Intestinal obstruction. Intestinal obstruction postoperative period

Treatment of intestinal obstruction is first carried out conservatively, if it is ineffective, it is used.

Conservative treatment of intestinal obstruction

The treatment of any type of obstruction is always first conservative, which in one part relieves obstruction, and in the other is the preoperative preparation of the patient. In addition, about half of all patients with obstruction are cured by conservative methods.

In the absence of peritoneal phenomena, the repeated use of siphon enemas is first shown, which can sometimes eliminate fecal obstruction, straighten the volvulus of the sigmoid colon, and produce ileocecal or colonic disinvagination.

Gastric lavage, and sometimes prolonged active aspiration of its contents using a thin probe inserted through the nose, are very effective techniques.

Perirenal novocaine blockade has become widespread, which is a therapeutic and diagnostic technique that sometimes makes it possible to distinguish between mechanical and dynamic obstruction.

In the treatment of intestinal obstruction, accompanied by bouts of abdominal pain, the use of 1 ml of a 0.1% solution of atropine is indicated, and for intestinal paresis - eserin and hypertonic saline solution. With mechanical obstruction, the use of these drugs is indicated after the removal of the obstruction. Conservative therapy is indicated for all forms of dynamic obstruction. It also benefits in the initial phases of adhesive obstruction.

In patients with peritonitis, intoxication, collaptoid state or shock, a siphon enema, pararenal blockade, the introduction of atropine and ezerin should not be performed. They need to raise their heart activity, eliminate dehydration, reduce intoxication, improve protein, water-salt metabolism. Such patients are injected with cardiac agents, glucose, pantopon, empty and wash the stomach, transfuse single-group blood, plasma or protein hydrolysates, intravenously and subcutaneously inject up to 1 liter of saline. With nodulation, other severe forms of strangulation obstruction, the use of other anti-shock measures is also indicated.

Surgical treatment of intestinal obstruction

Surgical activity with mechanical obstruction is 95%. The remaining 5% of patients do not undergo surgical treatment of intestinal obstruction (4.31% due to the severity of the condition and 0.69% due to the fact that the diagnosis is not established in vivo).

Indications and contraindications for surgery

With mechanical obstruction in the vast majority of patients, surgery is the only saving measure, therefore, contraindications for its production are limited only to the extremely difficult condition of the patients. The modern development of abdominal surgery, anesthesia and anti-shock measures does not allow interventions only in the preagonal and agonal state of patients.

Anesthesia is of great importance for the outcome of surgical treatment of intestinal obstruction. The following types of anesthesia are used: anesthesia, local anesthesia, spinal anesthesia. Each method has its own advantages and disadvantages that should be considered.

Intratracheal anesthesia and curare-like substances are widely used as muscle relaxers; this type of anesthesia has great advantages.

Regardless of the type of anesthesia, novocaine blockade of the mesentery of the small intestine and the solar plexus and celiac nerve is absolutely indicated.

Operational accesses and techniques

When localizing the obstruction in the area of the ileocecal angle, it is better to use the right lower pararectal or oblique incision; with localization in the area of the hepatic or splenic corners of the colon - an oblique incision; when localizing an obstruction in the sigmoid colon - with the left lower pararectal or oblique incision. If it is impossible to establish the nature and localization of the obstacle, as is the case in most observations, then it is most advisable to make a lower median, and then, if necessary, lengthen the incision upward or supplement it with a transverse one.

The liquid in the abdominal cavity is best removed with a water jet or electric pump. Gauze wipes are less suitable, as they injure the serous cover of the abdominal organs more.

The location of the obstruction is determined by the condition of the intestinal loops: they are swollen above the obstruction, and collapsed below. The revision starts from the ileocecal angle. If the cecum is collapsed - an obstruction in the small intestine, if it is swollen, then you should look for it along the colon. Inspection of the gastrointestinal tract is better to start from the ileocecal angle also because it is here that the cause of acute intestinal obstruction is most often localized. It must be remembered that the obstacle may not be in one, but in two or more places at the same time, which requires an examination of the entire intestine.

When the localization and nature of the obstruction is established, the very first treatment for intestinal obstruction should be to eliminate the cause of the circulatory disorder, which is often the removal of a mechanical obstruction. This happens with all forms of internal infringement, many forms of adhesive obstruction, volvulus, nodulation and bowel.

When the intestines are overstretched by the contents, to restore blood circulation, it is necessary to reduce the intra-intestinal pressure. This is achieved by puncturing the intestine through a previously applied purse-string suture with a trocar or a thick needle with a rubber drainage tube put on it. The intestines should be emptied as much as possible, without resorting to the milking method, in which the intestinal loops are injured and their postoperative paresis is aggravated.

With impaired viability of the intestine and its obvious necrosis, resection is performed. When deciding on resection and the size of the area to be removed, it should be remembered that necrosis begins from the mucosal side and subsequently spreads to all layers of the intestinal wall, and the peritoneum is affected by the latter. This may lead to an overestimation of the viability of the intestine and subsequently end in an unfavorable outcome. Therefore, any intestinal loop of dubious viability should be resected within apparently healthy ends with the imposition of an anastomosis according to one of the accepted methods, preferably end-to-end. In this case, the adductor knee must necessarily be resected over a longer distance (40-50 cm from the site of necrosis) than the efferent one (15-20 cm from the site of necrosis).

Peritonitis is not a contraindication for resection of a non-viable or gangrenous bowel in the treatment of bowel obstruction.

The severity of the patient's condition also cannot serve as a contraindication for resection of the dead area. Other surgical techniques in the form of delimiting a dead loop with tampons in the abdominal cavity or removing a dead section of the intestine into the surgical wound can only be performed for special indications, since these techniques are more difficult for the patient than bowel resection.

Any kind as an independent method of treatment for neglected mechanical obstruction is not currently used, except for non-removable malignant neoplasms, accompanied by obstruction of the distal part of the colon: the imposition of an unnatural anus in such cases only eliminates acute obstruction and somewhat prolongs the life of patients.

If an unremovable tumor of the obstructed intestine is localized in higher parts of the intestine, an internal bypass, interintestinal anastomosis can be applied. A similar indication for such an operation in the treatment of intestinal obstruction can sometimes serve as extensive intestinal adhesions in which it is not possible to establish the exact localization of the obstruction. Enterostomy has not lost its significance as an independent method of treating severe forms of paralytic ileus, including after surgery for diffuse peritonitis. Surgical intervention in such patients should be as sparing as possible, since severe, debilitated patients do not tolerate relaparotomy. Under local novocaine anesthesia, a small incision is made in the abdominal wall in the lower quadrant on the left or right. The first swollen intestine that fell into the hands of the surgeon is carefully removed into the wound and a fistula is applied to it, preferably like a hanging ileostomy according to Yudin, the advantages of which over the usual labial intestinal fistula are obvious. With it there is no uncontrolled wetting of linen, there is no severe maceration and ulceration of the skin, and it closes itself when it is no longer needed.

Treatment of bowel obstruction after surgery

The first hours there is a constant threat of development or deepening of postoperative shock. For the purpose of prevention and treatment of its patients, transfusion of one-group whole blood, plasma, anti-shock fluid, protein hydrolysates, cardiac agents, morphine, glucose, physiological saline solution is used.

In the fight against postoperative paresis, a very effective therapeutic measure is the constant aspiration of the contents of the stomach with a thin probe inserted through the nose, since a large amount of fluid accumulates in the stomach, the timely aspiration of which, in combination with other measures, prevents the development of postoperative paresis of the gastrointestinal tract.

Recently, the introduction of a probe into the intestine during surgery has begun to be recommended again. A thin, long probe is passed through the esophagus, stomach, and duodenum into the small intestine. This allows postoperative aspiration of intestinal contents and removal of gases, which eliminates excessive bloating.

Aspiration continues 2-4 days after the obstruction is removed. The amount of fluid should be replenished by paraenteral drip method of 3-4 liters of 5% glucose solution or saline solution per day with the addition of 1 ml of 1% ephedrine for every 1000 ml of fluid administered.

In the presence of peritonitis, a complex should be used. In order to prevent peritonitis, the introduction of capillary vinyl chloride or nipple tubes into the abdominal cavity during surgery should be more widely used for the subsequent administration of antibiotics and novocaine through them.

Unfavorable results in the treatment of intestinal obstruction were noted where the operation for mechanical obstruction ended with resection of the intestine due to late admission of patients, and in repeated operations for adhesive obstruction, where even more extensive adhesions developed after the next laparotomy.

Further improvement of the long-term results of the treatment of intestinal obstruction depends on the speed of hospitalization, on reducing the time from the moment of admission to the moment of surgery, and on improving the skills of surgeons. Perfect surgical technique, the strictest asepsis, complete hemostasis and peritonization of surfaces deprived of peritoneum give the best results of surgical treatment of this disease.

The article was prepared and edited by: surgeon

If intestinal obstruction is found in the elderly, what should be done in the presence of such a dangerous disease? Where to apply? What drugs to take? Is it possible to recover qualitatively, without surgical intervention?

One of the keys to good physical health is the normal functioning of the intestines. Violation of the natural movement of the contents (half-digested food masses) causes a state of obstruction in this organ, which is very dangerous and for the most part inherent in elderly people.

Types of intestinal obstruction

If intestinal obstruction is detected in the elderly, only a specialist decides what to do. This disease, depending on the causes of occurrence, is divided into two types:

In turn, the first of them is divided into:

obstructive - the intestinal walls are simply squeezed;
strangulation - squeezing the walls is accompanied by a violation of the nutrition of their vessels, the pain is permanent.

Bowel obstruction in the elderly is of two subspecies:

Spastic, in which there is an increase in peristalsis (wave-like contractions that help push food through which provokes intestinal spasm;
Paralytic. The walls of the intestines are relaxed, which causes a complete stop of peristalsis.

