Today, a friend of mine came to consult about surgery. She had recurrent episodes of intestinal obstruction after radiotherapy after radical cervical cancer surgery many years ago, with episodes occurring once every six months to a year, and came to consult about surgery. For this reason, we will talk about the treatment principles of intestinal obstruction again.
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, 24 to 48 hours of observation is possible, and for strangulated intestinal obstruction, surgical treatment should be carried out as early as possible, and generally observation should not exceed 4 to 6 hours.
Basic therapy includes fasting and gastrointestinal decompression, correction of water and electrolyte disorders and acid-base imbalance, prevention and control of infection and toxemia. Traditional Chinese medicine and acupuncture therapy can also be used.
(2) Surgical treatment
If the condition of adhesive intestinal obstruction does not improve or is 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 Intestinal alignment is feasible for those with extensive adhesions that repeatedly cause intestinal obstruction.
2. Strangulated intestinal obstruction Once diagnosed, immediate surgical treatment should be performed, and the surgical method should be decided according to the cause of strangulation.