Acute intestinal obstruction. Classification, diagnosis, treatment tactics

– a violation of the passage of contents through the intestine, caused by obstruction of its lumen, compression, spasm, hemodynamic or innervation disorders. Clinically, intestinal obstruction is manifested by cramping abdominal pain, nausea, vomiting, stool retention and the passage of gas. In diagnostics intestinal obstruction data from a physical examination (palpation, percussion, auscultation of the abdomen), digital rectal examination, and plain radiography are taken into account abdominal cavity, contrast radiography, colonoscopy, laparoscopy. For some types of intestinal obstruction, conservative tactics are possible; in other cases, surgical intervention is performed, the purpose of which is to restore the passage of contents through the intestine or its external diversion, resection of a non-viable section of the intestine.

General information

Intestinal obstruction (ileus) is not an independent nosological form; in gastroenterology and coloproctology, this condition develops in a variety of diseases. Intestinal obstruction accounts for about 3.8% of all emergency conditions in abdominal surgery. With intestinal obstruction, the movement of contents (chyme) - semi-digested food masses through the digestive tract.

Intestinal obstruction is a polyetiological syndrome that can be caused by many reasons and have various shapes. Timely and correct diagnosis of intestinal obstruction are decisive factors in the outcome of this serious condition.

Causes of intestinal obstruction

The development of various forms of intestinal obstruction has its own reasons. Thus, spastic obstruction develops as a result of a reflex intestinal spasm, which can be caused by mechanical and painful irritation due to helminthic infestations, intestinal foreign bodies, bruises and hematomas of the abdomen, acute pancreatitis, nephrolithiasis and renal colic, biliary colic, basal pneumonia, pleurisy, hemo- and pneumothorax, rib fractures, acute myocardial infarction and other pathological conditions. In addition, the development of dynamic spastic intestinal obstruction may be associated with organic and functional lesions of the nervous system (TBI, mental trauma, spinal cord injury, ischemic stroke, etc.), as well as circulatory disorders (thrombosis and embolism of mesenteric vessels, dysentery, vasculitis), Hirschsprung's disease.

Paralytic intestinal obstruction is caused by intestinal paresis and paralysis, which can develop as a result of peritonitis, surgical interventions in the abdominal cavity, hemoperitonium, poisoning with morphine, salts of heavy metals, food toxic infections, etc.

With various types of mechanical intestinal obstruction, there are mechanical obstacles to the movement of food masses. Obstructive intestinal obstruction can be caused by fecal stones, gallstones, bezoars, and accumulation of worms; intraluminal intestinal cancer, foreign body; removal of the intestine from the outside by tumors of the abdominal organs, pelvis, kidney.

Strangulated intestinal obstruction is characterized not only by compression of the intestinal lumen, but also by compression of the mesenteric vessels, which can be observed with strangulated hernia, intestinal volvulus, intussusception, nodulation - overlapping and twisting of intestinal loops among themselves. The development of these disorders may be due to the presence of a long intestinal mesentery, scar cords, adhesions, adhesions between intestinal loops; sudden loss of body weight, prolonged fasting followed by overeating; sudden increase in intra-abdominal pressure.

The cause of vascular intestinal obstruction is acute occlusion of mesenteric vessels due to thrombosis and embolism. mesenteric arteries and veins The development of congenital intestinal obstruction, as a rule, is based on anomalies in the development of the intestinal tube (duplication, atresia, Meckel's diverticulum, etc.).

Classification

There are several options for classifying intestinal obstruction, taking into account various pathogenetic, anatomical and clinical mechanisms. Depending on all these factors, a differentiated approach to the treatment of intestinal obstruction is used.

For morphofunctional reasons, they distinguish:

1. dynamic intestinal obstruction, which, in turn, can be spastic and paralytic.

2. mechanical intestinal obstruction, including forms:

• strangulation (volvulus, strangulation, nodulation)
• obstructive (intraintestinal, extraintestinal)
• mixed (adhesive obstruction, intussusception)

3. vascular intestinal obstruction caused by intestinal infarction.

According to the level of location of the obstacle to the passage of food masses, high and low small intestinal obstruction (60-70%) and colonic obstruction (30-40%) are distinguished. According to the degree of obstruction of the digestive tract, intestinal obstruction can be complete or partial; according to the clinical course - acute, subacute and chronic. Based on the time of formation of intestinal obstructions, congenital intestinal obstruction associated with embryonic intestinal malformations is differentiated, as well as acquired (secondary) obstruction due to other reasons.

There are several phases (stages) in the development of acute intestinal obstruction. In the so-called “ileus cry” phase, which lasts from 2 to 12-14 hours, pain and local abdominal symptoms prevail. The stage of intoxication that replaces the first phase lasts from 12 to 36 hours and is characterized by “imaginary well-being” - a decrease in the intensity of cramping pain, weakening of intestinal peristalsis. At the same time, there is a failure to pass gas, stool retention, bloating and asymmetry of the abdomen. In the late, terminal stage of intestinal obstruction, which occurs 36 hours after the onset of the disease, severe hemodynamic disturbances and peritonitis develop.

Symptoms of intestinal obstruction

Regardless of the type and level of intestinal obstruction, severe pain, vomiting, stool retention and failure to pass gas occur.

Abdominal pain is cramping and unbearable. During a contraction that coincides with a peristaltic wave, the patient’s face is distorted with pain, he groans, and takes various forced positions (squatting, knee-elbow). At the height of a painful attack, symptoms of shock appear: pale skin, cold sweat, hypotension, tachycardia. The subsidence of pain can be a very insidious sign, indicating intestinal necrosis and death of nerve endings. After an imaginary lull, on the second day from the onset of intestinal obstruction, peritonitis inevitably occurs.

Another characteristic symptom of intestinal obstruction is vomiting. Especially profuse and repeated vomiting, which does not bring relief, develops with small intestinal obstruction. Initially, the vomit contains food debris, then bile, and in the later period - intestinal contents (fecal vomit) with a putrid odor. With low intestinal obstruction, vomiting, as a rule, is repeated 1-2 times.

A typical symptom of low intestinal obstruction is retention of stool and gas. Finger rectal examination detects the absence of feces in the rectum, distension of the ampulla, gaping of the sphincter. With high obstruction of the small intestine, there may be no stool retention; emptying of the lower parts of the intestine occurs independently or after an enema.

With intestinal obstruction, attention is drawn to bloating and asymmetry of the abdomen, peristalsis visible to the eye.

Diagnostics

Percussion of the abdomen in patients with intestinal obstruction reveals tympanitis with a metallic tint (Kivul's symptom) and dullness of percussion sound. Auscultation in early phase increased intestinal peristalsis and “splashing noise” are detected; in the late phase - weakening of peristalsis, the sound of a falling drop. With intestinal obstruction, a distended intestinal loop is palpated (Val's symptom); in the later stages – rigidity of the anterior abdominal wall.

Of great diagnostic importance is rectal and vaginal examination, which can be used to identify obstruction of the rectum and pelvic tumors. The objectivity of the presence of intestinal obstruction is confirmed by instrumental studies.

A survey X-ray of the abdominal cavity reveals characteristic intestinal arches (gas-swollen intestine with fluid levels), Kloiber's cups (dome-shaped clearings above the horizontal fluid level), and a symptom of pennation (the presence of transverse striations of the intestine). X-ray contrast examination of the gastrointestinal tract is used in difficult diagnostic cases. Depending on the level of intestinal obstruction, radiography of the passage of barium through the intestines or irrigoscopy may be used. Colonoscopy allows you to examine the distal parts of the large intestine, identify the cause of intestinal obstruction and, in some cases, resolve the phenomena of acute intestinal obstruction.

Carrying out an ultrasound of the abdominal cavity in case of intestinal obstruction is difficult due to severe pneumatization of the intestine, however, the study in some cases helps to detect tumors or inflammatory infiltrates. During diagnosis, acute intestinal obstruction should be differentiated from intestinal paresis - drugs that stimulate intestinal motility (neostigmine); Novocaine perinephric blockade is performed. In order to correct water electrolyte balance intravenous administration of saline solutions is prescribed.

If, as a result of the measures taken, intestinal obstruction does not resolve, one should think about mechanical ileus, requiring urgent surgical intervention. Surgery for intestinal obstruction is aimed at eliminating mechanical obstruction, resection of a non-viable section of the intestine, and preventing recurrent obstruction.

In case of obstruction of the small intestine, resection of the small intestine can be performed with enteroenteroanastomosis or enterocoloanastomosis; deintussusception, unwinding of intestinal loops, dissection of adhesions, etc. In case of intestinal obstruction caused by a colon tumor, hemicolonectomy and temporary colostomy are performed. For inoperable tumors of the large intestine, a bypass anastomosis is performed; If peritonitis develops, transversostomy is performed.