Constipation is the main symptom of intestinal obstruction

Intestinal obstruction in the elderly, the causes of which are mostly due to malnutrition, age-related diseases, internal formations, is indicated by such a clear sign as constipation - the absence of gas and feces. Most often, it is caused by a sedentary lifestyle, characteristic of most elderly people and providing insufficient blood supply to the small pelvis and weakness of the pelvic muscles.

One of the options to alleviate the situation is a light massage of the abdomen, relaxing exercises, physiotherapy procedures aimed at stimulating intestinal motility.

With obstruction of a partial nature or localization of its focus in the upper intestine, the stool is meager, and the discharge of flatus is insignificant. Along the way, there is a clear "skewness" of the abdomen, bloating, frequent vomiting.

Phases of the disease

Initial. It is manifested by severe pain at the site of the focus, which spread throughout the abdominal region. The patient has a constant loud seething that can last 12 hours, after which the noises completely disappear: the disease develops into another stage.
Intoxication. It is characterized by difficult evacuation of feces, vomiting, bloody diarrhea, cramping constant pain, each attack lasts about 10 minutes. Bloating is asymmetrical, the patient has a significant loss of strength, the body is covered with cold sweat. The duration of this condition lasts from 2 to 3 days and signals a complete failure of the motor function of the intestine.
Peritonitis is inflammation of the peritoneum.

If suddenly there is intestinal obstruction in the elderly, what should I do? How to help a sick person?

At the slightest suspicion of the presence in the body of such a dangerous disease that poses a direct threat to human life, you should go to the hospital as soon as possible, thus increasing the chances of a speedy recovery.

Possible consequences of self-medication

It is important to understand that before examining a doctor, you should not wash your stomach yourself, do enemas, take laxatives and painkillers. After all, intestinal obstruction in the elderly, the symptoms of which are primarily determined by constipation and pain in the abdominal region, threatens with such undesirable, life-threatening consequences as heart failure, as well as kidney and liver failure.

The necrosis (necrosis) of the intestine can cause squeezing of the vessels. At an advanced stage of the disease, even surgical intervention cannot give a firm guarantee for the patient's recovery. Therefore, unwillingness to go to the hospital, misunderstanding of the seriousness of the situation, the decision to be treated independently, without consulting a doctor, can only harm an elderly person who has

Diagnostic methods

Diagnosis of intestinal obstruction consists in an initial survey and a thorough examination of the patient by a gastroenterologist. The doctor prescribes general urine and blood tests, and after receiving the results, certain examination methods:

Ultrasound of the abdomen is the most common way to detect intestinal obstruction, which allows you to clarify the clinical condition in both dynamic and mechanical forms;
a biochemical blood test that examines such indicators as protein, lipids, carbohydrates, enzymes, minerals, electrolytes, inorganic substances, protein metabolism products;
x-ray diagnostics of the abdominal cavity;
detailed blood test;
Schwartz tests to help identify small bowel obstruction;
colonoscopy - the study of the surface of the colon from the inside.

Through a vaginal or rectal examination, it is possible to detect blockage of the rectum, as well as tumors in the pelvis. During an external examination, the peristalsis of intestinal loops can be determined by a physician by a dry tongue coated with white coating and asymmetrically

If you suspect a bowel disease or a confirmed diagnosis, hospitalization is simply necessary.

Treatment of intestinal obstruction

In the presence of symptoms such as constipation and pain in the abdominal region, a medical examination in most cases confirms the diagnosis of "bowel obstruction" in the elderly. How to treat this disease in a hospital?

Initial therapy consists in the use of conservative methods, combined, if necessary, with clarifying diagnostics. These are enemas (removal of stagnant feces), drainage of the stomach, the introduction of medicinal compounds that relieve pain and help remove toxins. Such measures are effective in the dynamic variety of the disease and partially in the mechanical one.

Effective therapy is considered when the patient disappears pain, bloating and the absence of vomiting. Along the way, gases and feces should pass from the intestines. The prescribed radiography allows you to fix how positive the changes in the patient's physical condition are.

Of the therapeutic measures are carried out:

the introduction of a flexible probe into the stomach, which causes the release of stagnant contents in the upper part of the digestive tract;
intravenous administration of a solution in order to normalize the water-salt balance;
the appointment of painkillers and antiemetic drugs;
the introduction of the drug "Prozerin" in order to stimulate the activity of the intestine.

Bowel obstruction in the elderly: surgery

If after 12 hours no improvement is observed, an operation is urgently prescribed, during which adhesions are dissected, twists are straightened and loops, nodes, tumors that interfere with the movement of intestinal contents are removed. In severe cases, several surgical interventions may be used. These manipulations can restore intestinal obstruction in the elderly.

After the operation, the patient should not eat or drink for 12 hours. Nutrition, which is based on special mixtures, is administered intravenously during this period or using a probe. Only after the approval and permission of the attending physician, the patient is transferred to a "zero" meal, consisting of easily digestible foods. Salt in the diet should be no more than 1-2 g per day. The portion size is very small, meals are divided into 6 or 8 meals during the day. Dishes should be served in a jelly-like or grated state, warm (hot and cold are prohibited). The basis is low-fat meat broths, homemade berry-fruit jellies, juices and decoctions.

How to cure bowel obstruction in the elderly? The operation (the prognosis of which, given its timeliness, is mostly favorable) may not give the desired effect, when contacting doctors in the later stages or late diagnosis of intestinal obstruction. Also, neoplasms of an inoperable form may indicate an undesirable outcome of this disease.

If intestinal obstruction was diagnosed in the elderly, the operation, the prognosis of which we have already named, can also give a bright hope for a speedy recovery. But patients need to carry out such preventive measures as constant examinations and timely elimination of helminthic infections. If possible, injuries should be avoided and a balanced diet should be followed.

Bowel obstruction in the elderly: diet

An important role in the treatment of intestinal obstruction is played by a diet, the action of which is aimed at ridding the body of complex work and excessive nutritional stress. Its main principles are:

moderate and frequent meals. Any overeating causes an aggravation of the symptoms of the disease, and a fractional meal does not cause a feeling of hunger;
the absence in the diet of products that cause gas formation: cabbage, legumes, whole milk;
low calorie content: 1800-1900 kcal.

Menu for intestinal obstruction

We offer a suggested menu for intestinal obstruction, but you should definitely consult with your doctor about its contents:

The first breakfast is oatmeal cooked in water and grated, cottage cheese soufflé and tea.
Second breakfast - blueberry or quince broth.
Lunch - light low-fat broth, grated porridge from rice or semolina, steam meatballs, jelly.
Snack - a decoction based on wild rose.
Dinner - buckwheat porridge cooked on water (in grated form) or steam omelet, tea.
Before going to bed - fruit or berry jelly.

Symptoms such as prolonged constipation and abdominal pain may indicate bowel obstruction in the elderly. What to do when confirming this diagnosis?

Treatment of a dangerous disease requires qualified medical assistance. The use of folk methods is possible only after consulting a doctor, because for a patient an attempt at self-therapy can end very sadly. Alternative methods can be used if the disease is chronic, in which the obstruction is partial and does not require surgical intervention.

Sea buckthorn to help

You can remove internal inflammation and heal wounds with sea buckthorn juice and oil, which also has a slight laxative effect. To do this, rinse and grind 1 kg of berries, pour 0.7 liters of boiled cooled water. Squeeze out the juice. Drink half a glass 1 time per day 30 minutes before meals.

To prepare oil from sea buckthorn, you need to grind 1 kg of berries with a wooden spoon. Pour the resulting juice into an enamel bowl and leave for a day, after which collect the oil that has appeared on the surface. Approximate output from 1 kg of fruit - 90 g of the product. Oil is required to be taken in a teaspoon three times a day for half an hour before meals.

Available Treatments for Bowel Obstruction

How to cure bowel obstruction in the elderly? What to do? Folk remedies recommend the use of vegetables: pumpkins and beets. Helping to relieve intestinal colic, such products have a laxative effect on the body.

Boiled beets (100 g) should be combined with honey to taste and 2 tbsp. spoons of olive or sunflower oil. The resulting mixture is recommended to eat 2 times a day for 2 tbsp. l., drinking water. A small portion of pumpkin porridge with honey, taken every day, will also be useful for the body.

Ancient healers with constipation associated with poor intestinal patency advised to introduce bran into the diet. Every morning, you need to steam 2 tablespoons of the product with a glass of boiling water and insist for an hour. Then the cooled water must be drained, and the thick mass that has settled, after chewing thoroughly, is eaten. After a week, the chair will improve and the physical condition will noticeably improve.

As an effective laxative, it is recommended to use a decoction of fresh plums: half a glass three times a day. Half a kilogram of fruit free from seeds, pour water and boil. Boil on fire for about an hour. Add the finished product with water to the original level and boil again.

Herbal solutions in the treatment of the intestines

(1 tablespoon) is required to brew a glass of boiling water, insist and drink instead of the usual tea. The drink has a mild laxative effect, without any adverse reactions.

Intestinal obstruction in the elderly, in which the diet is one of the main factors in restoring the work of an important organ, is eliminated by infusion of flax seeds. It is recommended to take it shortly before going to bed. A teaspoon of raw materials should be steamed with a glass of boiling water, wrapped and insisted until morning in a warm place. Further, the remedy, characterized by a slight laxative effect, is required to be drunk along with the seeds.

Flaxseeds are also an effective basis for anti-inflammatory and cleansing enemas: a spoonful of raw materials needs to be steamed with a glass of boiling water. After an hour, filter the liquid and use as directed.

An infusion of blackberry leaves has an excellent laxative property. A tablespoon of raw materials should be brewed with a glass of boiling water and infused in a thermos for 4 hours. Healing agent to take a quarter cup during the day before meals.

It is important to remember that in order to restore intestinal patency, the diet should include foods containing a high percentage of dietary fiber (bread with bran, cereals, fruits, vegetables), and drink enough liquid to help swell dietary fiber, which improves peristalsis.

Of great importance is a mobile lifestyle (exercise, jogging, dancing), which contributes to the rapid establishment of the work of internal organs.

