Overview
Simple intestinal obstruction is an intestinal obstruction caused by a variety of reasons in which the intestinal contents fail to pass through the bowel, but the intestinal blood flow is normal, and is usually considered a type of mechanical intestinal obstruction. Neurogenic obstruction is usually simple; in mechanical intestinal obstruction, obstruction due to lesions of the intestinal canal itself, blockage in the intestinal lumen, and extrinsic intestinal compression is usually simple; and adhesive intestinal obstruction is also usually simple. Simple intestinal obstruction can only indicate the lesion in a particular case at a particular time, but not the whole course of the lesion.
Causes
1. Intestinal wall lesions
Such as pediatric congenital intestinal stenosis, atresia, intestinal wall tumors, intestinal tuberculosis and so on.
2. Intestinal lumen factors
Intestinal blockage is seen in fecal stone, roundworm mass and huge gallstones.
3. Lesions outside the intestinal wall
Pathological compression of the intestinal canal caused by various factors, such as abdominal inflammation, injury or surgery-induced peritoneal extensive adhesions or the formation of adhesion bands, as well as intra-abdominal hernia, extra-abdominal hernia incarcerated, intra-abdominal tumor and intestinal torsion, etc.
Symptoms
1. Symptoms
The common symptoms of intestinal obstruction are abdominal pain, vomiting, abdominal distension and cessation of defecation and evacuation.
(1) Abdominal pain is usually paroxysmal severe colic, caused by strong peristaltic movement of the intestinal tubes above the obstruction, if the abdominal pain becomes persistent, we should be alert to strangulated intestinal obstruction.
(2) Vomiting is a common symptom of intestinal obstruction, which can reflect the location of obstruction and the degree of development of the lesion. The higher the site of obstruction, the more complete the obstruction, the more frequent vomiting occurs, and the resting period is short.
(3) Abdominal distension appears later. The degree of abdominal distension is related to the site of obstruction, with high small bowel obstruction having insignificant abdominal distension and low bowel obstruction having obvious abdominal distension.
The degree of abdominal distension is related to the site of obstruction.
(4) Cessation of defecation and evacuation Complete intestinal obstruction may result in cessation of defecation and evacuation.
(5) Systemic symptoms: Frequent vomiting may lead to dehydration, and low potassium may lead to drowsiness, fatigue and arrhythmia.
2. Signs and symptoms
(1) Systemic manifestations There may be no obvious manifestations in the early stage, but in the late stage, there may be sunken eye sockets, reduced skin elasticity and increased heart rate.
(2) Abdominal manifestations often have different degrees of abdominal distension, sometimes see the intestinal pattern, intestinal peristalsis, abdominal wall soft, with pressure pain, percussion drumming, auscultation intestinal sound hyperpronunciation, can be heard vibration of water sounds.
Examination
1. Laboratory examination
In the advanced stage of simple intestinal obstruction, due to water loss and blood concentration, white blood cell count, hemoglobin, erythrocyte pressure may be elevated, urine specific gravity is also increased, and serum K+, Na+, CL- concentration are reduced to different degrees. Serum pH and carbon dioxide binding capacity, as well as urea nitrogen, creatinine, blood gas analysis and other measurements can understand the renal function and acid-base disorders.
2. Imaging examination
(1) X-ray examination: In the advanced stage of intestinal obstruction, there are multiple fluid planes in the intestinal collaterals, which are typically stepped. Repeat X-ray examination if necessary, and compare and observe the image changes of intestinal collaterals, which can help to understand whether intestinal obstruction is relieved or further aggravated.
(2) CT can understand the site of intestinal obstruction, and observe the intestinal lumen and wall of the intestines by looking for the junction of dilated and non-dilated segments.
Diagnosis
Diagnosis can be confirmed based on history and clinical manifestations, combined with laboratory tests and imaging examinations, of which X-ray examination is of great value, such as finding the presence of pneumatosis or gas-liquid planes in the small intestine, which can be taken as the evidence of intestinal obstruction.CT examination can identify the cause and location of intestinal obstruction.
Differential diagnosis
It should be differentiated from strangulated intestinal obstruction. Strangulated intestinal obstruction is characterized by the presence of blood flow obstruction in the intestinal canal, with the possibility of necrosis and peritonitis, which is urgent in treatment. Clinically, the onset of abdominal pain in colic obstruction is acute and severe, the pain is persistent and aggravated by paroxysm, vomiting occurs early and frequently, the vomit is sometimes bloody or fecal odor, abdominal distension is not obvious, and there are signs of peritoneal irritation and peritoneal effusion, etc. X-ray examination is characterized by the display of isolated distended intestinal collaterals, whose position is fixed and does not change over time, and the display of peritoneal effusion, and there is more effusion than pneumoperitoneum.
Treatment
1. Non-surgical treatment
Including fasting and water, gastrointestinal decompression, replenishment of fluids and correction of electrolyte disorders, nutritional support to improve the systemic condition, as well as according to the etiology of the anti-infective treatment, if necessary, the application of sedative, antispasmodic, analgesic drugs.
2. Surgical treatment
When the non-surgical treatment is ineffective, as well as intestinal tumors, congenital intestinal atresia and other conditions require surgical treatment. Surgical methods include caesarean section, one-stage resection and anastomosis of obstructive lesions, short-circuit anastomosis of intestinal collaterals, and enterostomy.
Questions you may be concerned about
What should I do if I have simple intestinal obstruction?
The treatment measures for simple intestinal obstruction mainly include fasting and gastrointestinal decompression, medication and surgery, etc. The details are analyzed as follows:
1. Fasting and gastrointestinal decompression: through fasting, it can reduce the gathering of intestinal food and alleviate the possibility of further aggravation of obstruction. Through gastrointestinal decompression, the gas and liquid in the gastrointestinal tract can be sucked out, which can reduce abdominal distension, improve the blood circulation of the intestinal wall, and promote the relief of obstruction.
2. Drug therapy: mainly antispasmodic drugs and anti-infective drugs, antispasmodic drugs are mainly atropine sulfate, 654-2 and so on. Anti-infective drugs are usually given intravenously, such as ceftriaxone sodium, levofloxacin and so on, in order to achieve the role of prevention and treatment of infection. Some simple intestinal obstruction is caused by constipation, which can be treated by enema such as glycerin enema.
3. Surgical treatment: It is mainly applied to the patients who are ineffective in non-surgical treatment or have tumors in the intestinal tubes, and the specific surgical situation needs to be clarified in the consultation.
It is recommended that patients with simple intestinal obstruction should actively consult the doctor at the onset of the disease and follow the doctor’s instructions.