In the postoperative period, BCC replacement, detoxification, antibacterial therapy, correction of protein and electrolyte balance, stimulation of intestinal motility.

Prognosis and prevention

The prognosis for intestinal obstruction depends on the start date and completeness of the treatment. An unfavorable outcome occurs with late recognized intestinal obstruction, in weakened and elderly patients, and with inoperable tumors. With a pronounced adhesive process in the abdominal cavity, relapses of intestinal obstruction are possible.

Prevention of the development of intestinal obstruction includes timely screening and removal of intestinal tumors, prevention of adhesions, elimination of helminthic infestation, proper nutrition, avoiding injury, etc. If you suspect intestinal obstruction, you should immediately consult a doctor.

Intestinal obstruction is an acute disease of the gastrointestinal tract, in which an obstruction to the exit of feces forms in the intestines. This is a very painful condition that can lead to fatal outcome if you do not seek medical help in time. Obstruction can occur at any age, from newborns to the elderly.

The symptoms of this disease are often mistaken for signs of other diseases of the gastrointestinal tract and people try to cope with them on their own. This is absolutely impossible to do, since only timely medical care can save the patient’s life. This disease can only be treated in an inpatient surgical department.

Types and reasons

There are several types of CN.

1. According to the causes of occurrence, congenital and acquired forms are distinguished. Congenital form revealed in infancy and is caused by abnormalities in the development of the small or large intestine. The acquired form becomes the result of certain processes that take place in the human body, usually in adulthood.

2. There are also functional and mechanical CI.

Functional CI - occurs as a result of negative processes in the intestines, after which it completely or partially stops functioning. This type of blockage can be caused by a variety of factors:

• concomitant gastrointestinal diseases;
• inflammation of the abdominal cavity (namely, diseases such as appendicitis, cholecystitis, pancreatitis, peritonitis);
• operations performed on the abdominal cavity;
• internal bleeding;
• abdominal injuries;
• heavy heavy food in large quantities after a long fast;
• intestinal colic.

All these processes can lead to functional blockage of the intestine, which manifests itself in two forms: as spastic and as paralytic blockage. Spastic CI is characterized by spasm of a certain area of ​​the intestines. Spasm can manifest itself in the small intestine or in the colon. At later stages of the disease, 18-24 hours after the onset of antispasmodic blockage may appear paralytic form, in which the entire intestine is paralyzed.

The second type of disease is mechanical CI. Unlike the functional form, with the mechanical variety, intestinal motility continues to work actively, but an existing obstacle prevents it from being eliminated feces out. In turn, mechanical blockage is divided into two forms depending on whether circulatory disturbances in the gastrointestinal tract appeared during the blockage.

A) Strangulation obstruction. In this case, circulatory disorders in the gastrointestinal tract are observed. The reasons for this phenomenon are as follows:

• advanced hernia (intestinal loops are strangulated in the hernial opening);
• adhesions;
• twisting of intestinal loops due to intestinal activity;
• formation of nodes in the intestines.

B) Obstructive intestinal obstruction, in which circulatory disturbances in the gastrointestinal tract are not observed. It usually occurs when the intestines become blocked

• foreign body;
• a lump of worms;
• tumors (a tumor can occur both in the intestine and in other organs, for example, tumors of the uterus, kidneys, pancreas can clog the intestines);
• fecal stone.

According to the clinical course, acute and chronic forms of intestinal obstruction are distinguished. The acute form of CI manifests itself sharply and painfully, getting worse every hour, leading to death. The chronic form is caused by the growth of adhesions or tumors in the gastrointestinal tract. It develops very slowly, from time to time reminding itself of symptoms of flatulence, constipation and diarrhea, alternating with each other. But sooner or later, when the tumor grows to a certain state, it clogs the intestine completely, and the problem enters the acute phase with all the negative consequences.

Symptoms of intestinal obstruction in adults

It is important to note that there is a basic set of symptoms of intestinal obstruction that appear the same at any age. So, a sign of intestinal obstruction on early stage There are three main symptoms:

• abdominal pain (most often observed in the navel area);
• constipation and inability to pass gas;
• vomit.

After 12-18 hours, new symptoms may be added to the course of intestinal obstruction:

• pronounced peristalsis;
• the stomach swells and takes on an irregular shape;
• observed bowel sounds, rumbling;
• dehydration;
• dry mouth.

On the third day after the onset of the disease, if timely treatment is not started, the patient begins to develop a fever and shock. The outcome of this condition can be peritonitis and death of the patient. This is serious illness, in which it is very important to seek medical treatment in a timely manner.

There are some specific symptoms of obstruction that everyone should know.

Vomit. Vomiting due to intestinal obstruction initially has the color and smell of gastric masses, but after a while it acquires a yellowish color and the smell of feces. This occurs when the intestines, unable to free themselves from feces naturally, use the route through the stomach to evacuate them. As a rule, this applies to situations where small intestinal obstruction occurs.

If colonic obstruction occurs, then the intestines are not able to “push” all the feces back along the length of the intestines. In this case, there is seething, rumbling, “transfusion”, painful spasms in the stomach, but there is no relief in the form of vomiting, although constant nausea is present.

Diarrhea. Sometimes bloody diarrhea may occur with intestinal obstruction. It indicates internal hemorrhage.

Diagnostics

When a patient is admitted with suspected intestinal obstruction, it is necessary to exclude other diseases with similar symptoms:

• peptic ulcer;
• appendicitis;
• cholecystitis;
• inflammation of gynecological nature in women.

After this, a study is carried out to confirm the diagnosis of CI and the correct medical or surgical treatment.

• First of all, examination and questioning of the patient (in the acute form, the patient can say exact time when pain processes begin), palpation of the abdomen is mandatory. With the help of palpation, you can assess the patient’s condition, identify the location of the blockage, and even in some cases determine its cause, be it a fecal stone, adhesions, or intestinal volvulus.
• X-ray with contrast agent(barium). This procedure determines if there is an obstruction. Also, with the help of x-rays, you can accurately determine the location of its localization in the small or large intestine.
• Ultrasound examination of the gastrointestinal tract.
• Colonoscopy. This procedure makes it possible to examine the entire intestine, find and examine the problematic part.

Treatment of intestinal obstruction

Features of treatment depend on the form of intestinal obstruction, its neglect and medical forecasts in each specific case. If a patient seeks help at early stages KN, then there is a possibility that conservative therapy will be carried out:

• cleansing the upper gastrointestinal tract through a special probe;
• administration of drugs that stimulate motor skills;
• administration of drugs that relieve spasms from the gastrointestinal tract.

If after conservative treatment there is no improvement in the patient’s condition within 12 hours, surgical intervention is used. During the operation, surgeons make an incision in the abdominal cavity, determine the cause of the problem and eliminate it depending on the form of the disease, for example:

• remove part of the intestine if it is necrosis;
• remove adhesions and tumors;
• correct volvulus and intestinal knots;
• in case of peritonitis, sanitation and drainage of the abdominal cavity are performed.

Postoperative period

To a greater extent, the postoperative period for intestinal obstruction depends on the severity of the patient’s condition and the operation performed. As a rule, the patient is prescribed bed rest for the first few days.

At first, nutrition can be administered to the patient intravenously. After a few days you can take the ground protein food. Next, dietary table No. 2 is prescribed.
Along with this, drug treatment is carried out. Appointed antibacterial drugs to avoid inflammatory processes in the body. In addition, it is necessary to normalize water-salt metabolism, which was disrupted during the disease. For this purpose, special drugs are prescribed intravenously or subcutaneously.

After discharge, you must adhere to diet No. 4, which is created for people with diseases of the gastrointestinal tract.

Diet

After treatment of any form of intestinal obstruction, it is necessary to strictly monitor nutrition and adhere to a diet.

As with any intestinal disease, with CI it is recommended to eat often and in small portions. This reduces the load on the gastrointestinal tract, regulates the secretion of gastric juices and bile acids, and facilitates the work of the small and large intestines.

Avoid eating foods that are too hot or too cold. Also, avoid eating rough foods that are difficult to digest. Minimize your salt intake. Drink plenty of water.

In the first month after surgery, eat pureed food. The following products are allowed:

• cereals (semolina, buckwheat, rice, oatmeal);
• lean meats and fish;
• vegetables after heat treatment that do not cause bloating;
• fruits that do not cause bloating, ground or baked;
• low-fat cottage cheese, acidophilus;
• compotes and jelly from fruits and berries.

In case of intestinal obstruction, products that promote flatulence and constipation are strictly prohibited:

• fatty meat, fish;
• cereals that are difficult to digest (millet, pearl barley);
• legumes, mushrooms;
• smoked, salted, hot, spicy foods;
• soda, coffee, alcohol;
• sweets and chocolate;
• fresh bread and pastries;
• white cabbage;
• apples;
• kefir, sour cream, cheese, cream, milk.