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Intestinal obstruction operation consequences

Treatment of intestinal obstruction

Among all the digestive organs, the intestines are the most mobile and have a large length - about 4 meters. It consists of 2 sections - small and large intestine, which in turn are also divided into sections that differ in their function. Movement (peristalsis) facilitates the passage of food, and secreted enzymes and abundant blood supply ensure its digestion and absorption.

In the thin section, which includes the duodenum, jejunum and ileum, the processes of splitting, enzymatic processing of food and absorption of nutrients, the production of immune bodies take place. The thick section, including the blind, colon, sigmoid and rectum, performs the function of absorption of salts, water, the formation of vitamins due to beneficial microflora, the formation of feces and their evacuation.

When obstruction occurs, all these functions are violated: metabolic processes in tissues and organs, water-salt balance, toxins accumulate. In the absence of treatment, the outcome is not difficult to predict.

Intestinal obstruction - concept, causes, types

A condition in which the passage of the contents through the intestines is completely or partially disturbed is called its obstruction (the medical name is ileus). The reasons for this can be very different:

tumors;
inflammatory process (Crohn's disease);
adhesions in the abdominal cavity;
strangulated hernia;
atony, paresis;
blockage by gallstones;
helminthic invasion;
fecal stones;
congenital anomalies;
abdominal trauma;
thrombosis of mesenteric vessels;
volvulus.

strangulation obstruction

Ileus can be congenital, associated with abnormalities of the digestive tract, and acquired. Depending on the cause, it can be mechanical as a result of closing the lumen with a tumor, adhesions, stones; dynamic, when peristalsis is weakened; strangulation associated with circulatory disorders; and mixed. Dynamic ileus in intestinal paresis and strangulation in violation of its blood circulation, as a rule, has a more severe course and a worse prognosis.

In children, strangulation obstruction is more common - intussusception, when part of the intestine is introduced into its nearby department. Volvulus is characteristic of rare meals and overeating. Thromboembolism of the mesenteric vessels more often develops in the elderly. Adhesive ileus is a frequent complication of surgical interventions - resection of the small intestine, stomach, gynecological interventions, appendectomy, and even after removal of the fistula of the rectum.

Tip: It must be remembered that strangulated hernias often lead to the development of ileus. Therefore, the "owners" of hernias, without expecting complications, should contact a surgeon for surgical treatment, when it is much easier and safer.

Symptoms and Diagnosis

Clinical manifestations. The disease is manifested by very characteristic symptoms. These are pains in the abdomen of a cramping nature, bloating, nausea, vomiting, no passing of gases, no stool, a violation of the general condition. The clinical form of the disease can be acute, when all the listed symptoms are pronounced, and chronic, in which they appear periodically and there are no sharp violations of the general condition.

These symptoms can occur both in the early and late postoperative period after operations on the intestines and other abdominal organs, they can be expressed to varying degrees.

Tip: The appearance of any of these symptoms should be a reason for immediate medical attention. For abdominal pain and stool retention, you should not take laxatives without consulting your doctor. With inversion, intussusception, obstruction of the intestinal lumen, they will only aggravate the condition.

Diagnostics. In the case of acute ileus, the patient is admitted to the surgical department on an urgent basis, where he undergoes a rapid examination confirming the diagnosis. This is an X-ray of the abdominal organs in a vertical position, an ultrasound examination. Horizontal levels of fluid are determined - stagnant intestinal contents, as well as "Cloiber bowls", formed by the accumulation of gas in the upper sections of the intestinal loops and having the appearance of inverted bowls. An ECG is also urgently performed, as well as basic laboratory tests to prepare for the operation.

Capsule endoscopy

If the disease has a chronic course, and evacuation disorders are partial, the patient undergoes a complete examination of the abdominal organs. Initially, a contrast x-ray examination with a barium enema (irrigoscopy) is prescribed, on which narrowing of the intestinal lumen, defects in its filling, displacement by adhesions can be detected. After that, preparations for colonoscopy are carried out - the intestines are cleaned, after which they are examined using an inserted fiber-optic probe with a video camera, a lighting system and magnification. Fibrocolonoscopy allows you to identify the inflammatory process, the presence of polyps, tumors, a biopsy and histological examination are performed. Based on the results and diagnosis, the question of choosing a method of treatment is decided.

The small intestine for these research methods is difficult to access because of the many bends and loops. In modern clinics, a new unique technology of capsule endoscopy is used. The patient swallows a capsule - a miniature video camera. Moving gradually along the digestive tract, it scans all its departments, transmitting information to the display, and is brought out naturally. This diagnostic technology is not traumatic, has no contraindications and is highly informative.

In the event that barium enema or colonoscopy are difficult procedures for the patient, for example, in case of heart failure, hypertension, a computed tomography examination is performed - a virtual colonoscopy. It is painless, short in time and easily tolerated by patients. After the introduction of liquid contrast, the patient is placed on the table under the arc of the tomographic scanner, the image is transmitted to the display in a three-dimensional (3D) format, and images are taken.

Treatment

Both acute and chronic forms of the disease are in most cases treated surgically. Only at the very beginning of the disease, when the general condition of the patient has not yet been disturbed, after the examination, conservative measures are carefully applied - gastric lavage, cleansing enemas, with atony, peristalsis is stimulated with drugs (prozerin, neostigmine injections). If within a few hours the treatment is ineffective or the cause is a tumor, adhesions, anomalies, mesenteric thrombosis, surgical treatment is performed.

Surgical treatment of intestinal adhesions

During the intervention, the cause of the disease is eliminated: adhesions are dissected, the tumor, stones, torsion, infringement of the loops are removed. Not in all cases, it is immediately possible to eliminate the cause of ileus, for example, with cancer or with a serious condition of the patient. Or when a large area of the intestine is removed due to a tumor, inflammation, necrosis. Then an unloading stoma is applied after an operation on the intestines - an external fistula for emptying. It can be permanent and temporary. The latter is removed during a second operation after the cause has been eliminated and the patency has been restored.

Very often, obstruction develops as a result of adhesions after interventions on the organs of the abdominal cavity, pelvis. They stick together intestinal loops, limiting their movements, causing their fusion with other organs. How to treat intestinal adhesions after surgery or prevent their formation? For this purpose, the patient is prescribed as early as possible getting up after the operation, therapeutic exercises, prescribe proteolytic enzymes and physiotherapy, if there are no contraindications to it.

Postoperative period

The first days or weeks of the postoperative patient is in the hospital and receives all the appointments of the attending physician:

diet therapy;
intestinal stimulation;
anti-inflammatory therapy;
intravenous infusions to replenish fluids, minerals, and eliminate toxins;
physiotherapy to prevent the formation of adhesions (an exception is a tumor of the abdominal cavity);
therapeutic gymnastics.

After discharge from the department, the patient is observed on an outpatient basis and follows all the recommendations and prescriptions of the doctor. Be sure to perform special physical exercises, but with limited load.

Tip: some operated patients try to spend more time in bed, believing that it is safer this way (the wound hurts less, the stitches will not open, and so on). This is a delusion, the consequence of which may again be obstruction due to the development of adhesions against the background of hypodynamia.

And finally, the diet, the observance of which is very important. Nutrition after intestinal surgery depends on its nature and volume, and should be within the framework of individual doctor's recommendations. However, there are general nutritional rules that must be followed. This is the exclusion of spicy and coarse foods, products that cause fermentation and bloating (milk, legumes, carbonated drinks), extractive products, rich broths. Limit the amount of fats and carbohydrates, and the intake of protein and vitamins should be sufficient.

Fermented milk products containing lactobacilli and bifidobacteria are recommended to restore the intestinal microflora, fruit purees and juices, boiled mucous porridges and soups. You can expand the diet no earlier than 2-3 months, and only after consulting with a specialist.

The state of health after surgery for intestinal obstruction largely depends on the patient himself. You can avoid a second operation and prevent undesirable consequences by carefully following all the necessary medical recommendations.

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Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

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Operations for intestinal obstruction: indications, course, rehabilitation

Intestinal obstruction is a condition of an acute obstacle to the normal passage of food masses (from the stomach to the anus). It can occur anywhere in the small or large intestine.

The causes of this condition may be different, but the clinical picture, the pathogenesis of complications, the principles of treatment and the need for urgent measures are the same for all types of intestinal obstruction.

Intestinal obstruction is one of the leading causes of surgical mortality. Without timely treatment, 90% of patients die.

The main causes of death of patients with intestinal obstruction:

Shock (pain, hypovolemic);
Endotoxicosis;
Abdominal sepsis;
Peritonitis;
Severe electrolyte disturbances.

What is the obstruction

According to the mechanism of occurrence, two main types of obstruction are distinguished:

dynamic;
Mechanical.

Dynamic obstruction is the result of a violation of the normal contraction of the intestinal wall. It can be due to both a strong spasm and complete relaxation of the muscles of the intestinal wall. This type of obstruction should be treated conservatively, surgery, on the contrary, can aggravate peristalsis disorders.

Mechanical obstruction is already a real obstacle in the way of food masses in the intestines. She happens:

obstructive;
strangulation;
Mixed.

Mechanical obstruction very rarely resolves on its own or with conservative measures. It is this type of obstruction that is an absolute indication for surgery. The causes of a mechanical obstruction in the intestine can be:

It is quite easy to suspect bowel obstruction based on the clinical picture. The main symptoms are pain, vomiting, bloating, lack of stool. The same symptoms can be observed in other catastrophes in the abdominal cavity, but in any case, this is an acute condition requiring emergency hospitalization.

In the presence of such symptoms, the patient is urgently sent to the surgical department. The timing of hospitalization determines the prognosis. The later the patient was admitted to the hospital, the higher the mortality rate.

To confirm the diagnosis, an x-ray of the abdominal cavity is prescribed, an emergency irrigoscopy (an x-ray of the intestine with contrast) or a colonoscopy can be performed. Sometimes, in difficult cases, a diagnostic laparoscopy is performed.

All necessary analyzes are carried out urgently. The most important indicators here are the levels of hemoglobin, hematocrit, leukocytes, ESR, in serum - the level of protein, sodium, potassium, creatinine, amylase. The blood type and Rh factor are determined.

