Today Thursday Nov 26, 2020

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Ileus


Digested food particles must pass through the intestine as part of normal digestion. These digested wastes are constantly moving. However, intestinal obstruction can prevent food from moving. Intestinal obstruction occurs when the small or large intestine is obstructed and can be partial or general, preventing the passage of digested fluids and foods.

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In case of intestinal obstruction, food, fluids, stomach acids and gas accumulate at the site of obstruction, and in case of high pressure in the intestine, they can cause intestinal rupture and spread harmful contents of the intestine and bacteria in the abdominal cavity. There are many causes for bowel obstruction and often these conditions cannot be prevented. Early diagnosis and treatment are very important in this condition and can be fatal if left untreated.

 


Cause of intestinal obstruction

The obstruction can be minor, in which case it may be removed without surgery. General obstruction is likely to require bowel surgery.

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1- Mechanical obstructions:

Mechanical obstructions occur when something physically blocks the bowel.

Some causes of small bowel obstruction include:

  • Hernia
  • Volvulus or twisting of the intestines
  • Tumors in the small intestine
  • Swallowing a foreign body, especially in children
  • Inflammatory bowel disease such as Crohn's disease
  • Push one part of the intestine to the next
  • Gallstones, however, rarely cause blockages.
  • Intestinal abnormalities often occur in infants, but also in children and adolescents.
  • Abdominal adhesions, which are made up of fibrous tissue and can occur after any abdominal or pelvic surgery or after severe inflammation.

Mechanical obstructions can also block the colon or rectum, although these are rare and the main causes are:

  • Diureticitis
  • ovarian cancer
  • Hardened stools
  • Colon cancer
  • Colon stenosis caused by ulceration or inflammation
  • Adhesions due to pelvic infections or surgeries
  • Hardening of meconium in infants (meconium is the baby's first stool)

 

2- Non-mechanical blockage :

The small and large intestines normally contract in a coordinated system. Any factor that can disrupt these coordinated contractions may cause functional bowel obstruction, commonly known as non-mechanical obstruction. Temporary non-mechanical obstruction is called ileus and chronic or long-term obstruction is called false occlusion.

The main causes of ileus are:

  • Abdominal or pelvic surgery
  • Electrolyte imbalance
  • Infections, such as gastroenteritis or appendicitis
  • Some medications, including opioid analgesics

 

3-False obstruction:

False bowel obstruction (false ileus) can cause signs and symptoms of obstruction, but there is no real physical blockage, and muscle or nerve problems cause the normal coordinated muscles of the intestines to contract, slowing or stopping the movement of food and fluids through the gastrointestinal tract.

Paralytic or false ileus can affect any part of the intestine. Various causes can include the following:

  • Infection
  • Hypothyroidism
  • Abdominal or pelvic surgery
  • Disorders caused by nerve damage such as diabetes
  • Hirschsprung's disease, a disorder in which there is a lack of nerves in parts of the large intestine.
  • Musculoskeletal disorders such as Parkinson's disease, multiple sclerosis and other neuromuscular disorders
  • Some drugs that affect muscles and nerves, including tricyclic antidepressants, such as amitriptyline and imipramine (topranil), and opioid analgesics, such as those containing hydrocodone (vicodin) and oxycodone (oxycontin).

See a doctor right away if you have symptoms of obstruction such as bloating, severe constipation, and loss of appetite, especially if you have recently had abdominal surgery.

 

4-Intestinal obstruction in infants:

Intestinal obstruction in infants is usually caused by infections, organ diseases, and decreased blood flow to the intestines (suffocation). Some children experience the disease after catching the stomach flu. Stomach flu can cause inflammation in the baby's gut. It is difficult to diagnose any type of bowel obstruction in infants because they cannot describe their symptoms. Instead, parents should be aware of their children for changes and symptoms that may indicate bowel obstruction, and see a doctor immediately if they occur.

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Some of the symptoms of obstruction in infants include:

  • Fever
  • the pain
  • Swelling of the abdomen
  • Blood in the stool
  • Very loud crying
  • Excessive drowsiness
  • Show vital signs of weakness
  • Pull the knees towards the chest
  • Vomiting, especially bile-like vomit that is yellow-green.

Risk factors in increasing the likelihood of intestinal obstruction

Diseases and conditions that can increase the risk of intestinal obstruction include:

  • Crohn's disease, which can cause the intestinal walls to thicken.
  • Abdominal or pelvic surgery, which often causes adhesions of the common intestinal obstruction.
  • Abdominal cancer, especially if surgery has been performed to remove the abdominal tumor or radiation therapy.
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Symptoms of intestinal obstruction

Bowel obstruction causes a wide range of distressing symptoms, including:

  • Diarrhea
  • Constipation
  • Vomit
  • stomach ache
  • nausea
  • Swelling of the abdomen
  • Severe bloating
  • Decreased appetite
  • Severe abdominal cramps
  • Inability to pass gas or feces

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Some symptoms may depend on the location and duration of the blockage. For example, vomiting is an early sign of small bowel obstruction. If it continues, colon obstruction may also occur. Partial blockage can lead to diarrhea, while complete blockage results in inability to pass gas or feces. Obstruction can also cause infection and serious inflammation of the abdominal cavity known as peritonitis. This happens when part of the bowel ruptures, leading to fever and increased abdominal pain. These symptoms are a dangerous condition that requires surgery.