Complications

Intestinal obstruction is a very dangerous disease with serious complications that occur within 2-3 days. If you do not consult a doctor in time, you can greatly aggravate the situation, even leading to death. A few days after the onset of acute blockage of the small or large intestine, negative processes such as intestinal perforation may begin.

Perforation of the intestine with CI occurs when necrosis (necrosis) of some part of the intestine occurs due to poor circulation. Because for a long time feces accumulate without having a way out, and under their pressure the wall of the dead intestine ruptures, so its walls lose elasticity.

Peritonitis is an infection of the abdominal cavity. As a rule, it occurs due to perforation of the intestine and the entry of feces into the peritoneum. In case of peritonitis, urgent surgical intervention is indicated.

Prevention

In order to minimize the occurrence of intestinal obstruction or eliminate its recurrence after surgery, you must adhere to the following rules.

• Promptly treat diseases of the gastrointestinal tract that can directly cause CI: and tumors in the intestines and other organs close to it.
• When undergoing forced abdominal surgery, give preference laparoscopic methods surgical intervention, since after laparoscopy the formation adhesive processes minimal.
• Stick to it fractional meals. Overeating can negatively affect the intestines after previous obstruction surgery. Eliminate junk food from your diet.
• An active lifestyle is very important for the health of the gastrointestinal tract, as it keeps intestinal motility at the required level.

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The appearance of intestinal obstruction in all of the above pathologies is caused by overstimulation of pain nerve receptors located in the peritoneum, retroperitoneal and pleural spaces. That is, intestinal obstruction in such cases occurs reflexively and is paralytic in nature. Muscle layer the intestines are simply temporarily incapable of peristaltic movements, which makes the movement of intestinal contents difficult.

Heavy metal poisoning

In case of lead poisoning, the so-called lead colic is quite common, which is a clinical syndrome accompanied by the patient experiencing severe abdominal pain, constipation, a metallic taste in the mouth, stomatitis ( gum inflammation), bradycardia ( decrease heart rate) and some other signs. With such colic, the muscular wall of the intestine is in a spastic-atonic state ( that is, some parts of it are strongly spasmed, while others are completely relaxed), resulting in disruption of normal intestinal motility and patency.

The mechanism of development of lead colic can be explained by the adverse effects that lead has on the nervous system. The point is that this chemical element causes overexcitation of the autonomic parts of the human nervous system, which are responsible for intestinal motility. Mercury poisoning may also cause intestinal obstruction. The penetration of large amounts of mercury into the body leads to overexcitation and damage to the tissues of the central nervous system, as a result of which proper intestinal motility is disrupted.

Thrombosis and embolism of the intestinal mesentery vessels

Thrombosis and embolism ( blockage of a vessel by a foreign body, for example, a drop of fat, a gas bubble, etc.) mesenteric vessels can cause intestinal infarction ( since inside the mesentery its vessels approach the intestine), that is, an acute disruption of the blood supply to its tissues, accompanied by their immediate death. With necrosis ( dying off) intestinal tissues, the function of the intestine itself is disrupted, it loses the ability to digest food, secrete mucus, and also to push intestinal contents further along the digestive tract ( due to its peristalsis). Thrombosis and embolism usually occur with a variety of injuries to the abdominal wall, cardiovascular diseases ( myocardial infarction, heart failure, heart defects, atherosclerosis, arterial hypertension and etc.), blood diseases, surgical interventions on the abdominal organs, arteritis ( inflammatory vascular diseases), abdominal tumors, etc.

Spasmophilia

Spasmophilia is a pathological syndrome caused by a disorder of phosphorus-calcium metabolism ( metabolism). Spasmophilia most often occurs in young children ( from 2 months to 2 – 3 years) and is characterized by low calcium levels and high concentrations of phosphorus and vitamin D in the blood, as well as some symptoms ( for example, cramps, increased sweating, increased heart rate, muscle twitching, spasm of the glottis, blue or pale appearance skin and etc.).

With this pathology, intestinal obstruction may occur. The mechanism of its appearance is directly related to hypocalcemia ( decreased amount of calcium in the blood). With hypocalcemia, the nervous system becomes hyperexcitable, as a result of which a large number of nerve impulses are sent to the cells of the muscular layer of the intestine, causing it to become severely spasmodic ( shrinks) and loses the ability to develop adequate motor skills. Violation of intestinal peristalsis slows down the movement of intestinal masses through the digestive tube and leads to the development of intestinal obstruction.

Fecal stones

If the digestive processes in the intestines are disrupted, in rare cases fecal stones may form ( coprolites), which are hardened and formed feces. In most cases, they are found in older people who have certain problems with the gastrointestinal tract. Fecal stones, under certain circumstances, can cause blockage of the intestinal lumen. If they are present, the patient always has some risk of developing intestinal obstruction.

Predisposing factors to the occurrence of coprolites in the intestine are impaired peristalsis and intestinal secretion, prolonged stagnation of intestinal contents inside the digestive tract. The main reasons for the appearance of fecal stones in the intestine are various developmental anomalies of the small or large intestine, Parkinson's disease, sedentary image life, brain injury and spinal cord, chronic inflammatory bowel diseases, malignant neoplasms of the intestine, etc.

Intussusception

Intussusception is a pathology of the gastrointestinal system in which retraction is observed ( implementation) one section of the intestine into the lumen of another – the neighboring section. This pathology can occur when wide range diseases of the intestinal system ( developmental anomalies, tumors, infectious diseases intestines, etc.), as well as in case of mechanical injuries of the anterior abdominal wall and dietary disturbances. With intussusception, intestinal obstruction very often occurs. This is caused by compression of the mesenteric vessels ( strangulation) intestines, and internal obstruction ( blockage) its lumen. Intestinal blockage is localized at the level of the section into which the neighboring section has been drawn in. The intestine pulled into the lumen simply mechanically interferes with the normal movement of feces.

Such obstruction is further complicated by compression of the mesenteric vessels. Clamping of the mesenteric vessels occurs at the time of intussusception ( implementation) intestines and as edema develops in the tissues of the retracted portion of the intestine, it progresses. Compression of blood vessels leads to the death of all tissues of the intussusception ( retracted intestine), as a result of which intestinal motility and secretion are disrupted and its patency worsens.

Volvulus

Volvulus is a pathological condition in which the intestinal loop twists around its axis or the axis of its mesentery ( double layer of peritoneum, through which the intestines are suspended from back wall abdominal cavity). When intestinal volvulus occurs, external infringement of its walls occurs, as a result of which its patency is impaired and intestinal obstruction appears. The development of such obstruction during intestinal volvulus is also favored by compression of the vessels located in its mesentery, which leads to disruption of the blood supply and necrosis ( dying off) tissues of the intestinal walls. Intestinal volvulus is often observed with abdominal injuries, nutritional disorders ( overeating, vegetarianism, etc.), malformations of the abdominal organs, inflammatory diseases of the intestines and peritoneum, after surgical interventions, food intoxication, physical overload.

Splenomegaly

Splenomegaly is an enlargement of the spleen due to various reasons. The size of the spleen can increase significantly with blood diseases ( hemolytic anemia, leukemia, lymphoma, hemoglobinopathies, thrombocytopenic purpura, etc.), autoimmune diseases ( systemic lupus erythematosus, rheumatoid arthritis, periarteritis nodosa, etc.), infections ( malaria, sepsis, typhoid, blastomycosis, mononucleosis, echinococcosis, histoplasmosis, brucellosis, etc.). A significantly enlarged spleen can put pressure on the outside of the intestinal loops, which can cause intestinal obstruction.

Cystic fibrosis

Cystic fibrosis is a genetic disease in which the functioning of glandular tissue in the exocrine glands is disrupted. Cystic fibrosis is caused by a mutation in the CFTR gene ( transmembrane regulator of cystic fibrosis), located on the seventh chromosome. This gene encodes a special protein responsible for transporting chlorine ions inside various cells. Since expression ( that is, activity) of the cystic fibrosis gene is more expressed in the salivary glands, respiratory tract tissues, glandular cells of the intestines, pancreas, then, first of all, it is these tissues that suffer from this disease. In them, the production of secretion is disrupted, it becomes thick, and is difficult to separate from the surface of the cells, which causes the clinical picture characteristic of cystic fibrosis.

Intestinal obstruction in this pathology is associated with impaired digestion of food in the upper parts of the digestive tract ( stomach, duodenum) due to lack of appropriate secrets ( gastric, pancreatic and intestinal juice) and slowing of intestinal motility ( due to the presence of undigested food and a deficiency of intestinal mucus, which facilitates the movement of feces through the intestine).