There are several groups of patients with symptoms of intestinal obstruction, to which different management tactics are applied:

Preparing for an operation to remove an obstruction

When a patient is admitted to the hospital:

Placement of a catheter in a central vein to control central venous pressure and parenteral infusions.
Bladder catheterization to control diuresis.
Installation of a nasogastric tube.

Principles of conservative therapy

Conservative therapy is also a method of preoperative preparation (if surgery is still required).

Aspiration of the contents of the stomach and upper intestines through the installed probe.
Carrying out cleansing and siphon enemas. Sometimes this measure can help remove an obstacle (for example, wash away dense fecal blockages).
Urgent colonoscopy. It is performed for diagnostic purposes, but can also eliminate some types of obstruction (for example, intussusception, or partially expand the intestine during obstruction).
Replenishment of fluid and electrolyte losses. To do this, under the control of CVP, diuresis, plasma electrolytes, infusions of saline, saline solutions, protein hydrolysates, rheological solutions, and plasma are carried out. Usually the volume of infused funds is up to 5 liters.
With increased peristalsis and pain, antispasmodics are prescribed, with intestinal paresis - agents that stimulate peristalsis.
Antibacterial agents are also prescribed.

Operations for intestinal obstruction

If conservative measures have not eliminated the problem, surgery cannot be avoided. The main tasks of surgical intervention:

Removing an obstacle.
If possible, the elimination of the disease that led to this complication.
The maximum possible actions for the prevention of postoperative complications and relapse.

The main stages of the operation and tactics of the surgeon

1. Anesthesia. Usually this is endotracheal anesthesia with muscle relaxants.

2. Access is most often a wide median laparotomy.

3. Revision of the abdominal cavity. Find the exact level of the obstacle. Above this point, the bowel loops are swollen, purple-bluish in color, while the efferent colon is collapsed, the color is usually not changed. The entire intestine is examined, since sometimes obstruction can be determined at different levels at the same time.

4. Decompression and cleansing of the afferent colon, if this could not be done before the operation. For this, nasointestinal intubation is performed (through the esophageal tube), or intubation directly of the intestine through a small incision.

5. Direct removal of the obstacle itself. Several types of interventions can be applied here:

Enterotomy - the intestinal wall is opened, an obstacle is removed (for example, a ball of ascaris, a foreign body, gallstones) and sutured.
When a hernia is incarcerated, the incarcerated loops of the intestine are reduced.
With strangulation obstruction - dissection of adhesions, untying of knots, elimination of intussusception and volvulus.
Resection of the intestine in the presence of a tumor or necrosis of the intestine.
Bypass anastomosis in the case when it is not possible to eliminate the obstruction in the usual way.
Imposition of a colostomy (permanent or temporary) - usually in cases of left-sided hemicolectomy.

6. Evaluation of the viability of the intestine and its resection.

This is a very crucial moment of the operation, the further prognosis depends on it. The viability of the intestine is assessed by its color, contractility and pulsation of the vessels. Any doubts about the normal state of the intestine are a reason for its resection.

With signs of intestinal necrosis, this area is resected within healthy tissues. There is a rule to resect the intestine 40-60 cm above the border of non-viability and 10-15 cm below it.

During resection of the small intestine, an end-to-end anastomosis is formed. In case of obstruction in the region of the blind, ascending or right half of the transverse colon, a right-sided hemicolectomy is performed with the imposition of an ileotransverse anastomosis.

When the tumor is located in the left half of the colon, a one-stage operation cannot be performed in most cases. In this case, a colostomy is applied with bowel resection, and subsequently a second operation is performed to remove the colostomy and create an anastomosis.

A one-stage radical operation is not performed even with developed peritonitis. In this case, the task of surgeons is to eliminate the obstruction, wash and drain the abdominal cavity.

Sometimes surgical treatment is even divided into three stages: 1 - the imposition of an unloading stoma, 2 - resection of the intestine with a tumor, 3 - the creation of an anastomosis and the elimination of the stoma.

7. Washing and removal of effusion from the abdominal cavity.

8. Drainage of the abdominal cavity.

9. Wound closure.

After operation

The postoperative stage in such patients is a very important moment of treatment, no less significant than the operation itself.

After the operation, the patient is sent to the intensive care unit. Main activities:

After 3-4 days, liquid food and drink are allowed. The diet is gradually expanding - mucous porridges, vegetable and fruit purees, meat soufflé, sour-milk products are allowed. Diets with the exception of rough, spicy foods, foods that cause increased gas formation and fermentation should be followed for up to 2 months.

Features of the operation for the most common types of obstruction

The most common type of small bowel obstruction is ileus with adhesive disease. For the large intestine, this is the occlusion of the intestinal lumen by a tumor.

Adhesive intestinal obstruction

Adhesions are scar bands in the form of bundles or films that occur after abdominal surgery. Adhesions can cause both obstructive obstruction (pinching the intestinal lumen) and strangulation (pinching the mesentery of the intestine).

The essence of the operation is the dissection of scar bands, resection of the necrotic area of the intestine. If possible, all adhesions are dissected, and not just those that caused complete obstruction.

The peculiarity of this type of obstruction is that adhesive obstruction is prone to relapse. By dissecting adhesions, we create the prerequisites for the formation of new adhesions. It turns out a vicious circle.

adhesive intestinal obstruction

In recent years, new methods have been proposed for the prevention of recurrence in adhesive obstruction. Briefly, their essence is as follows: to lay the loops of the small intestine in the abdominal cavity as correctly as possible, try to fix them in this way (sew the mesentery). But these methods do not guarantee the absence of relapses.

In addition, laparoscopic removal of adhesive obstruction is gaining popularity. This operation has all the advantages of minimally invasive surgery: less trauma, quick activation, and a short rehabilitation period. However, surgeons are reluctant to go for laparoscopic surgery for intestinal obstruction. As a rule, in the course of such operations, it is still often necessary to switch to open access.

Intestinal obstruction due to tumor

The tumor nature of obstruction is a special part of surgery. Operations with this type of obstruction are among the most difficult. Often, patients with intestinal tumors are admitted to the hospital for the first time only when the picture of intestinal obstruction has developed, the diagnosis is made on the operating table. Such patients, as a rule, are weakened, anemic long before the operation.

During the operation, there are two tasks: the elimination of obstruction and the removal of the tumor. It is very rare that this can be done all at once. The radical operation cannot be performed:

If it is technically impossible to remove the tumor.
Extremely serious condition.
With developed peritonitis.

In these cases, in order to eliminate obstruction, they are limited to removing the intestinal stoma to the outside. After eliminating the symptoms of intoxication, preparing the patient, a radical operation is performed in a few weeks - resection of the intestinal area with a tumor and elimination of the colostomy (removal of the colostomy can be delayed and transferred to the third stage).

If the patient's condition allows, removal of the tumor is carried out simultaneously with the elimination of intestinal obstruction. Removal is carried out in compliance with ablastics - that is, as widely as possible, in a single block with regional lymph nodes. For tumors in the large intestine, as a rule, a right-sided or left-sided hemicolectomy is performed.

right/left hemicolectomy

For tumors of the small intestine - subtotal resection of the small intestine. When the tumor is located in the sigmoid colon, Hartmann's operation is possible. In case of rectal cancer, an extirpation or amputation of the rectum is performed.

If it is impossible to remove the tumor, palliative operations are performed - an unnatural anus or a bypass anastomosis is created to restore patency.

Forecast

Mortality in acute intestinal obstruction remains quite high - an average of about 10%. The forecast depends on terms of the begun treatment. In those admitted to the hospital within the first 6 hours from the onset of the disease, the mortality rate is 3-5%. Of those who arrive later than 24 hours, already 20-30% die. Mortality is very high in elderly debilitated patients.

Price

The operation to eliminate intestinal obstruction is an emergency. It is carried out free of charge in any nearest surgical hospital.

A paid operation is also possible, but you need to know clinics that specialize in providing emergency care. The price depends on the scope of the intervention. The minimum cost of such operations is 50 thousand rubles. Then it all depends on the length of stay in the hospital.

The cost of laparoscopic surgery for adhesive intestinal obstruction is from 40 thousand rubles.

Video: intestinal obstruction in the program "Live healthy!"

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Surgery for intestinal obstruction: stages, consequences, diet

Intestinal obstruction leads to difficulty or complete cessation of the movement of the food bolus through the small or large intestine. Allocate mechanical (associated with an obstacle) and dynamic (due to a violation of the motor activity of the intestinal area) obstruction. Most pathological processes in which the normal movement of food through the digestive tube is disturbed require urgent treatment. The peculiarity of the treatment of this complication is that if intestinal obstruction occurs, the operation should be performed as soon as possible in the absence of the effect of the use of medications.

Why is intestinal obstruction dangerous?

What will be the consequences of the resulting obstruction depends on the immediate cause, the degree of reduction in the lumen of the intestine and the duration of this process.

The formation of adhesions with the development of intestinal obstruction is likely after surgery on the abdominal organs, with a breakthrough of an ulcer in the abdominal cavity, diseases of the internal reproductive system in women. They can occur under the influence of radiation during radiation therapy during oncological processes, as well as be long-term consequences of blunt trauma with damage to the gastrointestinal tract.

Not only intestinal cancer can cause obstruction, but also malignant neoplasms of closely located organs: the liver, adrenal glands and kidneys, bladder, uterus.

Intestinal obstruction can also occur when squeezing the ligamentous tissue that attaches the intestine to the back wall of the abdomen. Damage to blood vessels and nerves located in its thickness leads to malnutrition and regulatory activity of nerve fibers. Most often, this pathology is observed with volvulus of the intestines.

With the introduction of one part of the intestine into another, the development of invagination is possible. In this case, there is a partial overlap of the lumen by the invading part of the intestine, nerve fibers and blood vessels are pinched. Most often, such intestinal obstruction in infants up to 9 months.

