Intestinal obstruction is a condition in which the contents of the intestine do not function properly and pass smoothly through the intestine. Intestinal obstruction is one of the common surgical emergencies with many causes and types, which can lead to systemic pathophysiological changes after the onset and can be life-threatening in serious cases.
Classification of intestinal obstruction (a) Classification according to the cause of obstruction: mechanical, dynamic, hemodynamic (b) Classification according to the presence or absence of obstruction of blood flow in the intestinal wall: simple, strangulated (c) Classification according to the site of obstruction: high small intestine, low small intestine, colonic obstruction (d) Classification according to the degree of obstruction: complete, incomplete Diagnosis: (a) Typical clinical manifestations are: “pain, vomiting, distension (b) Typical clinical manifestations are: “pain, vomiting, distension, closure”.
1.Abdominal pain: mechanical intestinal obstruction is mostly paroxysmal colic, paralytic intestinal obstruction is mostly moderate diffuse distension, hemorrhagic intestinal obstruction is mostly persistent severe pain in the middle abdomen or middle back, and strangulated intestinal obstruction is mostly diffuse or limited persistent severe pain.
2, vomiting: early reflexive, for gastric contents. Mechanical intestinal obstruction vomiting characteristics: high small intestinal obstruction vomiting appears early and frequently, as gastric juice, intestinal fluid or bile; low small intestinal obstruction, vomiting more, first for the contents of the stomach and intestines, then for fecal-like; colonic obstruction vomiting appears late and less, fecal-like. In paralytic intestinal obstruction, vomiting is late and light. Vomiting in hemorrhagic or strangulated intestinal obstruction is intense and continuous, and can be brownish-brown bloody gastrointestinal contents.
3. Abdominal distension: related to the degree and location of obstruction. Mechanical intestinal obstruction: abdominal distension is not obvious in high obstruction, sometimes the stomach type is visible; in low obstruction, abdominal distension is obvious throughout the abdomen. In paralytic intestinal obstruction, abdominal distension can be obvious in the early stage and spread throughout the abdomen. In closed-collar intestinal obstruction such as intestinal torsion, the abdominal bulge is not uniform and symmetrical.
4.Stop venting and defecation: there can still be venting and defecation in high small bowel obstruction, a small amount of venting and defecation in low small bowel obstruction, and most of venting and defecation in colon obstruction.
（Mechanical intestinal obstruction: intestinal pattern and intestinal peristaltic waves can be seen. (c) Systemic manifestations: there are no obvious systemic changes in the early stage of simple intestinal obstruction; in the late stage of obstruction or strangulated obstruction, there may be dehydration and infection poisoning; in severe cases, shock may occur.
Causes of intestinal obstruction: There are many causes of intestinal obstruction, including adhesional intestinal obstruction (mostly in patients with a history of surgery or abdominal inflammation), tumor, intussusception or strangulated ventral hernia, intussusception, roundworm, fecal blockage (mostly in elderly patients), congenital malformation, etc.
Treatment: The treatment of intestinal obstruction is divided into conservative treatment and surgical treatment. For patients without obvious manifestations of intestinal necrosis and with mild symptoms, conservative treatment can be chosen, and most patients can be relieved by fasting water, gastrointestinal decompression and intravenous nutritional support, and those caused by constipation can be given enemas to laxative, and for intestinal obstruction caused by other reasons, enemas should be carefully, which may further aggravate the symptoms of obstruction, and in addition, water-electrolyte disorders and acid-base toxicity must be corrected in time; for patients with obvious symptoms and signs If the operation is too late, it may lead to large intestinal necrosis or serious infection, which can be life-threatening. During the diagnosis and treatment, we should pay great attention to and closely monitor the changes of the disease, and we must clarify the site, degree and nature of abdominal pain and the cause of obstruction before operation, and clarify whether there is intestinal ischemia or necrosis, so as to grasp the operation in time. We should not wait for the emergence of obvious signs of peritonitis and lose the best time for surgery, resulting in irreversible intestinal necrosis.