Intestinal obstruction refers to the failure of the intestinal contents to function normally and pass smoothly through the intestine caused by various reasons. With the accelerated aging of our population, intestinal obstruction in the elderly is becoming an increasingly common clinical disease and should be taken seriously.
General clinical manifestations of intestinal obstruction in the elderly
1, pain: that is, abdominal pain. In the early stage, it is often paroxysmal abdominal pain, and later it turns into continuous abdominal pain.
2 vomiting: that is, vomiting. High intestinal obstruction vomiting appears earlier, low intestinal obstruction vomiting appears later. Liu Xuejun, Department of General Surgery, Anyang Hospital of Traditional Chinese Medicine
3, distension: that is, abdominal distension. High intestinal obstruction abdominal distension is not obvious, but sometimes visible stomach type. Low intestinal obstruction and paralytic intestinal obstruction, abdominal distension is obvious.
4, closed: that is, the anal autonomic defecation and exhaustion stop. After the occurrence of complete intestinal obstruction, patients mostly no longer ventilate and defecate. However, in the early stage of obstruction, especially high intestinal obstruction, there can still be discharge because of the residual feces and gas in the intestinal cavity above the obstruction, so the existence of intestinal obstruction cannot be denied.
Examination: abdominal pressure pain, hyperactive bowel sounds with high-pitched metallic sound or air-over-water sound in the early stage, weakening or disappearing in the later stage. Standing abdominal x-ray plain film shows gas-fluid plane.
Common causes of intestinal obstruction in the elderly
1. Adhesive intestinal obstruction. Previous history of abdominal surgery, inflammation, injury.
2.Inserted hernia. Physical examination is comprehensive and not difficult to diagnose.
3.Fecal block obstruction. There is a history of prolonged constipation. Sometimes enema can not be completely relieved, rectal finger diagnosis can be palpated hard fecal ball, can be relieved after pulling out.
4, colon and rectal tumors. Clinical features are.
①Changes in bowel habits and traits. Such as increased frequency of defecation, constipation, blood in stool.
(2) Abdominal pain: it is often inaccurately characterized as vague pain, and the abdominal pain is aggravated when intestinal obstruction occurs.
③Abdominal mass: sometimes a mass can be felt.
④Symptoms of intestinal obstruction: pain, vomiting, distention and closure when complicated by intestinal obstruction.
⑤ Systemic wasting manifestations: wasting, weakness, anemia.
⑥Check: rectal finger diagnosis is helpful for rectal tumor diagnosis, and colonoscopy can clarify colon and rectal tumor.
5.Sigmoid colon torsion. It refers to the twisting of the sigmoid colon with its mesentery as the central axis, and mostly has a redundant sigmoid colon. It is common in elderly men, often with constipation habits, or a history of multiple episodes of abdominal pain relieved by defecation and exhaustion. In addition to abdominal cramps, clinical manifestations include significant abdominal distension, while vomiting is usually not obvious. If a low-pressure enema is given, often less than 500 ml can no longer be instilled. An abdominal radiograph shows a huge horseshoe-shaped double-lumen inflatable bowel loop with the dome up and both limbs down. Two nocturnal planes are seen in the upright position. Barium x-ray examination showed that the barium was obstructed at the torsion site and the tip of the barium shadow was in the shape of “bird’s beak”.
6, mesenteric vascular ischemic disease. It refers to mesenteric vascular embolism or thrombosis that affects intestinal blood flow, resulting in intestinal obstruction and necrosis. The diagnosis mainly relies on medical history and clinical manifestations. For abdominal pain with clinical manifestations similar to intestinal obstruction and unknown causes, the disease should be highly suspected if there are corresponding high-risk factors, such as atrial fibrillation, coronary heart disease, portal hypertension, etc.
In conclusion, intestinal obstruction in the elderly has both general clinical manifestations of intestinal obstruction and its special characteristics in terms of pathogenesis, etc., which should be paid attention to. In particular, when recurrent intestinal obstruction or intestinal obstruction that cannot be completely relieved for a long time is found clinically, non-surgical treatment alone is not possible. The possibility of colorectal tumor and sigmoid colon torsion should be thought of, and a clear diagnosis should be made by colonoscopy, so that radical measures can be taken as early as possible to avoid delaying the disease.