All these pathologies are dangerous for their consequences in the absence of adequate and timely treatment. Violation of the normal movement of the food bolus sharply worsens the course of the underlying disease. And also in itself has serious consequences.

The most dangerous changes in intestinal obstruction:

loss of fluid, violation of the normal content of salts, acids and alkalis in the body;
poisoning with metabolic products that are not excreted through the intestines, leading to a deterioration in the functioning of all internal organs;
the occurrence of incessant vomiting, nausea;
malnutrition of organs and tissues;
activation of the processes of decay and reproduction of pathogenic microbes;
necrosis of the intestine, in the most severe cases - rupture of the wall with the ingress of contents into the abdominal cavity and the development of purulent inflammation.

With the further development of the pathology, the purulent infection spreads throughout the body, which, in the absence of effective therapy, can lead to the death of the patient.

A sharply disturbed cleansing function of the intestine ultimately leads to irreversible damage to all organs and systems. This process also poses a direct threat to the life of the patient.

In what cases is an operation required?

If there are signs of intestinal obstruction, it is necessary to consult a surgeon. It is this specialist who determines the amount of necessary therapeutic measures.

Intestinal obstruction is a mandatory indication for surgery if it was caused by a mechanical obstruction. In this case, it is necessary to remove as much as possible the cause that caused the intestinal lumen to overlap, to restore the normal progression of the food bolus.

Absolute indications for surgery:

tumor formations;
overlapping of the intestinal lumen with gallstones;
twisting of the loops of the large or small intestine with the formation of nodes;
invagination (the introduction of part of the intestine into another).

Intestinal obstruction due to impaired motor function and nervous regulation is treated with medications. The goal of therapy is to eliminate the provoking factors, which in some cases leads to the restoration of the normal progression of the food bolus. If, in this pathology, the vessels and nerves are damaged, tissue necrosis is possible, then the operation is also mandatory.

Preparing for the operation

Depending on the cause of development, the timeliness of the diagnosis, the general condition of the patient, surgery can be urgent and planned. Before the intervention, the patient is prepared. With a planned operation, it can be started at home, continued in the hospital, with an urgent one - within a few hours, in a hospital.

The main components of the preparatory stage:

a special diet for the intestines with enough water, excluding vegetables, fruits and bread;
the appointment of laxatives daily (Fortrans, a solution of magnesia, vaseline oil);
cleansing enemas every evening;
the use of drugs to reduce spasms (drotaverine, baralgin);
intravenous administration of solutions to normalize the level of electrolytes, the amount of fluid, acid-base indicators, energy metabolism, blood protein composition;
consultations with narrow specialists about concomitant diseases, treatment in order to maximize the correction of changes.

The amount of fluid that needs to be consumed during the day is calculated based on the daily urine output (normally about 1.5 liters). The recommended volume is adjusted depending on the weight and functional state of the cardiovascular system, kidneys and urinary organs.

Simultaneously with the preparation, it is necessary to conduct a complete comprehensive examination of the patient. As a result of the analysis of all the received data, a decision is made on the method of the operation.

Stages

Depending on the location of the obstacle, doctors plan an operative access. Most often, an incision is made along the midline of the abdomen, which ensures maximum accessibility of the abdominal organs and minimal tissue trauma.

General steps of surgery for intestinal obstruction:

Laparotomy - an incision with access to the abdominal cavity.
Removal of physiological and inflammatory fluids from the abdominal cavity.
Additional injection of painkillers into the colon and small intestine mesentery, solar plexus area.
Inspection by the surgeon of the organs and tissues of the abdominal cavity, detection of a focus that blocks the lumen of the intestine.
Introduction through the nasal passages of the probe for aspiration of intestinal contents;
Removal of the pathological focus, as well as all non-viable tissues, restoration of the intestinal wall and its lumen.
Stitching in layers of all places of the incision.

Depending on the nature of obstruction, special individual approaches to surgical treatment have been developed.

Features of operational tactics depending on the cause:

in hernias, the affected loop of the intestine is removed, the viable sections are immersed in the abdominal cavity and the hernial sac is sutured;
with the development of adhesions of any nature, the resulting scars are dissected;
in the presence of a neoplasm, a tumor is removed, the affected part of the intestine within a healthy organ;
in case of intestinal volvulus, knot, strangulation, damaged tissues are straightened, their viability is determined by pulsation and movements, non-viable tissues are removed;
in the presence of worms, foreign bodies, the intestinal wall is cut and the cause of the obstruction is removed;
if it is impossible to restore intestinal patency with a tumor, part of the intestine is brought out with the formation of a colostomy (unnatural anus).

The operation for intestinal obstruction is large in volume, it is traumatic and difficult to tolerate by patients. Therefore, most interventions are performed in several stages. Then the task of the first stage will be the removal of the affected tissues and the immediate cause of the pathology, the formation of a colostomy. In the second stage, the integrity of the intestine is restored (it is carried out, on average, after a few months).

In newborns with intestinal obstruction, urgent surgery is performed if intestinal volvulus is diagnosed. In case of developmental anomalies, planned treatment is carried out after a complete examination and preparation, taking into account the immaturity of the child's organs.

Postoperative period

Operations for intestinal obstruction are major interventions with a long postoperative period. It is determined by the time of complete wound healing and the maximum possible recovery of the body.

The main treatment tactics during this period:

control and restoration of the normal functioning of internal organs (respiratory and cardiovascular systems);
adequate anesthesia;
lavage of the stomach, intestines;
restoration of normal peristalsis;
treatment of the surface of the surgical wound;
in the case of a colostomy, teaching the patient how to care for it.

Gastric lavage is carried out daily with a probe. Perhaps the constant suction of the contents of the intestine. The greatest effect is observed from the use of a probe inserted during the operation through the nose into the intestine. It allows during this period to remove the liquid contents of the intestine and gases, which reduces the effects of intoxication, helps to restore peristalsis. As a rule, in the middle of the postoperative period, the probe is removed (day 5).

Peristalsis is activated by the introduction of small amounts (up to 40 ml) of hypertonic solutions of 10% sodium chloride, the introduction of cholinesterase inhibitors (Prozerin).

Gradually, as the motor function of the intestine is restored, the patient is allowed to eat. During this period, food should be as gentle as possible mechanically and thermally. Food must be wiped or chopped with a blender. The temperature should correspond to the temperature of the human body.

Dishes should not contain salt, substances that affect peristalsis, spices and spices are excluded. Meals up to 8 times a day, in small portions. Vegetable decoctions, mashed cereals, boiled and chopped fruits (apples, pears), lean veal, chicken are acceptable. It is recommended to drink up to one and a half liters of fluid per day.

Diet

As the postoperative period is completed, the diet after surgery for intestinal obstruction expands. Its main task is to maximally prevent symptoms such as pain in the abdomen, increased gas formation and disturbed stools with a tendency to constipation or diarrhea.

Food should be energetically complete, contain a sufficient amount of proteins, fats, carbohydrates for the maximum possible restoration of the active functional state of the patient's tissues and organs, and ensure saturation of the body with vitamins.

The diet should contain:

vegetables, non-acidic fruits and berries, mainly in processed form;
oatmeal, wheat, rice porridge;
non-sour bread containing bran;
dairy products (low-fat cottage cheese, cheese);
weak tea, jelly, compote with a small amount of sugar;
low-fat varieties of beef and fish, rabbit meat, chicken, turkey stewed and boiled.

The diet after the operation should categorically not contain spicy, salty, smoked dishes, sausages, rich broths from meat, mushrooms, fish. It is better to exclude white cabbage, tomatoes, mushrooms, legumes, chocolate, carbonated and alcoholic drinks, buns and cakes, nuts.

The amount of liquid drunk - up to two liters per day. In the future, a gradual expansion of the diet is allowed under the supervision of a doctor. However, it is advisable to exclude products that are aggressive to the intestines from the diet completely.

Consequences

With a timely diagnosis, an effective operation and postoperative recovery, the prognosis for life and recovery from obstruction is favorable. Provided that the surgical intervention radically cured the underlying disease. The functional capacity of the intestine is restored, stool and weight are normalized.

However, in rare cases, operations for intestinal obstruction have adverse effects.

Possible occurrence:

single and multiple ruptures of the wall of the small intestine;
peritonitis - inflammation of the peritoneum;
necrosis - loss of viability of a section of the small intestine;
divergence of intestinal sutures;
dysfunction of the artificial anus.

These phenomena are rare, however, it is necessary to monitor the patient and follow all the recommendations of doctors in order to prevent them.

Intestinal obstruction is a dangerous complication of a number of diseases. The prognosis depends on the cause, timeliness of diagnosis and treatment. In most cases, adequate medical measures lead to a complete recovery. Even with the most severe pathologies, the malignant nature of the obstruction, surgical interventions remove obstacles, significantly improve the general condition, and prolong the patient's life.

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Typical symptoms and treatment of bowel obstruction

Intestinal obstruction, the treatment of which should be carried out without delay, is a difficult or completely impaired movement of food and feces through the gastrointestinal tract, due to various reasons. The main causes of intestinal obstruction are dysfunction of intestinal motility and the presence of mechanical obstacles along the path of fecal masses. Thus, dynamic and mechanical intestinal obstruction develops.

Dynamic intestinal need is caused by such reasons as:

Injuries of various kinds and adverse effects of surgical interventions that cause paralytic ileus.
Peritonitis.
Reduced concentration of potassium ions in the blood - hypokalemia.
Renal or biliary colic, not amenable to relief.
Violation of the efferent innervation of individual sections of the intestine.
Diverticulosis of the sigmoid colon (in the elderly).
Decreased intestinal motility due to physical inactivity or bed rest.
A sharp increase in the amount of food consumed after a long-term fasting or malnutrition.

As a result of oncological diseases or poisoning with salts of heavy metals, spastic intestinal obstruction begins. It can also be caused by diseases such as hysteria or dorsal tabes.

