. "Compensated disorders" - it is equivalent to a typical postoperative intestinal paresis. The duration of symptoms lasts for 2-3 days.
II stage. “Subcompensated disorders” - characterized by the fact that there is a significant bloating, signs of intoxication and peritonism of the body appear. Peristalsis noises are not heard. Many signs are observed in the radiographic image.
III stage. "Decompensated disorders" - the body is in a state of significant intoxication. You can observe intestinal adynamia, vomiting of intestinal contents. There are symptoms of abdominal irritation, the abdomen is significantly swollen. An x-ray study shows many horizontal fluid levels in the loops of the intestines (thin and thick at the same time).
IV stage. “Gastrointestinal tract paralysis” - at this stage, there is a violation of all organ systems important for human life. Negative systems are felt by the patient continuously.
Since in modern medicine there are still no developed differential diagnostic signs of various pathologies that appear in the postoperative period, therefore, early diagnosis of the disease is almost impossible
Paralytic bowel obstruction : symptoms
In adults, against the background of this disease, the general condition is significantly exacerbated. He feels a constant pain, which has a diffuse character. However, it is not as intense as with mechanical bowel obstruction. There is vomiting with a green admixture. The patient notes an increase in symptoms of exicosis, toxicosis, as well as cardiovascular depression.
With paralytic obstruction, the patient’s abdomen swells, through its front wall you can notice an increase in the volume of loops of non-peristaltic intestines. If peritoneal symptoms are absent, the area of the abdominal cavity is soft to the touch.
Since this disease is a staged process, the patient's condition worsens with an increase in the duration of the disease. In the later stages, tachycardia and shortness of breath, bloating, lingering peristaltic noises, which are rarely heard, can be noted. Vomiting is aggravated.
At the last stages, a sharp predominance of morphological changes in the neuromuscular apparatus is noted. The patient complains of gas and stool retention, has rare urination.
Dynamic intestinal obstruction in children
In children, acute dynamic intestinal obstruction, which is most often manifested in a paralytic form, is more common. We can distinguish the following reasons that provoke the development of the disease in childhood:
- obstructive or strangulation obstruction;
- limited or diffuse peritonitis ;
- abdominal injuries;
- pneumonia;
- empyema of pleura;
- violation of intestinal functions.
Quite often, dynamic intestinal obstruction affects children in the postoperative period. Also, the cause of the maturation of the paralytic form of this disease can be hypokalemia.
The danger of the disease in childhood is the possible loss of a large amount of fluid and salt due to constant vomiting, loss of appetite, excretion of potassium by the kidneys, and hypoproteinemia. The severity of the condition may be aggravated by the influence of negative toxic and bacterial conditions.
Dynamic intestinal obstruction in newborns can be triggered by a number of the following reasons:
- prematurity;
- violation of the intervention;
- the use of medications (including women in childbirth during pregnancy);
- hypermagnesemia;
- the use of a woman in labor of heroin;
- the use of hexamethonium;
- sepsis
- enteritis;
- central nervous system disease;
- necrotic enterocolitis;
- endocrine disorders.
Dynamic intestinal obstruction in children is often found, however, it is easily diagnosed and makes timely treatment possible. In case of suspicion of the presence of such obstruction, the main thing is not to succumb to the temptation of self-medication, but strictly adhere to the instructions provided by the appropriate specialist. A lethal outcome is a completely possible development of events with such a problem as dynamic intestinal obstruction.
Diagnosis of the disease
The symptoms of this disease are specific and vivid, which does not complicate the process of its diagnosis. The following diagnostic methods are used:
- history taking;
- examination of the patient;
- X-ray examination of organs in the abdominal region (the presence of gases above the level of fluid in the intestine matters);
- Ultrasound (not a mandatory study, since it is not a sufficiently informative indicator);
- general blood analysis.
Dynamic intestinal obstruction: treatment
As a rule, the treatment of the disease is aimed at eliminating the initial causes that provoke its development (diseases of an infectious nature, pneumonia, peritonitis, etc.). In the event that the disease is a consequence of toxic or reflex circumstances, conservative treatment is appropriate, which consists in drug therapy of all negative manifestations, which lead to a stop of standard intestinal peristalsis. Such therapy can be carried out by introducing into the human body such drugs as sodium chloride along with glucose. Then you need to wash the intestines with an enema, if necessary - perform the introduction of a gastric probe. With high pain, it is allowed to take painkillers.
In the case when the patient's condition does not improve over six hours of conservative treatment, surgery is performed. Also, emergency surgery is performed for congenital intestinal obstruction.
Usually an operation consists of partial removal of the intestine, which no longer performs its functions. In especially severe episodes, it is necessary to impose a colostomy (an artificial anus in the abdominal wall, along which stool moves and can exit into a special attached bag).
You can do without removing a piece of the intestine only in case of intussusception. In this circumstance, it is possible to straighten the intestines due to the passage through the intestine of air and further control of the overall picture using x-rays.
Postoperative treatment consists of an individual diet, which depends on the volume of surgical intervention. The first two days after surgery, the patient is recommended to be in the position of Fowler, it is also necessary to perform breathing exercises. Also at this stage, there is a need to undergo drug therapy, which includes detoxification therapy, normalization of electrolyte metabolism, the use of broad-spectrum antibiotics, stimulants of the gastrointestinal tract, and if indicated, hormonal treatment.
With complications in the postoperative period, wounds, bleeding, peritonitis, adhesive disease of the peritoneum may be aggravated.
With dynamic bowel obstruction, as with any other disease, not so much treatment is essential, but rather the prevention of this problem. Preventive methods include:
- electrolyte balance correction;
- drug treatment with prokinetics;
- taking antibiotics;
- an appropriate diet that has a low amount of fat, dairy products and plant foods with a high content of components that are not digested by the human body.