Intestinal obstruction (ileus) refers to the failure of the intestinal contents to pass and run smoothly in the intestine. When the passage of intestinal contents is obstructed, a series of symptoms such as abdominal distension, abdominal pain, nausea and vomiting, and bowel obstruction can occur. Intestinal obstruction is one of the common acute abdominal diseases.
Clinical manifestations of intestinal obstruction: abdominal pain, vomiting, abdominal distension, anal cessation of defecation and exhaustion, clinical manifestations do not fully comply with the 4 items.
Etiology of intestinal obstruction: intestinal adhesions, intestinal strictures, gastrointestinal tumors, extraluminal pressure, intestinal dysplasia, etc.
Treatment options
The treatment of intestinal obstruction is to relieve the obstruction and restore the patency of the intestinal canal. It is worth noting that the threat to the patient’s life does not lie entirely in the intestinal obstruction itself, but in the systemic pathophysiological changes caused by the intestinal obstruction. In order to save the patient’s life, water and electrolyte disorders should be corrected in time to reduce intestinal lumen distension. Surgical treatment should be carried out after the systemic pathophysiological changes are corrected.
1.Gastrointestinal decompression.
2.Water and electrolyte supplementation.
3.Application of antibiotics.
4.Surgical treatment
After the above treatment, some patients can be relieved. If abdominal pain worsens, vomiting does not stop, white blood cells increase, and body temperature also increases, surgical treatment is necessary. The duration of observation should not exceed 48h to avoid necrosis of intestinal strangulation. Surgical methods vary according to the cause of obstruction, and there are generally four methods.
(1) adhesiolysis and repositioning.
(2) short-circuit anastomosis between intestinal loops There are generally two types of anastomosis: (1) lateral anastomosis and (2) end-lateral anastomosis.
(3) enterostomy
(4) intestinal resection and intestinal anastomosis.
Surgical intervention should pay attention to the following cases
1.Adhesive intestinal obstruction
(1) Non-surgical treatment For simple and incomplete intestinal obstruction, especially for extensive adhesions, non-surgical treatment is generally chosen; for simple intestinal obstruction, observation can be made for 24 to 48 hours, and for strangulated intestinal obstruction, surgical treatment should be performed as early as possible, and observation should not exceed 4 to 6 hours in general.
Basic therapy includes fasting and gastrointestinal decompression, correction of water and electrolyte disorders and acid-base imbalance, prevention and control of infection and toxemia. Chinese herbal medicine and acupuncture therapy can also be used.
(2) Surgical treatment If the condition of adhesive intestinal obstruction is not improved or aggravated by non-surgical treatment; or if it is suspected to be strangulated intestinal obstruction, especially closed loop intestinal obstruction; or if adhesive intestinal obstruction has recurrent and frequent attacks, which seriously affects the quality of life of patients, surgical treatment should be considered. ①Simple cutting and separation of adhesions or small pieces of adhesions. If the intestinal loops with small confined tight adhesions cannot be separated, or if the intestinal tube is necrotic, intestinal resection anastomosis is feasible. ③If the patient’s condition is very poor, or the intraoperative blood pressure is difficult to maintain, it can be preceded by external intestinal placement. ④If the intestinal loops are closely adhered and cannot be resected and separated, lateral anastomosis of the distal and proximal intestines at the site of obstruction is feasible. ⑤ For those with extensive adhesions and repeated intestinal obstruction, intestinal alignment is feasible.
2.Strangulated intestinal obstruction should be treated immediately after diagnosis, and the surgical method should be decided according to the cause of strangulation.
Prevention of intestinal obstruction.
1, diet: pay attention to the regularity of diet, quantitative, regular meals, avoid overeating, remember to overeat. Food should be soft, easy to digest and nutritious diet. Pay attention to dietary hygiene and prevent intestinal infections. Eat foods with high fiber content and drink more water to keep bowel movements smooth.
2, activities: avoid strenuous activities after meals, especially bending, continuous squatting and standing activities, to prevent intestinal torsion.
3, should maintain a calm state of mind: to avoid adverse reactions caused by mood swings resulting in intestinal dysfunction or abnormalities in the function of the vegetative nerves.
4, should maintain a smooth bowel movement: abnormal bowel function, such as: patients with constipation should be given timely laxatives, if necessary, give enemas to assist defecation. Can also massage the lower abdomen clockwise every day to increase intestinal motility.
5, intestinal obstruction, especially the symptoms of adhesive intestinal obstruction are prone to recurrence: when there is abdominal pain, abdominal distension, nausea, vomiting, anal stop venting and defecation and other symptoms in a timely manner.