Mechanical obstruction is caused by the following reasons:

Malignant or benign neoplasms (tumors).
Anatomical pathologies of the peritoneum.
Compression of the intestinal tubes.
Prolapse of organs - hernia.
Narrowing of the intestinal lumen.
Heavy and soldering.
Invagination of individual sections of the intestine.
Intestinal pathologies of an anatomical nature - dolichosigma, etc.
Accumulations of worms.
Foreign objects accidentally introduced into the intestines.

Acute intestinal obstruction most often becomes a complication of a painful lesion of the gastrointestinal tract. In the presence of adhesions and pathological growths in the intestinal tubes, a chronic form of intestinal obstruction develops.

2Main symptoms

Acute intestinal obstruction, the symptoms of which will be discussed below, is partial or complete. Symptoms of obstruction in both cases are similar. Only in the case of complete intestinal obstruction, the symptoms are more intense.

The first signs of intestinal obstruction are difficult gas release, fecal discharge (with partial obstruction) and the absolute impossibility of implementing these processes (with complete obstruction).

Against the background of these signs, symptoms of obstruction appear, such as:

an increase in the size of the abdominal cavity (bloating);
nausea, frequent vomiting;
severe pain syndrome (cramping pain localized around the navel or slightly higher);
alternating constipation and diarrhea;
lack of physiological hunger;
increased intra-intestinal gas formation - flatulence.

In children - especially infants and younger preschoolers - acute obstruction causes the following symptoms:

hyperthermia;
swelling of the upper part of the abdominal wall;
vomiting immediately after eating;
abundant content of bile in vomit;
unnatural grayish skin color;
significant weight loss caused by fluid loss;
restless behavior of the child, tearfulness, lack of sleep.

One of the most common causes of intestinal obstruction in infancy is the transfer of a child to artificial feeding after weaning.

If at least one of these symptoms appears, you should immediately consult a doctor. Otherwise, even through surgical intervention, it will not be possible to save the patient.

Before the medical examination is strictly prohibited:

taking laxatives or painkillers;
put enemas;
gastric lavage.

This can not only disrupt the reliable clinical picture of the ailment, but also greatly harm the patient.

3Diagnosis

The condition of a patient with suspected obstruction is determined using various diagnostic methods. It can be:

palpation;
percussion;
laboratory tests of urine and blood;
X-ray examination;
irrigoscopy for examination of the colon;
colonoscopy to examine the mucous membranes of the intestines;
laparoscopy for examination of internal organs using an endoscope.

It is mandatory to conduct an examination of the pelvic organs through the vagina or rectum, which allows to detect neoplasms in these organs or a blocked area of the rectum.

4Treatment

Before treating intestinal obstruction, the patient is cleaned of the digestive tract. To do this, with the help of a special probe, the upper sections of the digestive system are freed from food debris. Feces are removed from the lower sections by administering siphon enemas. These procedures are mandatory for all patients from childhood to the elderly.

After that, the pain syndrome is eliminated, body temperature is normalized, the consequences of fluid loss are eliminated, and normal intestinal motility is restored. To do this, the patient is administered analgesics, antispasmodics, antipyretics, antiemetics, drugs that stimulate intestinal motility.

After taking emergency measures, the general direction of treatment is determined depending on the individual data of the patient.

The determining factors for deciding how to treat intestinal obstruction are the age of the patient, the main signs of the disease, its form, etc.

With functional intestinal obstruction, treatment with agents that restore normal intestinal motility and a course of maintenance therapy are sufficient. Such treatment in compliance with regimen measures and diet is carried out within 7-10 days. If these measures do not allow you to restore the normal functioning of the intestine, an operation is prescribed.

5Surgery methods

Treatment of intestinal obstruction by carrying out certain surgical operations and manipulations is established in each case strictly individually. This must take into account:

patient's age;
the severity of his condition;
data obtained through diagnostics;
accompanying illnesses;
risk of death.

Without fail, a surgical operation is performed if the patient has:

intestinal nodules;
volvulus, especially in the small intestine;
blockage of the intestinal tubes by gallstones;
mutual immersion of individual sections of the intestine.

6Diet

Intestinal obstruction requires adherence to the strictest diet and diet. During treatment and during the recovery period, the patient should eat according to the instructions of the attending physician and the nutritionist who compiled the diet.

It is necessary to take food every 2 hours quite a bit. It is desirable that meals always take place at the same time. The daily diet should include 80 g of protein, 50 g of fat and 200 g of carbohydrates, while the calorie content is allowed no more than 1020 kcal. You can drink no more than 2 liters of liquid per day: tea, juices, dietary decoctions and drinks.

All hot dishes should be steamed or boiled with little or no salt. Various spices, spices, food additives cannot be used for cooking diet food. You need to take food only in the form of heat. It should be soft or even rubbed.

All irritating and indigestible foods should be excluded from the diet. Including:

whole milk;
dairy products;
heavy food;
carbonated drinks.

7Nutrition after surgery

Within 12-13 hours after the abdominal operation, the nutrition of the operated person is carried out only by the parenteral route. For this, nutrient solutions are injected intravenously directly into the rectum. Then the patient is given a probe for several days for oral administration of nutrient mixtures. After removal of the probe, the patient switches to self-feeding. First, these are fermented milk products, then the diet gradually expands.

8Traditional medicine

Alternative medicine for intestinal obstruction most often recommends mild laxatives to help cleanse the intestines. One such remedy is sea buckthorn berries. They are used to extract juice and oil. Juice is squeezed from washed and crushed berries immediately before use. You need to drink juice daily 30 minutes before meals, 0.1 l 1 time per day.

Sea buckthorn oil can be bought ready-made or made independently. To do this, grind the berries (1 kg) with a wooden spoon in an enameled bowl. After 24 hours, the surface of the mashed berries will be covered with oil, which must be carefully collected. You need to drink oil 1 teaspoon before meals in the morning, afternoon and evening.

Dried fruits help well: dried apricots, prunes, sultanas, figs. All ingredients must be taken in the same amount, pour boiling water and pass through a blender or meat grinder. Add some honey and mix thoroughly. Consume 1 tbsp before breakfast. spoon.

Every day, you need to eat a little porridge from boiled pumpkin, adding honey to taste. This remedy has not only a laxative, but also an antispastic effect.

With intestinal obstruction, a mixture of boiled beets (100 g), olive oil (2 tablespoons) and honey (to taste) will be useful. The resulting product is taken at 2 tbsp. spoons twice a day.

Another remedy is a decoction of fresh plums. Washed pitted fruits (0.5 kg) are poured with water (1 l) and boiled for 60 minutes. The broth is passed through 3 layers of gauze, squeezed. Top up with boiling water to the original volume and bring to a boil again. You need to drink it three times a day for 0.1 liters.

It should be remembered that any non-traditional means can be used only with partial obstruction. You must first consult with your doctor. Self-treatment of intestinal obstruction can lead to an intensification of pathological processes and create a serious threat to the health and life of a sick person.

9Possible complications

Intestinal obstruction in adults and children causes serious complications:

necrosis of the intestinal walls;
peritonitis - inflammation of the peritoneum.

These processes develop due to the ingestion of feces from the intestines into the abdominal cavity. Gradually, this leads to blood poisoning and death. Therefore, when the first suspicions appear, you should immediately consult a doctor.

10Preventive measures

The basis for the prevention of intestinal obstruction in adults is a proper balanced diet and regular daily bowel movements. It is also necessary:

Lead the right way of life.
Move as much as you can.
Immediately begin to cure newly discovered pathologies.

Also, of course, you will have to give up bad habits and regularly visit a gastroenterologist for a preventive examination.

Intestinal obstruction is a condition of an acute obstacle to the normal passage of food masses (from the stomach to the anus). It can occur anywhere in the small or large intestine.

Intestinal obstruction is one of the leading causes of surgical mortality. Without timely treatment, 90% of patients die.

The main causes of death of patients with intestinal obstruction:

Shock (pain, hypovolemic); Endotoxicosis; Abdominal sepsis; Peritonitis; Severe electrolyte disturbances.

What is the obstruction

According to the mechanism of occurrence, two main types of obstruction are distinguished:

dynamic; Mechanical.

Mechanical obstruction is already a real obstacle in the way of food masses in the intestines. She happens:

obstructive; strangulation; Mixed.

Mechanical obstruction very rarely resolves on its own or with conservative measures. It is this type of obstruction that is an absolute indication for surgery. The causes of a mechanical obstruction in the intestine can be:

Tactics for suspected intestinal obstruction

There are several groups of patients with symptoms of intestinal obstruction, to which different management tactics are applied:

Patients presenting within the first 24 hours of onset of symptoms with dynamic obstruction or with suspicion of obturation, but without peritonitis. Conservative therapy and intensive observation are prescribed. Conservative measures can eliminate the symptoms of dynamic and some types of mechanical obstruction. If the condition does not improve within 2 hours, the patient is taken for surgery. Patients with suspected strangulation obstruction with symptoms of inflammation of the peritoneum, in a compensated state, they are taken immediately for surgery. Patients in serious condition who arrived after 24 hours, in a state of hypovolemic shock, severe electrolyte disturbances, intensive preoperative preparation is carried out (sometimes this takes more than 3-4 hours) and subsequent emergency surgery.

Preparing for an operation to remove an obstruction

When a patient is admitted to the hospital:

Placement of a catheter in a central vein to control central venous pressure and parenteral infusions. Bladder catheterization to control diuresis. Installation of a nasogastric tube.

Principles of conservative therapy

Conservative therapy is also a method of preoperative preparation (if surgery is still required).

Aspiration of the contents of the stomach and upper intestines through the installed probe. Carrying out cleansing and siphon enemas. Sometimes this measure can help remove an obstacle (for example, wash away dense fecal blockages). Urgent colonoscopy. It is performed for diagnostic purposes, but can also eliminate some types of obstruction (for example, intussusception, or partially expand the intestine during obstruction). Replenishment of fluid and electrolyte losses. To do this, under the control of CVP, diuresis, plasma electrolytes, infusions of saline, saline solutions, protein hydrolysates, rheological solutions, and plasma are carried out. Usually the volume of infused funds is up to 5 liters. With increased peristalsis and pain, antispasmodics are prescribed, with intestinal paresis - agents that stimulate peristalsis. Antibacterial agents are also prescribed.