Types of intestinal obstruction

There are many types of intestinal obstruction. She may be tall ( obstruction at the level of the small intestine) or low ( obstruction at the level of the large intestine), acute or chronic, complete or partial, congenital or acquired. However, first of all, this obstruction is classified depending on the mechanism of its occurrence. There are mechanical, dynamic and vascular intestinal obstruction. This classification is fundamental because it explains not only the mechanism of origin of intestinal obstruction, but also its causes, as well as some morphofunctional features of the course of the pathology.

Mechanical intestinal obstruction

Mechanical intestinal obstruction is of three types. The first of these is obstructive intestinal obstruction. It occurs with mechanical occlusion ( blockage) intestinal lumen at any level. Closure of the lumen of the small or large intestine may be due to a pathological process ( Crohn's disease, tumor, tuberculosis, scar adhesions, etc.), located in the intestinal wall ( from the inside), or may be associated with the presence of intestinal cavity gallstones, foreign bodies, fecal stones, accumulations of helminths ( worms).

Obstructive intestinal obstruction sometimes occurs when intestinal loops are compressed from the abdominal cavity. This is usually observed with tumors and cysts of organs located in the abdominal cavity and adjacent to the intestines. They can be the liver, pancreas, gall bladder, stomach. In some cases, a tumor growing from the intestine can compress its neighboring loops, which will also make it difficult for its contents to pass through the digestive tract. Mechanical compression of the intestine from the abdominal cavity also occurs with splenomegaly ( enlargement of the spleen), caused by various pathologies.

The second type of mechanical intestinal obstruction is strangulating intestinal obstruction. This type of obstruction occurs in cases where intestinal loops are strangulated in the hernial orifice ( with a hernia) or connective tissue adhesions or form nodes or twists ( twisting a loop around its axis) between themselves. In such cases, not only partial or complete blocking of the movement of intestinal contents occurs, but also compression of the intestinal mesentery occurs, which is accompanied by a disruption of its blood supply. Sudden ischemia ( lack of blood supply) of the intestinal wall leads to the rapid death of the tissues of which it consists.

The last type of mechanical intestinal obstruction is mixed intestinal obstruction. With it, simultaneous mechanical obstruction is observed ( blockage) intestinal lumen and strangulation ( compression) its mesentery, that is, a combination of the first two types of mechanical intestinal obstruction. Mixed intestinal obstruction is usually observed with intussusception ( pulling one loop into another) intestines, hernias ( external and internal) and abdominal adhesions. Mixed intestinal obstruction is very similar to strangulating intestinal obstruction ( In both the first and second cases, there is a blockage of the intestinal lumen and compression of its mesentery), however it is slightly different from it. In case of mixed intestinal obstruction, obstruction ( blockage) and strangulation run parallel and are independent of each other. With strangulation intestinal obstruction, occlusion of the intestinal lumen always depends on the degree of strangulation of its mesentery. The stronger the strangulation, the more severe the blockage of the intestinal cavity.

Dynamic intestinal obstruction

Dynamic obstruction develops due to impaired intestinal motility. In some conditions, a disorder occurs in the periodic and sequential change of contractile movements of the muscular layer of the intestinal wall, ensuring the gradual movement of intestinal contents along the entire digestive tract. Slowing or complete absence of intestinal motility leads to blocking the transit of intestinal mass through the intestinal system. This is the essence of dynamic ( functional) intestinal obstruction. It is worth noting the fact that with this obstruction there is no mechanical obstruction ( blockages) no bowel lumen or strangulation of its mesentery is observed. Depending on the mechanism of occurrence, dynamic intestinal obstruction is divided into paralytic and spastic.

Paralytic obstruction develops as a result of a significant decrease in myocyte tone ( muscle cells) intestinal wall. With such obstruction, the smooth muscles of the intestine lose the ability to contract and peristalsis, that is, its total ( full) paresis ( paralysis). There are a large number of reasons that contribute to the occurrence of this form of dynamic intestinal obstruction. They may be metabolic disorders ( metabolism) in organism ( uremia, hypoproteinemia, hypokalemia, etc.), disorders of the central nervous system ( injuries and tumors of the brain and spinal cord, strokes, etc.), inflammatory diseases of abdominal organs and tissues ( peritonitis, appendicitis, pancreatitis, cholecystitis, etc.) and chest ( pneumonia, myocardial infarction, pleurisy) cavities, etc. With paralytic intestinal obstruction, all its loops are uniformly swollen and tense ( with mechanical intestinal obstruction, bloating is observed only above the area of ​​blockage).

Symptom	The mechanism of appearance of this symptom	How it manifests itself this symptom?
Stomach ache	Abdominal pain due to intestinal obstruction is caused by damage to the nerve receptors located in the intestinal wall. Damage to receptors during mechanical and dynamic obstruction is caused by compression ( for example, when forming knots, twists between loops) or hyperextension ( with bloating) intestinal walls. Damage to the intestinal receptor apparatus during vascular obstruction, in most cases, is triggered by rapid tissue death due to a lack of blood supply. With strangulation obstruction ( a type of mechanical obstruction) nerve damage is also associated with a lack of blood supply to the intestinal walls.	Abdominal pain is the leading and most pronounced symptom. At the beginning of the disease, they occur in the form of attacks, which are followed by periods of calm. As the pathology progresses, the pain becomes constant. Abdominal pain due to intestinal obstruction is initially acute and unbearable, then it becomes aching and dull. The pain can be diffuse, diffuse, without clear localization or have a clear location.
Nausea	Nausea and vomiting initial stages diseases develop as a reflex response of the body to a violation of the passage of gastrointestinal contents through the digestive canal. In more late stages These symptoms are due to general intoxication of the body ( harmful toxins formed in the intestines and entering various organs through the blood) and hyperdistension of the upper parts of the small intestine.	Nausea and vomiting are fairly common symptoms of intestinal obstruction. They are observed in 70–90% of cases. At the beginning of the disease, the vomit consists of gastric and duodenal contents, a little later they acquire a putrid, fetid character ( fecal vomiting), which indicates serious stagnation in the small intestine.
Vomit
Headache	Headache and weakness develop as a result of intoxication of the body harmful products exchange formed during the life of intestinal microflora.	Headache and weakness are not specific symptoms of intestinal obstruction, but their occurrence is not uncommon in this pathology. These two symptoms can occur at any time during the illness.
Weakness
Bloating	Abdominal bloating is caused by a significant expansion of the intestinal loops, the causes of which are usually certain pathogenetic factors, such as the accumulation of gases and feces in the intestinal lumen, transudation of excess fluid from the vessels into its cavity, disorder nervous regulation (paresis or paralysis of the nerve endings innervating the intestinal wall).	Bloating is one of the main ( but not permanent) symptoms of intestinal obstruction ( occurs in 75–85% of cases). Abdominal bloating is usually not observed with spastic intestinal obstruction ( one of the forms of dynamic obstruction). With paralytic and vascular obstruction, abdominal bloating is most often diffuse. With obstructive and strangulation it is uneven, asymmetrical ( swelling occurs only in the area of ​​the adductor loop, while the abducent loop collapses).
Retention of stool	Stool retention with mechanical intestinal obstruction is caused by a violation of the patency of the intestinal tube, which occurs as a result of the appearance of any obstacle to the transit of intestinal contents. With dynamic intestinal obstruction, stool retention occurs as a result of disruption of its normal peristalsis. With vascular obstruction, the slowdown in the movement of intestinal contents through the intestine is associated with impaired blood supply to the intestinal walls.	Stool retention due to intestinal obstruction is not constant symptom. This should be remembered. According to statistics, this symptom occurs only in 60–70% of new cases. The patient's stool may persist if the intestinal blockage occurs in its upper sections. In such cases, the remaining intestinal contents below the area of ​​compression or strangulation will freely move towards the anus. In rare cases, only stool retention with normal gas discharge may occur.
Dry tongue	Dry tongue, tachycardia ( ), shortness of breath, decreased blood pressure occur with intestinal obstruction due to endotoxicosis and a decrease in the total volume of circulating blood ( BCC). Endotoxicosis ( internal intoxication) in the patient’s body is caused by the absorption of toxic waste products of bacteria from the intestines into the blood. A decrease in BCC is associated with extravasation ( penetration) excess fluid from the intestinal vessels into its cavity.	These symptoms ( dry tongue, tachycardia, shortness of breath, decreased blood pressure) do not develop in the patient immediately. As a rule, this occurs in the middle of the disease ( 12 – 17 hours from the onset of the disease). Some of these symptoms may develop earlier ( especially with significant pain in the abdominal area). Here everything depends on the type of intestinal obstruction, its severity, the presence of complications, and the cause of obstruction of the digestive tract.
Tachycardia
Dyspnea
Lower blood pressure

Stages of intestinal obstruction

At the very beginning of the disease ( ileus cry phase) the patient is observed sharp pains in the abdominal area. The pain syndrome is sometimes very pronounced, so it is often accompanied by signs of shock ( decreased blood pressure, increased breathing and heart rate, pale skin, etc.). The pain is not constant and often disappears for some indefinite period, after which a new attack of abdominal pain occurs. This phase usually lasts from 12 to 17 hours. The phase of ileus cry is immediately followed by the phase of intoxication. At this stage of the disease, the patient, in addition to abdominal pain, experiences vomiting, nausea, and constipation ( stool and gas retention), palpitations, sometimes blood pressure decreases, a splashing noise appears when moving in the abdominal area. Painful sensations in the stomach become permanent.

