Obstructive intestinal obstruction is a pathology that is accompanied by a violation or a complete stop of the movement of intestinal contents through the gastrointestinal tract (in the segment from the stomach to the anus). A similar disease is considered the most dangerous surgical pathology in the abdominal cavity.
Classification
According to the factors that cause this pathology, there are:
- Mechanical intestinal obstruction.
- A dynamic variety of the disease.
A dynamic variant of obstruction appears when there are obstacles to the intestinal contents, and a mechanical one is a consequence of impaired intestinal motility and, in turn, is divided into partial or complete, as well as obstructive or strangulation obstruction. Mechanical intestinal obstruction can form in any of the gastrointestinal tract, although it is most often found in the small intestine.
In the case of a complete or partial violation of the advancement of intestinal contents due to narrowing or blockage of the intestinal lumen, this pathology is called obstructive obstruction.
Causes of pathology
As a rule, mechanical intestinal obstruction develops due to the following reasons:
- Benign neoplasms in the small intestine.
- Malignant neoplasms that are localized in the large or small intestine.
- Foreign bodies.
Regardless of the nature of the formation, it grows into the intestinal lumen, slowing the progress of intestinal contents.
In elderly patients, obstructive bowel obstruction may occur due to coprostasis. In this case, the intestinal walls absorb water due to prolonged stagnation of the contents. As a result, fecal masses are significantly compacted and, as a result, fecal stones are formed that clog the lumen of the distal sections of the intestine.
Quite often, the formation of obstructive intestinal obstruction is provoked by calculous cholecystitis or cholelithiasis. Moreover, large stones, lingering in the lumen, cause the formation of pressure sores, and later - fistulas (located between the bladder and intestines). Through fistulas, stones can migrate, causing a blockage in the intestines.
More rarely, obstructive intestinal obstruction can occur with massive helminthic invasions, so with ascariasis, a coil of parasites clogs the intestinal lumen. In addition, pathology is also formed with mesenteric neoplasms, aberrant vessels, or congenital anomalies.
Clinic
General and particular signs of pathology are distinguished.
The first include:
- Spasmodic abdominal pain.
- Bouts of vomiting.
- Accelerated peristalsis, which occurs at the beginning of the disease, and its complete stop at a later date.
- Short periods (several days) of symptoms after obstruction.
- Inability to remove gases and feces.
It is worth noting that similar signs can to some extent accompany other pathologies, for example, dysbiosis (lack of live bacteria for the intestines), and therefore it is important to take into account local manifestations, history, age of the patient, and so on.
As a rule, pain is the first sign of the development of obstruction, while it has a cramping nature, suddenly arises and proceeds undulating. Patients characterize pain as unbearable.
In addition, the intestinal wall peristalsis intensifies (the body tries to get rid of the barrier that has arisen), but over time, the neuromuscular elements of the intestinal wall become depleted, as a result of which the peristalsis disappears altogether. At the same time, attacks of vomiting begin.
The nature of the vomit corresponds to the degree of obstruction:
- When the barrier is located in the upper sections of the gastrointestinal tract, bile and consumed food are present in the vomit.
- In the case of localization of obstruction in the lower sections - vomit has a very unpleasant odor and contains fecal inclusions.
- If blockage occurs in the colon, vomiting may be absent, but bowel paresis and bloating are observed.
Neoplasm obstruction
If the obstruction is caused by a neoplasm in the intestine, the disease develops gradually and rather slowly. At the same time, against the background of anemia, intoxication and general exhaustion, unstable cramping pain and bloating occur, alternating with periods of temporary well-being. If the gut is badly swollen, it can lead to ulcers and necrosis. Sometimes the first symptom of a bowel blockage due to neoplasms may be bleeding.
Obstruction due to abnormal location of the mesenteric artery
As a rule, a similar pathology occurs in young patients. At the time of food intake, the small intestine descends and pinches between the spine and the abnormally located mesenteric artery. In this case, spastic pain appears in the abdomen and reflex vomiting occurs.
The knee-elbow position brings significant relief, as the artery lowers and ceases to compress the intestines. The disease can occur in waves.
Gallstone obstruction
Biliary stones are the cause of obstructive intestinal obstruction in only 2% of cases. Moreover, this phenomenon occurs, as a rule, in the thinnest segment of the intestine, which leads to a complete blockage of its lumen. With calculous chronic cholecystitis as a result of pressure ulcers of the vesicle wall, the damaged tissues are soldered to the colon or duodenum.
As the bedsore increases, a duodenal-cystic or colonic-cystic fistula is formed, through which the calculus falls into the intestine. In this case, blockage of the latter occurs under the condition of a sufficiently large stone size (3 cm or more). Contributes to obstruction secondary bowel spasm. As a rule, blockage by a bile calculus occurs in the terminal portions of the ileum, due to its small diameter.
The clinic is pronounced and occurs acutely: patients complain of severe cramping pain, repeated bouts of vomiting, in which bile is present. During fluoroscopy, loops of the small intestine swollen from gas are found, which have a characteristic "spiral" pattern of the mucosa. In addition, quite often gas is also determined in the bile ducts.