Operations for intestinal obstruction

If conservative measures have not eliminated the problem, surgery cannot be avoided. The main tasks of surgical intervention:

Removing an obstacle. If possible, the elimination of the disease that led to this complication. The maximum possible actions for the prevention of postoperative complications and relapse.

The main stages of the operation and tactics of the surgeon

1. Anesthesia. Usually this is endotracheal anesthesia with muscle relaxants.

2. Access is most often a wide median laparotomy.

5. Direct removal of the obstacle itself. Several types of interventions can be applied here:

Enterotomy - the intestinal wall is opened, an obstacle is removed (for example, a ball of ascaris, a foreign body, gallstones) and sutured. When a hernia is incarcerated, the incarcerated loops of the intestine are reduced. With strangulation obstruction - dissection of adhesions, untying of knots, elimination of intussusception and volvulus. Resection of the intestine in the presence of a tumor or necrosis of the intestine. Bypass anastomosis in the case when it is not possible to eliminate the obstruction in the usual way. Imposition of a colostomy (permanent or temporary) - usually in cases of left-sided hemicolectomy.

6. Evaluation of the viability of the intestine and its resection.

This is a very crucial moment of the operation, the further prognosis depends on it. The viability of the intestine is assessed by its color, contractility and pulsation of the vessels. Any doubts about the normal state of the intestine are a reason for its resection.

With signs of intestinal necrosis, this area is resected within healthy tissues. There is a rule to resect the intestine 40-60 cm above the border of non-viability and 10-15 cm below it.

A one-stage radical operation is not performed even with developed peritonitis. In this case, the task of surgeons is to eliminate the obstruction, wash and drain the abdominal cavity.

7. Washing and removal of effusion from the abdominal cavity.

8. Drainage of the abdominal cavity.

9. Wound closure.

After operation

The postoperative stage in such patients is a very important moment of treatment, no less significant than the operation itself.

After the operation, the patient is sent to the intensive care unit. Main activities:

Round-the-clock monitoring of the main vital functions. Suction of intestinal contents through an intestinal tube. It is carried out to prevent intestinal paresis, reduce intoxication. Aspiration is combined with intestinal lavage and the introduction of antibacterial agents into its lumen. It is carried out before the appearance of active peristalsis (usually it is 3-4 days). Parenteral fluid administration under the control of CVP and diuresis. Parenteral administration of saline solutions under the control of plasma electrolytes. Parenteral nutrition (solutions of glucose, amino acids, protein hydrolysates). Antibacterial therapy. To stimulate intestinal peristalsis, a hypertonic solution of sodium chloride, anticholinesterase agents (prozerin) are introduced, cleansing enemas are performed, physiotherapy may be prescribed in the form of electrical stimulation of the intestine. A good effect is given by pararenal blockade. Elastic bandaging of the lower extremities for the prevention of thromboembolic complications.

After 3-4 days, liquid food and drink are allowed. The diet is gradually expanding - mucous porridges, vegetable and fruit purees, meat soufflé, sour-milk products are allowed. Diets with the exception of rough, spicy foods, foods that cause increased gas formation and fermentation should be followed for up to 2 months.

Features of the operation for the most common types of obstruction

The most common type of small bowel obstruction is ileus with adhesive disease. For the large intestine, this is the occlusion of the intestinal lumen by a tumor.

Adhesive intestinal obstruction

The peculiarity of this type of obstruction is that adhesive obstruction is prone to relapse. By dissecting adhesions, we create the prerequisites for the formation of new adhesions. It turns out a vicious circle.

adhesive intestinal obstruction

Intestinal obstruction due to tumor

During the operation, there are two tasks: the elimination of obstruction and the removal of the tumor. It is very rare that this can be done all at once. The radical operation cannot be performed:

If it is technically impossible to remove the tumor. Extremely serious condition. With developed peritonitis.

right/left hemicolectomy

If it is impossible to remove the tumor, palliative operations are performed - an unnatural anus or a bypass anastomosis is created to restore patency.

Forecast

Mortality in acute intestinal obstruction remains quite high - an average of about 10%. The forecast depends on terms of the begun treatment. In those admitted to the hospital within the first 6 hours from the onset of the disease, the mortality rate is 3-5%. Of those who arrive later than 24 hours, already 20-30% die. Mortality is very high in elderly debilitated patients.

Price

The operation to eliminate intestinal obstruction is an emergency. It is carried out free of charge in any nearest surgical hospital.

The cost of laparoscopic surgery for adhesive intestinal obstruction is from 40 thousand rubles.

Video: intestinal obstruction in the program "Live healthy!"

Why is intestinal obstruction dangerous?

What will be the consequences of the resulting obstruction depends on the immediate cause, the degree of reduction in the lumen of the intestine and the duration of this process.

Mechanical disruption of the passage of food leads to:

Not only intestinal cancer can cause obstruction, but also malignant neoplasms of closely located organs: the liver, adrenal glands and kidneys, bladder, uterus.

The most dangerous changes in intestinal obstruction:

loss of fluid, violation of the normal content of salts, acids and alkalis in the body; poisoning with metabolic products that are not excreted through the intestines, leading to a deterioration in the functioning of all internal organs; the occurrence of incessant vomiting, nausea; malnutrition of organs and tissues; activation of the processes of decay and reproduction of pathogenic microbes; necrosis of the intestine, in the most severe cases - rupture of the wall with the ingress of contents into the abdominal cavity and the development of purulent inflammation.

With the further development of the pathology, the purulent infection spreads throughout the body, which, in the absence of effective therapy, can lead to the death of the patient.

A sharply disturbed cleansing function of the intestine ultimately leads to irreversible damage to all organs and systems. This process also poses a direct threat to the life of the patient.

In what cases is an operation required?

If there are signs of intestinal obstruction, it is necessary to consult a surgeon. It is this specialist who determines the amount of necessary therapeutic measures.

Absolute indications for surgery:

tumor formations; overlapping of the intestinal lumen with gallstones; twisting of the loops of the large or small intestine with the formation of nodes; invagination (the introduction of part of the intestine into another).

Preparing for the operation

The main components of the preparatory stage:

a special diet for the intestines with enough water, excluding vegetables, fruits and bread; the appointment of laxatives daily (Fortrans, a solution of magnesia, vaseline oil); cleansing enemas every evening; the use of drugs to reduce spasms (drotaverine, baralgin); intravenous administration of solutions to normalize the level of electrolytes, the amount of fluid, acid-base indicators, energy metabolism, blood protein composition; consultations with narrow specialists about concomitant diseases, treatment in order to maximize the correction of changes.

Stages

General steps surgery for intestinal obstruction:

Laparotomy - an incision with access to the abdominal cavity. Removal of physiological and inflammatory fluids from the abdominal cavity. Additional injection of painkillers into the colon and small intestine mesentery, solar plexus area. Inspection by the surgeon of the organs and tissues of the abdominal cavity, detection of a focus that blocks the lumen of the intestine. Introduction through the nasal passages of the probe for aspiration of intestinal contents; Removal of the pathological focus, as well as all non-viable tissues, restoration of the intestinal wall and its lumen. Stitching in layers of all places of the incision.

Depending on the nature of obstruction, special individual approaches to surgical treatment have been developed.

Features of operational tactics depending on the cause:

in hernias, the affected loop of the intestine is removed, the viable sections are immersed in the abdominal cavity and the hernial sac is sutured; with the development of adhesions of any nature, the resulting scars are dissected; in the presence of a neoplasm, a tumor is removed, the affected part of the intestine within a healthy organ; in case of intestinal volvulus, knot, strangulation, damaged tissues are straightened, their viability is determined by pulsation and movements, non-viable tissues are removed; in the presence of worms, foreign bodies, the intestinal wall is cut and the cause of the obstruction is removed; if it is impossible to restore intestinal patency with a tumor, part of the intestine is brought out with the formation of a colostomy (unnatural anus).

Postoperative period

Operations for intestinal obstruction are major interventions with a long postoperative period. It is determined by the time of complete wound healing and the maximum possible recovery of the body.

The main treatment tactics during this period:

control and restoration of the normal functioning of internal organs (respiratory and cardiovascular systems); adequate anesthesia; lavage of the stomach, intestines; restoration of normal peristalsis; treatment of the surface of the surgical wound; in the case of a colostomy, teaching the patient how to care for it.

Peristalsis is activated by the introduction of small amounts (up to 40 ml) of hypertonic solutions of 10% sodium chloride, the introduction of cholinesterase inhibitors (Prozerin).

Diet

The diet should contain:

vegetables, non-acidic fruits and berries, mainly in processed form; oatmeal, wheat, rice porridge; non-sour bread containing bran; dairy products (low-fat cottage cheese, cheese); weak tea, jelly, compote with a small amount of sugar; low-fat varieties of beef and fish, rabbit meat, chicken, turkey stewed and boiled.

Consequences

However, in rare cases, operations for intestinal obstruction have adverse effects.

Possible occurrence:

single and multiple ruptures of the wall of the small intestine; peritonitis - inflammation of the peritoneum; necrosis - loss of viability of a section of the small intestine; divergence of intestinal sutures; dysfunction of the artificial anus.

These phenomena are rare, however, it is necessary to monitor the patient and follow all the recommendations of doctors in order to prevent them.

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Intestinal obstruction

Intestinal obstruction - concept, causes, types

tumors; inflammatory process (Crohn's disease); adhesions in the abdominal cavity; strangulated hernia; atony, paresis; blockage by gallstones; helminthic invasion; fecal stones; congenital anomalies; abdominal trauma; thrombosis of mesenteric vessels; volvulus.

strangulation obstruction

Advice: it must be remembered that strangulated hernias often lead to the development of ileus. Therefore, the "owners" of hernias, without expecting complications, should contact a surgeon for surgical treatment, when it is much easier and safer.