The duration of the intoxication phase does not exceed 36 hours. After 30 - 36 hours from the onset of the disease, the terminal phase begins, characterized by severe metabolic disorders and disruption of the normal functioning of many organs ( heart, kidneys, liver, lungs, brain, etc.) bloating, a sharp decrease in blood pressure, a small and rare pulse, the appearance of fecal vomiting and peritonitis ( inflammation of the peritoneum). The terminal phase of intestinal obstruction very often ends in the death of the patient.

Diagnosis of intestinal obstruction

Diagnosis of intestinal obstruction is quite difficult, since this pathology is easily confused with a large number of other diseases of organs located both inside the abdominal cavity and outside it. The main methods of its diagnosis are clinical ( anamnesis, external examination, palpation, percussion, auscultation) and radial ( radiography and ultrasound examination) research methods. In addition to them, in case of intestinal obstruction, additional examinations are also prescribed, for example, a half-glass Schwartz test, probe enterography, some types laboratory research (general blood test and biochemical blood test).

Methods used in the diagnosis of intestinal obstruction

Diagnostic method	Methodology	What signs of disease does this method reveal?
Anamnesis	Taking an anamnesis involves asking the patient’s doctor about his complaints, the time and place of their occurrence, the duration of the pathology, factors ( for example, physical activity, abdominal injuries, etc.), contributing to the development of the disease. When collecting anamnestic information, the doctor is also obliged to ask the patient about the presence of additional diseases and previous surgical interventions on the abdominal organs.	By collecting anamnesis, it is possible to determine whether the patient has symptoms and signs characteristic of intestinal obstruction ( abdominal pain, bloating, lack of stool, nausea, vomiting, etc.). In addition, you can get a lot of useful additional information that helps the doctor more accurately assess the patient’s condition, predict the course of the disease, determine and plan effective tactics treatment.
External examination of the abdomen	An external examination is a mandatory procedure that every doctor uses in his daily practice. The patient is examined in a lying position, undressed to the waist, after or during anamnesis collection.	With intestinal obstruction, abdominal bloating, asymmetry, and, quite rarely, visible intestinal peristalsis can be detected. The tongue of such patients is dry and covered with a white coating. Their general condition is usually moderate or severe. Their skin is pale. The patients themselves are quite restless, occasionally having elevated temperature body, shortness of breath.
Palpation	During palpation, the doctor examines the patient's abdomen using his fingers. This is necessary to more accurately establish the localization of abdominal pain, detect its bloating and various pathological processes (e.g. tumors, cysts).	Thanks to palpation, it is possible to identify the most painful points, which helps to suggest the level of obstruction ( blockages) intestines. If space-occupying formations are detected, one can also conclude that possible reason obstruction.
Percussion of the abdomen	During abdominal percussion, the doctor taps his fingers on the abdominal wall of the patient's abdomen. With this tapping, various sounds arise, which he analyzes.	With intestinal obstruction, a pronounced tympanic sound is heard ( drum) sound, which indicates severe bloating intestinal loops. Such sound can be local or, conversely, diffuse ( widespread). In some cases, with intestinal obstruction, percussion can reveal the sound of splashing in the abdomen.
Auscultation of the abdomen	During auscultation, the patient's abdomen is heard using a phonendoscope. This device helps to determine the presence of various noises inside the abdominal cavity.	Characteristic signs of intestinal obstruction during auscultation are hyperperistaltic sounds ( that is, noises associated with increased intestinal peristalsis ). In later stages, intestinal peristaltic sounds may disappear altogether. In such cases, the noise of a falling drop is often detected.
Radiography	An X-ray is taken with the patient standing. In case of a serious condition of the patient, such an examination is performed in the lateral lying position ( that is, lying on the left side). X-rays passing through the patient's body fall on a special film that captures them, resulting in an image being formed in which the abdominal cavity can be seen from the inside.	In case of intestinal obstruction on a radiograph ( X-ray image), as a rule, it is possible to identify Kloiber bowls ( horizontal fluid levels in intestinal loops), pneumatosis intestinalis ( accumulation of gas in its lumen). In addition to these two signs, with this pathology it is also possible to detect transverse striations in the intestinal loops, which is formed due to the thickening of the round folds of its mucous membrane.
Half-glass Schwartz test	To carry out this test, the patient is given 100 ml of a radiopaque substance to drink, and then a plain radiography of the abdominal cavity is taken.	The half-glass Schwartz test, compared with conventional radiography, can more effectively detect intestinal occlusion ( blockage) and determine its location.
Tube enterography	Probe enterography is a much more progressive diagnostic method, in contrast to the half-glass Schwartz test or simple radiography. With this method radiopaque agent injected through a special catheter directly into the cavity of the duodenum. After this procedure, an x-ray of the abdominal cavity is taken.	Probe enterography, like the half-glass Schwartz test, helps to quickly and accurately determine the presence of intestinal obstruction in a patient and establish its localization.
Ultrasonography (Ultrasound)	During this study, an ultrasonic wave transmitter is placed on the anterior abdominal wall. It is used to examine the entire abdominal cavity. This sensor not only reproduces ultrasonic waves, but also registers them. The echo signals that return to the transmitter are transported to a computer, in which the information is converted into electronic information and displayed on the screen of the ultrasound machine in the form of a picture.	In case of intestinal obstruction, ultrasound can reveal a significant expansion of its lumen, thickening of its walls, separation of round intestinal folds from each other, and accumulation of fluid in areas of the intestine that are localized above the blockage. Also, with the help of ultrasound, you can discern the presence of back-and-forth movements of the muscular wall of the intestine, which will serve as a sign of mechanical intestinal obstruction. With dynamic obstruction, a complete absence of intestinal motility can be observed.
General blood analysis	Blood sampling for general, toxicological and biochemical analysis is carried out directly from the ulnar vein. Blood is taken in the morning, on an empty stomach, into special disposable vacuum syringes ( vacutainers). Then it is delivered to the laboratory. Blood for general analysis is placed in hematological analyzers, which are necessary to count the number of cellular elements in it, as well as some other indicators. Blood for biochemical ( toxicological) analysis is placed in a biochemical ( toxicological) an analyzer that calculates the percentage of various chemicals contained in blood plasma.	With the help of a general blood test for intestinal obstruction, anemia can be detected ( decrease in the number of red blood cells and hemoglobin in the blood), leukocytosis ( increase in the number of leukocytes in the blood), increased ESR ( erythrocyte sedimentation rate) . Sometimes ( for example, with thrombosis of mesenteric vessels, splenomegaly) thrombocytosis can be detected ( increase in platelet count), shift of the leukocyte formula to the left ( that is, an increase in the blood of young forms of leukocytes - myelocytes, promyelocytes, etc.).
Biochemical and toxicological blood test		By using biochemical analysis Some pathological changes can be detected in the blood ( increased creatinine, urea, aspartate aminotransferase, alanine aminotransferase, bilirubin, decreased total protein, albumin, potassium, calcium, iron, etc.). If intestinal obstruction was caused by poisoning, then using a toxicological analysis it is possible to determine the toxic substance that caused the intoxication.

Can intestinal obstruction be treated without surgery?

Intestinal obstruction is treated by a surgeon. If a patient has symptoms of intestinal obstruction, he should immediately contact this specialist, since this disease is quite serious and can quickly lead to death. It is categorically not recommended to treat intestinal obstruction at home, since, in most cases, such treatment turns out to be useless, and in some cases it also leads to a worsening of the patient’s condition and smearing ( masking) true clinical picture at the time of admission to surgery department, which adversely affects the speed and accuracy of establishing final diagnosis. It is believed that only in 40% of patients, when they are admitted to the surgical department, conservative treatment helps eliminate intestinal obstruction.

