Intestinal Obstruction

Description

Bowel obstruction is a blockage that keeps food or liquid that passes through your small intestine or large intestine (colon). The causes of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery; hernias; colon cancer; certain medications; or stenosis of the bowel inflammation caused by certain conditions, such as Crohn's disease or diverticulitis.

Without treatment, the blocking of parts of the intestine can die, leading to serious problems. However, with prompt medical care, bowel obstruction can often be treated successfully.

Symptoms

The signs and symptoms of intestinal obstruction include:

  • Crampy abdominal pain that comes and goes
  • Loss of appetite
  • Constipation
  • Vomiting
  • Inability to have a bowel movement or pass gas
  • Swelling of the abdomen

When to see a doctor

Due to the serious complications that can develop from a bowel obstruction, seek medical attention right away if you have abdominal pain or other symptoms of intestinal obstruction.

Causes

The most common cause of intestinal obstruction in adults are:

  • Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that may form after abdominal or pelvic surgery
  • The Herniated portions of intestine protruding in another part of your body
  • Colon cancer

In children, the most common cause of intestinal obstruction is telescoping of the intestine (intussusception).

Other possible causes of intestinal obstruction include:

  • Inflammatory bowel diseases such as Crohn's disease
  • Diverticulitis — a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected
  • The torsion of the colon (volvulus)
  • Impacted stool

Pseudo-obstruction

Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but does not imply a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated contractions of the muscles of the intestines, slowing or stopping the motion of food and fluids through the digestive system.

Paralytic ileus can affect any part of the intestine. The causes may include:

  • Abdominal or pelvic surgery
  • Infection
  • Certain medications that affect the muscles and nerves, including antidepressants and opioids
  • Muscle and nerve disorders, such as Parkinson's disease

Risk factors

The diseases and conditions can increase your risk of bowel obstruction include:

  • Abdominal or pelvic surgery, which often causes adhesions — common-bowel obstruction
  • Crohn's disease, which can cause the gut wall to thicken, narrowing the passageway
  • Cancer in the abdomen

Complications

Untreated, intestinal obstruction can cause serious, life-threatening complications, including:

  • The death of the tissues. The Intestinal obstruction, can cut off the blood supply to a part of your bowel. The lack of blood causes the intestinal wall to die. Tissue death can result in a tear (perforation) in the intestinal wall, which can lead to infection.
  • Infection. Peritonitis is the medical term for an infection in the abdominal cavity. It is a life-threatening condition that requires immediate medical and often surgical care.

Intestinal Obstruction

Diagnosis

Tests and procedures used to diagnose intestinal obstruction include:

  • Physical exam. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there is a lump in your abdomen. He or she may listen for bowel sounds with a stethoscope.
  • X-ray. To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal x-ray. However, some of bowel obstructions can't be seen using standard X-rays.
  • The computed tomography (CT). A computed tomography (CT) scan combines a series of X-ray images taken from different angles to produce cross-sectional images. These images are more detailed than conventional X-rays, and are more likely to show an intestinal obstruction.
  • Ultrasound. When a bowel obstruction occurs in children, ultrasound is often the preferred type of images. In young people with an intussusception, an ultrasound will usually display a "bull's eye", which represents the intestine coiled in the gut.
  • Air or barium enema. An air or barium enema improve the image of the colon. This can be done by certain alleged causes of obstruction. During the procedure, the doctor will insert the air or liquid barium in the colon through the rectum. For intussusception in children, air or barium enema can really solve the problem that most of the time, and no further treatment is needed.

Treatment

The treatment for intestinal obstruction depends on the cause of your disease, but it usually requires hospitalization.

Hospitalization to stabilize your condition

When you arrive at the hospital, the doctors stabilize you so that you can undergo treatment. This process may include:

  • The placement of an intravenous line (IV) into a vein in your arm so that fluids can be given
  • Place a tube through the nose into the stomach (nasogastric tube)to suck out air and fluid and relieve abdominal swelling
  • The placement of a thin, flexible tube (catheter) in your bladder to drain urine and to pick up for the tests

The treatment of intussusception

A barium or air enema is used as a diagnostic procedure and treatment for children with intussusception. If an enema works, further treatment is usually not necessary.

The treatment for partial obstruction

If you have a blockage in some foods and liquids, you can still get through (partial obstruction), you may not need further treatment after you have been stabilized. Your doctor may recommend a special diet low in fiber that is easier for your partially blocks the intestine to the process. If the obstruction is not clear on its own, you may need surgery to relieve the obstruction.

The treatment of complete obstruction

If you are not able to pass through your gut, you'll usually need surgery to relieve the obstruction. The procedure will depend on what is the cause of the obstruction, and the part of the intestine is affected. The surgery usually involves the removal of the obstruction, as well as any section of your intestine that has died or is corrupted.

As an alternative, your doctor may recommend treatment of the obstruction with self-expanding metal stent. The wire mesh tube is inserted into the intestine through an endoscope through the mouth or the colon. Forces to open the intestine, so that the blockage can be cleared.

Stents are generally used for the treatment of people with cancer of the colon or to provide a temporary relief in the people for whom emergency surgery is too risky. You may need a surgery, once your condition is stable.

The treatment for pseudo-obstruction

If your doctor determines that your signs and symptoms are caused by the pseudo-obstruction (paralytic ileus), he or she can monitor your condition for a day or two in the hospital, and treat the cause, if known. Paralytic ileus may improve on their own. In the meantime, you'll likely be given food through a nasogastric tube or intravenously (IV) to prevent malnutrition.

If paralytic ileus does not improve by itself, your doctor may prescribe a medication that causes muscle contractions, which can help to move food and liquid through the intestines. If paralytic ileus is caused by a disease or medication, the doctor will treat the underlying disease or to stop taking the medicine. Rarely, surgery may be needed.

In cases where the colon is enlarged, a treatment called the decompression can provide relief. The decompression can be done with the colonoscopy, a procedure in which a thin tube that is inserted into the anus and guided in the colon. The decompression can also be done through surgery.

Preparing for your appointment

Bowel obstruction is usually a medical emergency. As a result, you may not have much time to prepare for an appointment. If you have time before your appointment, make a list of your signs and symptoms, so you can better respond to the questions of your doctor.

What to expect from your doctor

Your doctor may ask you a series of questions, including:

  • When do you start to experience abdominal pain or other symptoms?
  • Do your symptoms come about all of a sudden or has had symptoms like these before?
  • Is your pain ongoing?
  • Have experienced nausea, vomiting, fever, blood in the stool, diarrhea, or constipation?
  • Have you had surgery or radiation to the abdomen?
Symptoms and treatment of Intestinal obstruction