Symptoms and Diagnosis

Clinical manifestations. The disease is manifested by very characteristic symptoms. These are pains in the abdomen of a cramping nature, bloating, nausea, vomiting, no passing of gases, no stool, a violation of the general condition. The clinical form of the disease can be acute, when all the listed symptoms are pronounced, and chronic, in which they appear periodically and there are no sharp violations of the general condition.

These symptoms can occur both in the early and late postoperative period after operations on the intestines and other abdominal organs, they can be expressed to varying degrees.

Advice: The appearance of any of these symptoms should be a reason for immediate medical attention. For abdominal pain and stool retention, you should not take laxatives without consulting your doctor. With inversion, intussusception, obstruction of the intestinal lumen, they will only aggravate the condition.

Diagnostics. In the case of acute ileus, the patient is admitted to the surgical department on an urgent basis, where he undergoes a rapid examination confirming the diagnosis. This is an X-ray of the abdominal organs in a vertical position, an ultrasound examination. Horizontal levels of fluid are determined - stagnant intestinal contents, as well as "Cloiber bowls", formed by the accumulation of gas in the upper sections of the intestinal loops and having the appearance of inverted bowls. An ECG is also urgently performed, as well as basic laboratory tests to prepare for the operation.

Capsule endoscopy

Treatment

Surgical treatment of intestinal adhesions

Postoperative period

The first days or weeks of the postoperative patient is in the hospital and receives all the appointments of the attending physician:

diet therapy; intestinal stimulation; anti-inflammatory therapy; intravenous infusions to replenish fluids, minerals, and eliminate toxins; physiotherapy to prevent the formation of adhesions (an exception is a tumor of the abdominal cavity); therapeutic gymnastics.

Advice: some operated patients try to spend more time in bed, believing that it is safer this way (the wound hurts less, the stitches will not open, and so on). This is a delusion, the consequence of which may again be obstruction due to the development of adhesions against the background of hypodynamia.

Video

Attention! The information on the site is presented by specialists, but is for informational purposes only and cannot be used for self-treatment. Be sure to consult a doctor!

In the case of a diagnosis of intestinal obstruction, surgery often becomes the only treatment that can save the patient's life. However, the results of surgical intervention are not always successful, which is associated with a large number of postoperative complications. The most rapid initiation of treatment, the right choice of the necessary method of operation, complex infusion and supportive therapy can improve the results of a favorable outcome.

Ileus requires surgical intervention without fail for mechanical intestinal obstruction. In such a situation, if possible, the cause that caused the disease is eliminated:

intestinal tumor;
abdominal adhesions, etc.

The main task for surgeons is to restore the continuity of the gastrointestinal tract. However, in some cases, the treatment is multicomponent and requires a second operation.

Indications for the operation

Therapeutic tactics for intestinal obstruction is determined by the cause, type and severity of the pathology. Indications for surgical intervention are determined by the surgeon based on clinical manifestations and research results. With dynamic ileus, therapy always begins with conservative measures. Mechanical intestinal obstruction in most cases requires surgery.

Surgical intervention is necessary when:

Strangulation obstruction of the intestine, which led to the death of a section of the intestine due to:

inversion;
nodulation;
infringement of hernial contents.

Obstructive intestinal obstruction, when there is a mechanical obstruction to the movement of intestinal contents. The reasons may be:

fecal blockage;
gallstones;
accumulation of helminths;
foreign body;
intestinal tumor;
cicatricial changes in the intestine;
abdominal neoplasm.

Intussusception of the intestine in case of ineffectiveness of conservative measures.
Adhesions of the abdominal cavity in the absence of the results of conservative treatment.

Surgery for bowel obstruction can be performed on an emergency and urgent basis. If an emergency intervention is necessary, the operation is carried out immediately after the diagnosis is established. Any delay could endanger the patient's life. Surgical interventions are indicated on an emergency basis in cases of:

thrombosis of the arteries supplying the intestine;
infringement of hernial contents;
obstructive intestinal obstruction.

Urgently, but with a delay of 4-6 hours, operations are performed in complicated cases of the disease. The reason for postponing surgery is the need to restore fluid and electrolyte disturbances and prepare the body, which will improve the prognosis. Postponement is required for:

significant losses of water and electrolytes;
serious condition of the patient;
long periods of more than one and a half days from the onset of the disease.

Urgent surgery is carried out with the ineffectiveness of conservative treatment after 12 hours. This occurs with intussusception of the intestine and adhesions of the abdominal cavity. Signs of the ineffectiveness of conservative measures are:

persistence or resumption of complaints of abdominal pain;
recurrence of nausea and vomiting;
determination of free fluid in the abdominal cavity;
the appearance of symptoms of peritonitis;
an increase in the amount of probe content to 0.5 liters or more;
lack of dynamics of promotion of contrast content through the intestines.

Quite often, bowel surgery is required for intestinal obstruction in elderly patients. Young patients are more likely to avoid surgery.

Preoperative patient preparation

In addition to situations requiring emergency surgical intervention, preoperative preparation includes a set of conservative measures for the treatment of intestinal obstruction. The patient with ileus is made:

unloading of the intestines above the place of obstruction with the help of a nasogastric tube;
infusion therapy, including saline and colloidal solutions to correct water-salt metabolism and replenish the deficiency of minerals and protein;
the introduction of antispasmodics;
siphon enema;
injection of contrast into the intestine.

Methods of surgical interventions

The choice of the method of surgical intervention depends on the cause of intestinal obstruction, the severity of the adhesive process and obstruction, the condition of the intestine. Surgical operations for ileus are carried out:

Laparoscopically through small holes in the abdominal cavity using video technology.
Laparotomy, carrying out a large incision of the abdominal wall. The most convenient access is along the midline of the abdomen.

Laparoscopy is used in the adhesive process. Contraindications for its implementation are several operations on the abdominal organs in history, necrosis of part of the intestine and peritonitis.

There are the following stages of surgical intervention:

During the operation, a revision (examination) of the abdominal cavity is performed and the cause of the obstruction is identified.
Determination of signs of viability of the part of the intestine in the area of obstruction. Based on an assessment of its color and peristalsis, pulsation of blood vessels, a decision is made on the need for resection of the intestine (removal of part of the intestine).
In case of detection of signs of necrosis of a part of the intestine, it is removed within the limits of viable tissues.
Then the tactics are different depending on the section of the affected intestine. In case of obstruction in the small intestine, after its resection, an anastomosis (connection) is applied between its viable ends. When the colon is damaged, a colostomy is removed (a hole in the abdominal wall into which the end of the intestine is sewn).
With the help of a nasogastric (through the nose into the stomach) or nasointestinal (through the nose into the intestines) probe, the sections of the digestive tract are unloaded above the place of the obstacle.
Washing and drainage of the abdominal cavity.
Layer-by-layer restoration of the integrity of the abdominal wall.

With ileus, the following surgical options are possible:

adhesiolysis (separation of adhesions) with adhesive intestinal obstruction without intestinal necrosis;
reduction of intestinal loops with their viability back into the abdominal cavity (with protrusion of the intestine into the hernial sac);
enterotomy (section of the intestinal wall) with the removal of an obstruction from the intestine (with obstructive ileus caused by gallstones, bezoar, etc.);
resection of the intestine with the creation of an anastomosis for necrosis of the small intestine;
the imposition of a bypass anastomosis if it is impossible to remove the cause of the ileus;
resection of the intestine with removal of the colostomy with necrosis of the colon or extensive damage to the small intestine.

The colostomy may be temporary when planning the next operation in a few months to restore the integrity of the gastrointestinal tract. In some cases, a colostomy is a necessary measure, and it is formed for life. This occurs in palliative surgical interventions, when it is not possible to cure the patient (inoperable malignant neoplasms).

Postoperative period

Surgery for ileus does not guarantee a favorable prognosis. This is due to the fact that intestinal obstruction after surgery is characterized by structural changes in the digestive tract and a violation of homeostasis in the body. Internal toxins resulting from ileus continue to poison the body. In order to avoid postoperative complications, it is necessary to implement a set of conservative measures. Postoperative therapy consists of:

Infusion therapy to correct the water-salt balance and replenish the deficiency of water, minerals and protein. For this, crystalloid (saline, glucose solution, etc.) and colloidal solutions (rheopolyglucin, gelatin, etc.) are used.
Adequate pain relief to improve the patient's well-being and stimulate intestinal motility.
Antibiotic therapy. A broad-spectrum antibiotic (carbapenems, 3rd generation cephalosporins, fluoroquinolones) is prescribed.
Parenteral (intravenous) nutrition before switching to independent meals.
Enterotherapy. It consists in unloading the small intestine and washing it with the help of an inserted probe. With the help of it, nutrient mixtures are also introduced.
Treatment of postoperative wound.
Restoration of normal peristalsis of the gastrointestinal tract (prozerin, hypertonic solution).

In the postoperative period, the patient is closely monitored. The results of a general blood test, a biochemical blood test and an acid-base balance are regularly evaluated. An ultrasound examination of the abdominal organs is also performed to assess the functioning of the digestive tract.

Diet in the postoperative period

The diet in the postoperative period with ileus is quite strict. In the early days, eating is completely prohibited. Parenteral nutrition is provided. When signs of bowel function appear, liquid food is allowed. Products are crushed or pureed with a blender. In most cases, eating is allowed 3-4 hours after surgery.

smoking and alcohol are excluded;
spicy, fried, smoked, pickled, pickles are prohibited;
seasonings and spices are excluded, the use of salt is limited;
portions should be small;
you need to eat often 5-7 times a day;
products can be boiled or baked;
puree-like food is recommended at the beginning: puree soups, vegetable purees, cereals, etc.;
food should be warm (too hot and too cold are excluded);
vegetables and fruits must be thermally processed;
a small amount of dairy products is allowed;
it is necessary to limit foods that increase gas formation in the digestive tract (cabbage, legumes, muffins, carbonated drinks).

What needs to be done to avoid complications

Complications after surgery for intestinal obstruction are quite common. They are primarily due to untimely start of treatment and inadequate preoperative preparation and postoperative measures. The following actions can reduce the risk of complications.