Clinic of obstructive obstruction due to fecal calculi
In elderly patients, obstruction (in the colon) is most often caused by fecal stones, while patients suffer from constipation or atony of the intestinal wall. In this case, fecal stones are formed due to chronic colitis or developmental abnormalities (congenital membranes in the mucosa, megasigma, megacolon). In some cases, fecal calculi can go away spontaneously, but more often cause pressure sores of the intestinal wall and, as a result, the development of perforation and peritonitis.
The characteristic features of such obstruction are:
- Severe cramping pain.
- Balloon-like swollen empty rectum.
- Gas and stool retention.
- Peristalsis is enhanced and lasting.
Diagnosis of intestinal obstruction
A differential diagnosis of this pathology (especially in infants) should be carried out with dysbiosis (lack of live bacteria for the intestine).
The most accessible and simplest methods for detecting intestinal obstruction are radiological methods.
So, for the diagnosis of intestinal obstruction, a survey radiography of the abdominal organs is prescribed, which can reveal air arches, Kloiber’s bowls and the level of (horizontal) fluid. Similar radiological symptoms may occur several hours after the onset of the disease.
If necessary, an aiming gastric radiography or duodenum is used (if a foreign body, bile calculi in the intestines or an abnormally lying mesenteric artery are suspected), as well as studies in lateral or horizontal positions, on the left or right side.
In the absence of obvious signs of obstruction, a contrast x-ray examination (irrigography and barium passage through the small intestine) is performed, which allows to most accurately determine the level and localization of intestinal obstruction.
MSCT and ultrasound of the intestine, which shows the presence of tumors, foreign bodies and calculi, allows you to identify the causes of obstruction and analyze the condition and blood supply of internal organs, as well as the presence / absence of peritonitis.
A more accurate diagnosis of the pathology is carried out with an endoscopic examination, which allows you to visualize the damaged section of the intestine, identify the cause of obstruction, and also make therapeutic measures. In addition, endoscopic examination of the colon (colonoscopy) allows you to remove fecal calculi or dissolve them with water and avoid surgery. In the case of the effectiveness of this method, it is necessary to study feces to determine the latent blood in it, due to which it is possible to confirm / refute perforations and pressure sores of the intestine.
Which doctor treats the intestines
- Urgent gastrointestinal pathologies associated with infections (salmonellosis, foodborne infections, cholera, shigellosis) are treated by an infectious disease specialist.
- Acute pathologies that are not associated with infections (paraproctitis, acute appendicitis, obstructive intestinal obstruction, ulcer complications: perforation, malignancy, bleeding) are treated by a surgeon.
- Chronic gastrointestinal pathologies (gastritis, colitis, duodenitis and so on) are treated by a gastroenterologist.
- For the treatment of diseases of the rectum, you should contact a proctologist.
Regardless of the type of gastrointestinal pathology, consultations of the following specialists are required to establish the correct diagnosis:
- An endoscopist conducting, for example, FGDS.
- A sonologist conducting an ultrasound of the intestine, which shows the condition of the internal organs and so on.
- Radiologist.
That is, there is no clear answer to the question "which doctor treats the intestines", because it is worth considering not only the cause of the disease, but also its course, the patient's condition and the presence of complications.
Tumor Obstruction
The choice of a particular treatment method depends on the reason that provoked an obstruction of the intestine.
In case of obstruction caused by a tumor, complex treatment can be used, including surgical interventions, as well as radiation and chemotherapy. With neoplasms of the small intestine, the intestine is excised in parallel, forming inter-intestinal anastomoses.
In case of obstruction in the ascending colon or cecum, hemicolectomy is prescribed. If the tumor is inoperable, a bypass ileotransverse anastomosis is performed. If the neoplasm is localized in the colon (its left parts), two- or three-stage interventions are performed. In cases where the tumor in these sections is inoperable, an unnatural anus is formed.
Therapy of intestinal arteriomesenteric obstruction
With this pathology, conservative treatment is first applied: fractional frequent meals, being in a horizontal position after eating (preferably on the right side). In case of inefficiency of such measures, surgical treatment is prescribed (the formation of duodenoanastomosis).
Treatment for obstruction due to gallstones
Therapy is purely surgical. At the same time, intestinal decompression, enterotomy of the intestinal obstruction of the calculus and its removal are indicated.
Subsequently, if there is evidence, a cholecystectomy is performed.
Treatment of bowel obstruction with fecal stones
In this case, treatment begins with conservative methods: oil or siphon enemas, grinding the calculus with your fingers or an endoscope, followed by its removal through the anus. If such therapy does not bring effect, an operation is performed in which a colostomy is performed, removal of stones and the subsequent application of a temporary colostomy.
Forecasts
The prognosis of the pathology depends on the cause that caused it, as well as the presence / absence of complications. If perforation, peritonitis, bleeding are absent, the prognosis is favorable. In the case of inoperable tumors - unfavorable.
Prevention
There are no specific preventive measures for intestinal obstruction. Secondary prevention is reduced to the timely determination and elimination of the causes of this pathology.