When your child has abdominal pain, vomiting and abdominal distension, you should not take it lightly and should pay attention to it, because there is a type of intestinal obstruction which is mechanical intestinal obstruction, and simple conservative treatment may not necessarily solve the problem. Moreover, sometimes the condition progresses rapidly and cannot be delayed, otherwise, the consequences are serious!
What is mechanical intestinal obstruction?
Mechanical intestinal obstruction is a partial or complete blockage of the passage of intestinal contents through the intestine caused by mechanical factors inside or outside the intestine. It can occur in the small intestine (including the duodenum) or in the colon (i.e., large intestine). Common causes of pediatric mechanical intestinal obstruction include intussusception, incarcerated hernia, intestinal adhesions (more common with a history of surgery or abdominal infection), foreign bodies in the GI tract, megacolon disease, fecal impaction, and intestinal torsion. In addition, obstruction of the duodenum in the neonatal period (within the first month of life) is commonly associated with duodenal atresia, stenosis and cricothyroid pancreas. Small bowel obstruction in infancy is often due to torsion of poorly rotated bowel segments, incarcerated hernia and intussusception.
Simple intestinal obstruction is classified into simple intestinal obstruction and strangulated intestinal obstruction according to whether the blood supply to the intestine is impaired, while strangulated intestinal obstruction has a severe impairment of blood supply to the intestine.
In small intestine obstruction, abdominal pain is mainly around the umbilicus or upper abdomen, while in colon obstruction, abdominal pain is concentrated in the lower abdomen; vomiting occurs earlier in small intestine obstruction and later in colon obstruction, and the symptoms of colon obstruction appear more slowly than those of small intestine obstruction. The ileocecal valve is located between the small intestine and the colon, which can not only control the speed of intestinal contents flowing down, but also prevent the colonic contents from flowing back into the small intestine, and has a certain role in the distribution of normal intestinal flora. In intestinal obstruction without intestinal blood flow obstruction, the typical presentation is a high-pitched bowel sound and enhanced intestinal peristalsis during paroxysmal pain episodes. There is no obvious pressure pain in the abdomen at this time. The typical manifestation of colonic obstruction on physical examination is abdominal distension with loud bowel sounds, no abdominal pressure pain, and rectal emptiness. Auxiliary examination: X-ray examination of typical small bowel obstruction in supine and upright positions shows a stepped change in small bowel collaterals, showing a gas-fluid plane.
In children with strangulated intestinal obstruction, venous obstruction occurs first, followed by arterial obstruction, which leads to acute ischemia of the intestinal wall, edema and necrosis of the intestinal wall, followed by perforation to form peritonitis, shock, and even life-threatening. When the blood flow of the intestinal canal is impaired, the abdominal distension is obviously aggravated, there may be abdominal pressure pain, and the bowel sounds are absent or very faint on auscultation. Sometimes, abdominal masses can be found. However, strangulated intestinal obstruction can only be diagnosed by caesarean section.
Special manifestations: 1. In upper jejunal obstruction, there may be no dilated intestinal collaterals on examination, and 2 air-fluid planes can be seen on standing plain radiograph of the abdomen, which is called the double bubble sign in imaging; 2. In closed-collaterals type strangulated intestinal obstruction (which may occur in intestinal torsion), no dilated intestinal collaterals are seen but only a mass suggesting intestinal obstruction. If the condition becomes more and more serious, the intestinal wall may become ischemic and necrotic, followed by intestinal perforation, and the intestinal contents overflow into the peritoneal cavity, then peritonitis will appear, which may be life-threatening without timely treatment.
Treatment principle: According to the clinical symptoms, signs and related auxiliary examinations, some need direct early treatment or even surgery after clear intestinal obstruction, while some need observation and identification, especially shock and oliguria suggest strangulated or late simple intestinal obstruction, which must be treated quickly.
Notes: 1. Patients suspected of intestinal obstruction should be hospitalized to facilitate observation of changes in the condition and timely detection of problems to prevent intestinal necrosis and intestinal perforation; 2. Gastrointestinal decompression for several hours, usually not more than 24~48 hours, no relief during the observation period, the condition is not reduced but aggravated, should be promptly operated.
4.The treatment of colonic obstruction is similar to that of small bowel obstruction. Before emergency surgery, gastric tube gastrointestinal decompression, intravenous fluids and electrolytes should be placed, and acid-base balance disorder should be corrected. In case of perforation and diffuse peritonitis, if there is an indication for emergency surgery, intestinal resection and anastomosis should be performed.