Diagnosis of intestinal obstruction

The doctor will ask about the patient's medical history and symptoms and perform a physical examination to assess his or her condition. Your doctor may suspect intestinal obstruction if your abdomen swells and even listen to your bowel sounds with a stethoscope.

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The presence of a hard mass or certain types of sounds, especially in a child, may help determine if there is an obstruction.

In addition, your doctor may order other diagnostic tests, including:

- X-Ray: Your doctor may recommend an abdominal radiograph to confirm the diagnosis. However, some intestinal obstruction is not seen using standard X-rays.

- Computed tomography(CT): CT scan is a combination of a set of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than standard radiographs and may show intestinal obstruction.

- Ultrasound(sonography): When obstruction occurs in children, ultrasound is often the preferred type of imaging. In young people with visual perception, an ultrasound usually shows a "cow's eye" that wraps around the intestine.

- Barium enema test: The barium enema test is essentially an imaging of the large intestine that is performed for some reason suspected of obstruction. In this procedure, the doctor inserts barium into the patient's colon through the rectum, air, or fluid. To diagnose obstruction in children, barium testing can solve the problem in most cases and no further treatment is needed.


Complications of intestinal obstruction

Left untreated, intestinal obstruction can have serious and dangerous complications, including:

  • Kidney failure
  • Dehydration
  • Electrolyte imbalance
  • Intestinal perforation that can lead to infection.

If the blockage prevents blood from reaching a part of the intestine, it may cause more complications:

  • Infection
  • Intestinal perforation
  • Multiple organ failure
  • Sepsis, a dangerous and serious blood infection
  • Tissue death, intestinal obstruction can cut off blood flow to part of the intestine. Lack of blood causes the intestinal wall to collapse and tissue to die. Tissue death can lead to rupture (perforation) of the intestinal wall and infection.
  • Death

Treatment of intestinal obstruction

Appropriate treatment depends on the location, severity of the blockage and the type of blockage. For partial obstruction or ileus, injecting intravenous (IV) fluids and relaxing the bowel can be helpful. Bowel rest means that the patient does not eat for a certain period of time. In this case, the doctor can prescribe IV fluids to treat dehydration and attach a catheter to the patient's bladder to drain urine. In addition, the patient may need a tube to relieve pressure and inflammation and vomit out of the throat and intestines.

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If these measures are not successful or the patient's symptoms worsen, he will need surgery and hospitalization. A serious complication of intestinal obstruction can be permanent damage to the intestine. In this case, the surgeon performs surgery to remove part of the dead tissue and connect the two healthy ends of the intestine.

Treatment generally involves the following general steps:

1- Hospitalization of the patient to stabilize the condition

When a patient goes to the hospital, doctors first work on stabilizing the patient.

This process may include the following:

  • Insert a catheter into the bladder to drain and collect urine
  • Insert an intravenous (IV) line into a vein in the patient's arm to administer fluids
  • Insert a nasogastric tube through the patient's nose and stomach to suck in air and fluids and relieve bloating

2-Treatment of partial obstruction

In case of partial obstruction, the patient does not need further treatment after stabilization. Your doctor may recommend a low-fiber diet.

3-Complete obstruction treatment

Treatment for general obstruction usually depends on the surgery, the cause, and the location of the obstruction. Surgery typically involves removing the obstruction and removing part of the damaged bowel. For some people who have a chronic obstruction due to narrowing of the bowel, the doctor may insert a metal stent into the bowel that expands using a long tube called an endoscope. The stent opens the bowel. This operation may not require cutting the abdomen. Stents are commonly used to treat patients with colorectal cancer or for temporary relief in people undergoing dangerous emergency surgery. It is possible that the patient will still need surgery after the condition has stabilized.

Prescription drugs cannot cure the blockage on their own, but may help reduce the patient's nausea. Some medications that your doctor may prescribe include:

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  • Housing
  • Antibiotics to reduce infection
  • Analgesics to prevent vomiting

4-Treatment of false obstruction

If the doctor determines that the patient's signs and symptoms are due to a false obstruction (ileus paralysis), he or she may stay in the hospital for one or two days for further monitoring and treat if the cause is known. Paralytic ileus heals and heals on its own. In addition, to prevent malnutrition, the patient may be fed through a nasal tube or IV.

If the false ileum does not heal on its own, your doctor may prescribe injections into the muscles, which can help transport food and fluids through the gut. If ileus paralysis is caused by an illness or medication, the doctor will treat the underlying disease or stop taking the medication. Rarely, surgery may be needed to remove part of the bowel. In cases where there is an obstruction in the rectum, a treatment called decompression is performed with a colonoscopy, in which a thin tube is inserted into the patient's anus and guided to the rectum. Decompression can also be done through surgery.