Dilatation of the small intestine is an important manifestation of malabsorption syndrome, mostly in the jejunum, especially in the lower and middle part of the jejunum, sometimes causing dilatation of the entire small intestine including the duodenum. The degree of small bowel dilatation is related to the severity of the disease, and the cause of dilatation is low tone of the small bowel. It is believed that a small bowel diameter greater than 31 mm can be considered dilated, and the bowel diameter can be two to three times the normal size when it is significantly dilated. Inflation of the small intestine can be mild or severe, while most of the colonic inflations are more significant, often manifesting as peri-abdominal inflation of the whole colonic frame. The distribution of small bowel inflation is mostly in the middle abdomen within the colonic frame.
Examination of dilated and inflated small intestine caused by intestinal obstruction: I. Laboratory tests 1. If the obstruction is prolonged and the sign of dehydration appears, hematocrit and leukocyte increase can occur. When the leukocytes increase and left shift, it indicates the presence of intestinal strangulation.
2.The determination of serum electrolytes (K, Na, Cl-), carbon dioxide binding capacity, blood gas analysis, urea nitrogen and blood cell pressure is used to judge the dehydration and electrolyte disorder and to guide the fluid input.
3. Determination of serum inorganic phosphorus, creatine kinase and isoenzymes Many experiments have shown that inorganic phosphorus and creatine kinase in blood increase when the intestinal wall is ischemic and necrotic.
X-ray examination X-ray examination is very important for the diagnosis of intestinal obstruction. After the jejunum and ileum are filled with gas, their X-ray images have their own characteristics: jejunal mucosal folds are arranged parallel to the mesenteric margin in a fishbone shape, and the gap is regular like a spring; ileal mucosal folds disappear, and the outline of the intestinal tube is smooth; colonic distention is located at the periphery of the abdomen, showing colonic pouch shape.
X-ray manifestation of small intestinal obstruction: pneumatization and fluid accumulation in the intestinal canal above the obstruction with dilatation of the intestinal canal. The fluid surface appears in the intestinal lumen soon after the obstruction. The longer the time of obstruction, the more fluid there is. Low-level obstruction has more fluid. The fluid surface usually appears after 5-6 h of obstruction. In the standing position, a stepped fluid plane of varying length can be seen. The distribution of distended bowel loops can be seen in the prone position, with the small intestine in the center and the colon occupying the periphery of the abdomen. In high jejunal obstruction, a large amount of gas and fluid is seen in the stomach. In low small bowel obstruction, there are more fluid planes. In complete obstruction, there is no gas or only a small amount of gas in the colon.
Manifestations of strangulated intestinal obstruction: round or lobulated soft tissue masses are imaged in the abdomen. Individual distended fixed bowel loops with “C” shaped dilatation or “coffee bean sign” can also be seen.
In paralytic intestinal obstruction, the small intestine and colon are uniformly dilated, but there is less pneumatization and fluid in the intestinal canal. In case of paralytic intestinal obstruction caused by peritonitis, there is exudative fluid in the abdominal cavity and the intestinal canal floats in it. The intestinal canal spacing is widened, the edges are blurred, and the jejunal mucosal folds are thickened.
2.B-type ultrasonography Soft masses can be formed in the abdomen, and the intestinal cavity can be seen to be peristaltic, and fluid retention can be seen. The intestinal lumen sound image can be seen in concentric circles, with strong echogenicity in the center of the circle, and multi-layer tube wall structure can be seen in the longitudinal plane. The use of B-mode ultrasound to diagnose intestinal obstruction is subject to further study and improvement.