This treatment, first of all, includes intestinal decompression, that is, the evacuation of their contents from the stomach and intestines. Nasogastric tubes are commonly used to decompress the upper bowel ( special tubes inserted into the gastrointestinal tract through the nose) or endoscopes. To resolve colonic obstruction, a siphon enema is prescribed ( rinsing the colon with warm water through a special probe). Decompression measures allow you to unload the gastrointestinal system, reduce pressure in it and reduce the amount of harmful substances in the intestines that, when released into the blood, cause general intoxication of the body.

In addition to these measures, the patient with intestinal obstruction is prescribed drug therapy, including the introduction of detoxifying drugs through a drip ( rheopolyglucin, refortan, polyglucin, etc.) and protein ( albumin, plasma) drugs. These medications help normalize microcirculation in blood vessels, equalize blood pressure, reduce internal toxicosis, and compensate for water and electrolyte losses. In addition to these drugs, novocaine paranephric drugs are also prescribed ( perirenal) blockade ( a type of pain-relieving procedure) and antispasmodics ( no-spa, papaverine, atropine, etc.). They are needed to restore normal intestinal motility. In some cases, such patients are prescribed a variety of antibacterial drugs to prevent rapid necrosis ( dying off) intestinal walls with actively multiplying in an obstructed ( clogged) intestinal microflora.

For intestinal obstruction caused by heavy metal poisoning ( mercury, lead), appropriate antidotes are prescribed ( antidotes), for example, for mercury poisoning, sodium thiosulfate or unithiol is prescribed, for lead intoxication - dimercaprol, D-penicillamine. For conditions associated with hypokalemia, which may be one of the causes of intestinal obstruction, potassium supplements are prescribed. Spasmophilia ( one of the causes of intestinal obstruction) are treated with anticonvulsants (for example, gamma-hydroxybutyric acid, seduxene), calcium chloride, calcium gluconate, magnesium sulfate. In the early stages of vascular thrombosis of the intestinal mesentery, anticoagulants are prescribed ( heparin) and thrombolytics ( streptokinase, alteplase, tenecteplase, etc.). These medications promote rapid resolution of intravascular blood clots and restore blood supply to the tissues of the intestinal walls.

Regardless of the cause of intestinal obstruction, the degree of effectiveness of conservative treatment is assessed by the general condition of the patient. If during the first 3–4 hours from the moment the patient is admitted to medical institution all the therapeutic measures did not improve his well-being, did not reduce the pain in his abdomen, and did not relieve the main symptoms of this disease and did not contribute to the normal passage of gases and stool, then a conclusion is made that it is inappropriate, as a result of which the patient is referred for surgical intervention.

Alternative treatment for intestinal obstruction

Due to the high risk of various complications ( for example, peritonitis, intestinal perforation, internal bleeding, sepsis, etc.) and death due to intestinal obstruction, it is not recommended to use folk remedies as treatment without first consulting with your doctor.

When is surgery necessary?

Emergency surgery ( that is, the operation is performed within the first 2 hours from the moment the patient is admitted to the hospital) for intestinal obstruction is necessary when, in addition to the signs and symptoms of obstruction, there are also signs of peritonitis ( inflammation of the peritoneum), severe intoxication and dehydration ( dehydration). Such signs may be low blood pressure, increased body temperature, tachycardia ( increased heart rate), tension in the abdominal wall muscles, positive Shchetkin-Blumberg symptoms ( increased abdominal pain with special palpation of the anterior abdominal wall) and Mendel ( increased abdominal pain when tapping fingers on the anterior abdominal wall) etc. Emergency surgery is also required in cases where, based on anamnesis and external examination, the doctor has the impression that intestinal obstruction is strangulation. For example, this often happens when a patient has an external abdominal hernia.

According to statistics, only 25% of new incoming patients require emergency surgical treatment, while the rest are examined within a few hours to establish an accurate diagnosis and receive conservative treatment, which includes decompression of the gastrointestinal tract and drug therapy to reduce the degree of internal intoxication and enteral ( intestinal) insufficiency. Conservative treatment should be carried out only for the first 3 to 4 hours from the moment the patient is admitted; if it is ineffective, then this fact also serves as an indication for surgical treatment of intestinal obstruction.

Surgical treatment of intestinal obstruction

Surgical treatment of intestinal obstruction consists of several successive stages. First of all, such patients are given anesthesia ( general anesthesia ). In the vast majority of cases, endotracheal anesthesia is used ( sometimes with epidural anesthesia). Duration surgical intervention, as well as its volume ( that is, the number of different surgical procedures), depends on the type of intestinal obstruction, its severity, cause, presence of complications, additional diseases organs of the cardiovascular, gastrointestinal, genitourinary and other systems. After anesthesia, a median laparotomy is performed ( an incision of the anterior abdominal wall of the abdomen right along its middle) to open the abdominal cavity and examine it. Then the abdominal cavity is cleaned of the transudate accumulated in it ( effusion of fluid from blood vessels), exudate ( inflammatory fluid), blood, feces ( which may end up in the abdominal cavity due to intestinal perforation) and etc.

Revision ( inspection) of the abdominal cavity for the presence of a blocked section of the intestine in it, they begin with a novocaine blockade ( pain relief) root of the intestinal mesentery. During the examination, attention is paid to all areas of the small and large intestines, especially their hard-to-reach and invisible parts. After determining the cause of intestinal obstruction, they begin to eliminate it. Treatment methods always vary because there are different causes of intestinal obstruction. So, for example, with the usual volvulus of a loop of the small intestine without connective tissue adhesions, they are simply unfolded in the opposite direction, without any additional surgical measures, and in case of an intestinal tumor, this is carried out complete removal with partial resection ( by cutting) its adductor and abducens sections.

During the operation ( or after it) carry out decompression ( evacuation of intestinal contents) gastrointestinal tract. This procedure carried out using special transnasal or transrectal probes ( inserted either through the nose or anus), the choice of which depends on the level of intestinal obstruction. For small intestinal obstruction, transnasal probes are used, and for colonic obstruction, transrectal ones are used. Bowel emptying can be carried out through a probe and from the intestine itself, after its enterotomy ( cutting a healthy loop of intestine). After decompression, the wound edges are sutured and the patient is prescribed various groups of drugs ( detoxifying, anti-inflammatory drugs, antibiotics, anticoagulants, microcirculation correctors, vitamins, mineral elements, etc.) to maintain normal general condition and prevention of various adverse complications ( for example, peritonitis, suture ruptures, thrombosis, sepsis, etc.).

Prevention of intestinal obstruction

Due to the presence of a large number of causes and factors that can contribute to the occurrence of intestinal obstruction, its prevention is quite difficult. However, if the patient pays close attention to his health, then this will not be such a serious problem for him.

What complications can arise from intestinal obstruction?

Despite the fact that intestinal obstruction itself is, in fact, a complication, this does not prevent it from causing other equally serious complications. In fact, intestinal obstruction is dangerous because it can lead to other most catastrophic complications ( for example, sepsis, peritonitis, intestinal perforation, etc.), which lead, in most cases, to the death of the patient. The problem is that often intestinal obstruction is complicated not by one single pathology, but by several. For example, with intestinal obstruction, bowel perforation may occur with massive internal bleeding, which then leads to peritonitis ( inflammation of the peritoneum). The appearance of such complex cascades is due to various predisposing factors, which often cannot be controlled during the treatment of intestinal obstruction, therefore, if the patient shows the slightest signs of this pathology, he should contact a surgeon as soon as possible.

The main complications of intestinal obstruction can be:

• Peritonitis. Peritonitis is a pathology in which the layers of the peritoneum, a thin membrane covering the abdominal organs from the outside and the abdominal cavity from the inside, become inflamed. The occurrence of peritonitis with intestinal obstruction is mainly due to the penetration of microflora from the cavity of the intestinal tube ( through its damaged walls) into the abdominal cavity.
• Sepsis. Sepsis is an excessive inflammatory response of the body that occurs in response to a systemic infection in which a large number of microbes multiply in the patient's blood. Bacteria entering the bloodstream during intestinal obstruction is possible due to the fact that during intestinal obstruction the tissue of its walls often undergo necrosis, which is why the vessels are exposed and the intestinal contents, containing a large number of microbes, come into contact with them.
• Intestinal perforation. Perforation ( perforation) intestine is a pathological condition in which one or more holes of varying diameters form in the intestinal wall. Through this hole ( holes) intestinal contents can enter the abdominal cavity, so intestinal perforation is a very serious complication. The appearance of perforation during intestinal obstruction is associated with an increase in intracavitary pressure in the blocked intestine, disruption of its blood supply and damage to its wall under the influence of microflora.
• Necrosis of the intestinal wall. Necrosis ( dying off) tissue of the intestinal wall occurs as a result of disruption of its blood supply. Such necrosis is a fairly common occurrence with intussusception, volvulus, thrombosis and embolism of the vessels of the intestinal mesentery, tumors and cysts of the abdominal organs. In all these cases, the intestinal vessels are either compressed mechanically or clogged with a blood clot or other foreign bodies (for example, drops of fat), due to which their permeability to blood is impaired.
• Internal bleeding. Internal bleeding is a common occurrence with intestinal obstruction, complicated by perforation ( perforation) and/or partial rupture. It appears as a result of mechanical rupture of the vessels feeding the intestines.

