Intestinal obstruction is a partial or complete termination of the promotion contents (chyme) in the intestines. Intestinal obstruction requires immediate medical attention, as it is life-threatening conditions.
Types and causes of intestinal obstruction
By the nature of the flow are acute and chronic intestinal obstruction, and bowel obstruction may be complete or partial.
By origin can be congenital or acquired. Congenital intestinal obstruction in children is caused by abnormalities of the bowel or blockage of his thick meconium - feces, formed during fetal development.
Depending on the cause of her intestinal obstruction is divided into two types: dynamic and mechanical.
Dynamic intestinal obstruction caused by disorders of innervation and blood circulation in the intestine.
In turn, is divided into the following forms:
- Paralytic ileus. Arises as a result of paralysis of the muscular layer of the intestine, because of what stops peristalsis - movements promoting the chyme through the intestines. Is a complication of peritonitis (inflammation of the peritoneum). Paresis (partial paralysis) of the intestine occurs in renal and biliary colic, acute attacks of pancreatitis, trauma pelvis, spine and abdominal hematoma and postoperative can be;
- Spastic ileus. The cause of spastic bowel obstruction is a spasm of the intestine as a result of poisoning by certain drugs and heavy metal salts.
Mechanical bowel obstruction - the most common type of intestinal obstruction. Divided into the following subtypes:
- Obstructive ileus. There is the presence of neoplasms, partially or completely blocks the lumen of the intestine (fecal stones, tumors, cysts, helminths balls), it is characterized by a gradual increase in symptoms;
- Strangulation intestinal obstruction. Associated with compression of the infringement or mesenteric intestine (volvulus, units intestines), this kind of characteristic rapid development, 4-6 hours after the start to the complete obstruction;
- Mixed, or a combination of intestinal obstruction. Occurs when intussusception when the lumen of the intestine becomes blocked intruded other gut, thus squeezed mesentery intruded loop. Intussusception - the most common cause of intestinal obstruction in children.
Intestinal obstruction is also classified by level:
- Thinly intestinal obstruction;
- Thick intestinal obstruction;
- High intestinal obstruction;
- Low intestinal obstruction.
Symptoms of bowel obstruction
Each type of bowel obstruction symptoms vary, but there are signs common to all the cases:
- The emergence of severe pain in the abdomen;
- The appearance of vomiting;
- Termination of flatus and constipation.
These three symptoms of intestinal obstruction have features peculiar to this state, so you should talk about them in more detail.
- Pain. It has cramping in nature, cramping coincide with the rhythm of peristalsis. At the initial stage in the interval mezhbolevom patient can generally nothing to worry and can remain weak dull aching pain. During the attack the pain becomes so intense that patients are rushing around trying to find a position in which it would be reduced. At the peak of the pain the patient can neither cry nor speak, and one of the characteristic symptoms of intestinal obstruction is a low moan ("ileusny groan"). At this time appears cold sweat, pulse rate - there are signs of shock.
- Vomiting. In the case of multiple thin intestinal obstruction, debilitating, abundant, not bringing relief, initially containing the remains of undigested food, then consisting of intestinal juice with bile. In the next period, with the accession of peritonitis occurs painful vomiting stagnant content lower intestine, having the sight and smell of feces - "fecal vomiting." When thick ileus vomiting may be no more than - two times copremesis is not observed.
- Symptom delay chair and flatus also varies depending on the form of the disease. With a low, thick or intestinal obstruction chair and gases can be completely absent for a few days before the start of acute intestinal obstruction. But at high or thin intestinal obstruction in the initial stage can be an independent chair or a chair, caused by enema. In this case, the absence of the chair and gas production could be too late symptoms of intestinal obstruction.
For other symptoms of intestinal obstruction include: thirst, bloating, hyperperistalsis early in the disease, and a complete cessation of her as deterioration. At the beginning of the disease, due to the strong peristalsis, bowel sounds are heard loud and then peristalsis stops and there is complete silence - a symptom of "dead silence".
During the acute intestinal obstruction are three stages:
- Starting or period "ileusnogo groan," lasts for 2 to 12 hours. It is characterized by pain, bloating, increased peristalsis;
- The intermediate, 12 to 36 hours. The pain stops at all, or paroxysmal and loses its intensity, which is why this stage is called the stage of an imaginary being. Picking dehydration and intoxication. Peristalsis stops;
- Terminal or later. It occurs within 36 hours after the first signs of acute intestinal obstruction. At this stage the patient is much heavier, comes the lack of life-supporting systems.
Diagnosis of ileus
Diagnosis of acute intestinal obstruction should be immediate. Initial diagnosis is based on a thorough examination, determination of characteristic symptoms and samples, as well as on the basis of X-ray examination.
Treatment of intestinal obstruction
Treatment begins with intestinal obstruction of emergency measures to replenish the lost fluids and removal of shock. Upper gastrointestinal tract freed from residual content using the probe lower sections - via siphon enemas. To stop the enhanced motility in the initial stage is administered antispasmodic, relaxing the muscle wall. Sometimes, for the treatment of intestinal obstruction dynamic form these measures are sufficient to restore normal bowel function.
If the therapeutic treatment of intestinal obstruction in its dynamic form are ineffective, and in all cases of mechanical intestinal obstruction, resort to surgery, which is to eliminate the causes of the disease, in the case of the incident site necrosis of the intestine - its excision and reconstruction of the intestinal permeability.