How to distinguish constipation from intestinal obstruction?

Constipation ( or constipation) is a symptom characterized by difficult and untimely bowel movements ( bowel movement). With constipation, there is a rare passage of small amounts of hard, dry feces, and almost every trip to the toilet causes the patient serious discomfort. To relieve himself, he often has to strain or resort to certain specific techniques, which can speed up the evacuation of rectal contents ( for example, during bowel movements, help yourself with your fingers). The frequency of trips to the toilet “in a big way” in such patients is usually reduced ( less than three times a week).

There are so-called chronic and acute constipation. The first torment patients for quite a long time and usually arise as a result poor nutrition, physical inactivity ( passive image life), pregnancy, stress, insufficient fluid intake, significant physical activity, chronic diseases of the gastrointestinal tract, taking certain medications. In acute constipation, the patient most often does not have bowel movements for several days. The causes of such constipation are usually various forms of intestinal obstruction ( mechanical, dynamic, vascular), so that in addition to the absence of stool, he also has a variety of symptoms that are observed in patients with intestinal obstruction ( abdominal pain, nausea, vomiting, fever, etc.).

Thus, acute constipation is not separate disease, but serves ( more precisely - sometimes it can serve) is only one of the symptoms of intestinal obstruction, while chronic constipation serves as an indicator of an unfavorable state of the gastrointestinal system.

Can I use a laxative if I have an intestinal obstruction?

Laxatives cannot be used for mechanical or vascular intestinal obstruction. In such situations, they will only worsen the clinical picture and increase the patient’s risk of various complications. These drugs can be prescribed only for dynamic intestinal obstruction, which appears as a result of disruption of the innervation of the intestinal walls. Considering the fact that the patient is not able to independently determine the type of intestinal obstruction that is bothering him, before using any laxative, he is recommended to first consult a doctor who can help him in this matter.

Does an enema help with intestinal obstruction?

Enemas, as a means of conservative treatment, are often used in the fight against intestinal obstruction. However, they are not used for all types of this pathology ( for example, they are not prescribed for strangulation and vascular intestinal obstruction). The main indication for an enema, as a rule, is mechanical colonic obstruction, that is, obstruction resulting from internal blockage of the lumen of the large intestine by some obstacle. Enemas are usually not recommended for patients with hemorrhoids, inflammatory and oncological diseases of the rectum, prolapse ( loss) rectum, gastric and intestinal bleeding. It should be noted that enemas for mechanical colonic obstruction do not always bring a positive effect.

Human health and well-being largely depend on the proper functioning of the gastrointestinal tract and the timely removal of waste products from the body. Failure in the normal functioning of the intestines leads to ailments, and more serious violations may cause life-threatening conditions. One of these serious complications is intestinal obstruction.

Intestinal obstruction is a syndrome caused by impaired intestinal motility or mechanical obstruction and leading to the inability to move its contents along the digestive tract.

Intestinal obstruction can be caused by a variety of provoking factors. Understanding the cause of the disease helps a lot generally accepted classification intestinal obstruction.

All forms of intestinal obstruction are divided into the following types:

By origin:

• Congenital
• Purchased

Congenital obstruction is diagnosed with congenital pathologies such as the absence of the large, small intestine or anus. All other cases of obstruction are classified as acquired.

According to the mechanism of occurrence, intestinal obstruction occurs

• Mechanical
• Dynamic

According to the clinical course

• Full
• partial
• Acute
• Chronic

According to the options for compressing the vessels supplying the intestine:

• Strangulation (with compression of mesenteric vessels)
• Obstructive (when a mechanical obstacle occurs)
• Combined (in which both syndromes are expressed)

Causes of intestinal obstruction

Let's take a closer look at what factors cause this or that type of intestinal obstruction. The causes of mechanical intestinal obstruction include:

• Disorders of the structure of internal organs, mobile cecum
• Congenital cords of the peritoneum, abnormally long sigmoid colon
• Adhesions developing after surgery
• Strangulated hernia
• Incorrect formation of the intestines (twisting of intestinal loops, formation of nodes)
• Closure of the intestinal lumen by cancerous neoplasms and tumors emanating from other abdominal organs
• Blockage of the intestines by foreign bodies (accidentally swallowed objects, gallstones or fecal stones, accumulation of helminths).
• Volvulus of one of the intestinal sections
• Meconium accumulation
• Narrowing of the intestinal lumen due to vascular diseases, endometriosis
• Invagination of the intestinal walls, which occurs when one section of it is pulled into another and blocks the lumen

Dynamic intestinal obstruction, in turn, is divided into spastic and paralytic. The spastic form is extremely rare and largely precedes the paralytic state of the intestine. The causes of paralytic ileus are:

• Traumatic operations on the abdominal organs
• Peritonitis and inflammatory diseases of internal organs
• Closed and open injuries belly

Sometimes an additional provoking factor, causing change motility and the development of intestinal obstruction can be caused by a change in diet. Such cases include consuming large amounts of high-calorie food during a long period of fasting, which can provoke intestinal volvulus. A complication can be caused by a sharp increase in the consumption of vegetables and fruits during the season, or the transfer of a child in the first year of life from breastfeeding to artificial feeding.

The main symptoms of intestinal obstruction include:

In addition to these basic features, there is whole line other specific symptoms that only a specialist can understand. During the examination, the doctor may pay attention to characteristic gurgling sounds in the abdominal cavity or their complete absence, which may indicate a complete shutdown of intestinal motility.

With progression of the disease and failure to provide medical care the pain may subside within 2-3 days. This is a bad prognostic sign, as it indicates a complete cessation of intestinal motility. Another ominous sign is vomiting, which can become severe. It can become repeated and indomitable.

First, the contents of the stomach begin to leave, then the vomit mixes with bile and gradually turns greenish-brown. Abdominal tension may be severe and the abdomen may be distended like a drum. As a later symptom, after about a day, absence of stool syndrome and the inability to pass feces may develop.

In the absence of treatment or late treatment medical assistance There is a drop in blood pressure, increased heart rate, and the development of shock. This condition provokes a large loss of fluid and electrolytes with repeated vomiting, intoxication of the body with stagnant intestinal contents. A life-threatening condition develops that requires emergency medical attention.

Diagnostics

When threatening symptoms It is necessary to urgently seek medical help and undergo an examination to clarify the diagnosis. After the examination, the patient is prescribed laboratory tests of blood and urine, in addition, it will be necessary to undergo fluoroscopy and ultrasound.

1. At x-ray examination abdominal organs reveal specific symptoms of intestinal obstruction. The images will show swollen intestinal loops, overflowing with contents and gas (the so-called intestinal arches and Kloiber's cups).
2. An ultrasound examination confirms the diagnosis by the presence of free fluid in the abdominal cavity and distended intestinal loops.

If the diagnosis is confirmed, the patient should be urgently hospitalized in the surgical department. In a hospital setting, it is possible to conduct repeated examinations using irrigoscopy and colonoscopy.

• Emergency irrigoscopy is performed to identify pathologies in the colon. In this case, the intestine is filled with a barium suspension using an enema and X-ray photographs are taken. This will allow you to assess the dynamics of the disease and determine the level of obstruction.
• The large intestine is cleaned with an enema and a flexible endoscope is inserted through the anus to visual inspection intestines. This method allows you to detect a tumor, take a piece of tissue for a biopsy, or intubate a narrowed section of the intestine, thereby eliminating the manifestations of acute intestinal obstruction.

It is important to conduct a vaginal or rectal examination. Thus, it is possible to identify pelvic tumors and obstruction (blockage) of the rectum.

IN difficult cases in a hospital setting, it is possible to perform laparoscopy, when through a puncture in the anterior abdominal wall An endoscope is inserted and the condition of the internal organs is visually assessed.

Possible complications

In the absence of medical attention, intestinal obstruction can cause dangerous, life-threatening complications for the patient.

• Necrosis (death) of the affected area of ​​the intestine. An intestinal obstruction can cause blood flow to a certain area of ​​the intestine to be cut off, causing tissue death and can cause the intestinal wall to perforate and leak contents into the abdominal cavity.
• Peritonitis. It develops when the intestinal wall is perforated and an infectious process joins. Inflammation of the peritoneum leads to blood poisoning (sepsis). This condition is life-threatening and requires immediate surgical intervention.

Intestinal obstruction in children can be congenital or acquired. In newborns, intestinal obstruction is most often congenital and occurs due to intestinal malformations. This may be an abnormal narrowing of the intestine, strangulation of intestinal loops, an elongated sigmoid colon, disturbances of rotation and fixation of the mid-intestine, anomalies leading to closure of the intestinal walls.

Reason acute obstruction in newborns, there may be intestinal blockage with meconium (feces increased viscosity). In this case, the baby has a lack of stool, a large accumulation of gases, due to which the upper part of the tummy swells and vomiting begins with an admixture of bile.

In children infancy Often a specific type of intestinal obstruction is observed, such as intussusception, when part of the small intestine is inserted into the large intestine. Intussusception occurs frequently painful attacks, vomiting, instead of feces from anus mucus and blood are released. The development of the anomaly is facilitated by the mobility of the colon and the immaturity of the peristalsis mechanism. This condition is observed mainly in boys aged 5 to 10 months.

Intestinal obstruction in children is often caused by an accumulation of worms. A ball of roundworms or other helminths clogs the intestinal lumen and causes spasm. Intestinal spasm can be very persistent and cause partial or complete obstruction. In addition, sudden changes in diet or earlier initiation of complementary feeding can lead to peristalsis disturbances in children.

In children under one year of age, adhesive intestinal obstruction may be diagnosed, which occurs after operations or due to the immaturity of the digestive system against the background birth injuries, intestinal infections. An adhesive process in the abdominal cavity can cause volvulus. Children are very mobile; when running or jumping, a loop of intestine can wrap around the cords of the commissure.

Acute adhesive obstruction V early age- Very dangerous complication, giving a high mortality rate. Operations to remove the affected part of the intestine are technically complex; in children it is very difficult to sew together the thin intestinal walls, since there is a high risk of intestinal perforation.

Symptoms of acute obstruction in children manifest themselves in sharp cramping pain, bloating, and painful vomiting. Indomitable vomiting is more often observed with volvulus of the small intestine. First, food remains are present in the vomit, then bile mixed with meconium begins to come out.

If the colon is affected, vomiting may be absent, gas retention, bloating and abdominal tension are noted. The cramping pain is so severe that the child cannot cry. When the attacks of pain pass, the child becomes very restless, cries and finds no rest.

Any type of intestinal obstruction in children requires immediate hospitalization. Congenital intestinal obstruction in newborns is treated operationally. Urgent surgical intervention is necessary in case of intestinal volvulus and other emergency situations. Conservative treatment is carried out in cases where the cause of obstruction is functional impairment.

Once the diagnosis is confirmed, the patient is hospitalized in a surgical hospital. The patient must be examined by a doctor; before the examination, it is forbidden to give the patient painkillers or laxatives, perform an enema or gastric lavage. Emergency surgery is performed only for peritonitis.

In other cases, treatment begins with methods conservative therapy. Therapeutic measures should be sent for withdrawal pain syndrome, fight against intoxication of the body, recovery water-salt metabolism, removal of stagnant intestinal contents.

The patient is prescribed hunger and rest and emergency treatment is started. therapeutic measures:

• Using a flexible probe inserted into the stomach through the nose, the upper parts of the digestive tract are cleared of stagnant contents. This helps stop vomiting.
• Intravenous administration of solutions is started to restore the water-salt balance of the body.
• Painkillers and antiemetics are prescribed.
• For severe peristalsis, use antispasmodics(atropine, no-shpu)
• To stimulate intestinal motility in cases of severe paresis, proserin is administered subcutaneously

Treatment of functional (paralytic) intestinal obstruction is carried out by using medications , which stimulate muscle contraction and promote the movement of contents along the digestive tract. Such obstruction is most often a temporary condition and lasts for several days with proper treatment its symptoms may disappear.

If conservative therapy is ineffective, surgical intervention is performed. In case of intestinal obstruction, operations are aimed at eliminating mechanical blockage, removing the affected part of the intestine and preventing a recurrence of obstruction.

In the postoperative period, measures continue to be taken for intravenous administration of blood substitutes and saline solutions to restore electrolyte balance. Carry out anticoagulant and anti-inflammatory therapy, stimulate motor-evacuation functions of the intestines.

In the first few days after surgery, the patient must remain in bed. You can drink and eat only after the permission and recommendations of your doctor. You should not eat or drink anything for the first 12 hours. At this time, the patient is fed intravenously or using a tube through which liquid nutritional mixtures are supplied. To reduce the load on postoperative sutures, you can only get up and walk after the intervention with a special orthopedic bandage.

Prognosis and prevention of obstruction

A favorable prognosis for the treatment of intestinal obstruction depends on the timeliness of medical care. You can’t delay seeing a doctor, otherwise if you develop severe complications high risk of death. An unfavorable outcome may occur when late diagnosis, in weakened and elderly patients, in the presence of inoperable malignant tumors. If adhesions occur in the abdominal cavity, relapses of intestinal obstruction are possible.

TO preventive measures prevention of intestinal obstruction includes timely detection and removal of intestinal tumors, treatment helminthic infestations, prevention of adhesions and abdominal injuries, proper nutrition.

Treatment of intestinal obstruction with folk remedies

In case of intestinal obstruction, self-medication is extremely dangerous, as it can be fatal. Therefore the recipes traditional medicine can only be used after consultation with a doctor and under his direct supervision.

Traditional methods are used to treat only partial intestinal obstruction, if the disease is chronic and does not require surgical intervention. Optimal method The patient must choose treatment together with the doctor. This approach will avoid exacerbation of the disease and the development of dangerous complications.

Juice from sea buckthorn berries has a pronounced anti-inflammatory effect, and sea ​​buckthorn oil acts as a mild laxative. To prepare the juice, a kilogram of berries is washed, placed in a container and crushed. The crushed berries are mixed and the juice is squeezed out of them. Take 100 g of juice once a day half an hour before meals.

To prepare the oil, 1 kg of sea buckthorn fruit is ground with a wooden spoon and left in an enamel container for a day. After this period, up to 90 g of oil accumulates on the surface of the pureed mass. It is collected and drunk 1 teaspoon three times a day before meals.

• Treatment with dried fruits. For cooking remedy take 10 tablespoons of dried plums, dried apricots, figs and raisins. The dried fruit mixture is washed well and poured with boiling water overnight. In the morning, everything is passed through a meat grinder, 50 g of honey is added and mixed well. Take one tablespoon of the prepared mixture daily before breakfast.
• Treatment plum broth . This decoction acts as a mild laxative. To prepare it, 500 g of pitted plums are washed and poured cold water and cook over low heat for about an hour. The finished broth is topped up with water to the previous level and allowed to boil again. Drink chilled, 1/2 glass three times a day.

The main recommendations for intestinal obstruction are to limit the amount of food consumed. In no case should you overeat, this can lead to an exacerbation of symptoms when chronic obstruction. Meals should be fractional, you need to eat every 2 hours, in very small portions. The calorie content of the diet is only 1020 Kcal. Every day the diet should contain carbohydrates (200 g), proteins (80 g), fats (50 g). The maximum volume of liquid should not exceed 2 liters per day.

Products that cause gas formation are completely excluded, whole milk and dairy products, dense dishes, carbonated drinks. The purpose of such a diet is to eliminate fermentation and putrefactive processes in the gastrointestinal tract. All irritants of mechanical, thermal or chemical types are excluded. Food should be as gentle as possible, pureed or jelly-like, at a comfortable temperature (neither hot nor cold).

The basis of the diet should be weak, low-fat meat broths, mucous decoctions, pureed or pureed dishes. You can cook pureed porridge in water, cottage cheese and egg soufflés, and light omelettes. It is better to eat meat in the form of steamed cutlets, meatballs, and quenelles. Jelly, fruit jellies, and fermented milk drinks are useful. For drinks, green tea, rosehip, blueberry or quince infusions are preferable.

Flour and flour products are excluded from the diet confectionery, fried and hard-boiled eggs, fatty meats and fish, pickles, smoked meats, canned meat and fish, caviar. Raw vegetables, pasta, pearl barley, millet or barley porridge are not recommended. Use butter limited, no more than 5 g of oil can be added to dishes per day.

You cannot drink carbonated and cold drinks, cocoa, coffee and tea with milk. Salty and spicy dishes, seasonings, rich fish, meat and mushroom broths are excluded from the menu. You should not eat legumes, greens and vegetables containing coarse fiber (cabbage, radishes, radishes, turnips). All other vegetables must not be eaten raw; they must be boiled, stewed or baked.

In case of intestinal obstruction, the main goal of the diet is to unload the intestines, exclude indigestible food and limit its volume. Such a diet will improve the patient’s condition and help avoid exacerbation of the disease.