INTESTINAL OBSTRUCTION

The blockage in small or large intestine is referred to as intestinal obstruction. Gastric conditions such as adhesions, hernias, cancers, and certain medicines are some of the common causes of intestinal obstruction. When leftuntreated, the blocked parts of intestine may die, leading to complications.  This condition is often managed well with early diagnosis and treatment.

The types of intestinal obstruction include partial, pseudo or complete intestinal obstruction.

• Partial intestinal obstruction: It is caused when the patient’s large or small intestine is partially blocked.
• Pseudo intestinal obstruction:In this type, no actual mechanical obstruction is present, however, the movement of the food through the intestines is impaired. It is most caused by impaired function of smooth muscles of the intestine.
• Complete intestinal obstruction: It refers to a complete mechanical obstruction of the intestine that prevents movements of intestinal contents.

SIGNS AND SYMPTOMS

The following are the signs and symptoms of intestinal obstruction:

• Inability to pass gas or stool
• Severe abdominal cramps
• Abdominal swelling
• Decreased appetite
• Pain in abdomen
• Severe bloating
• Constipation
• Vomiting
• Diarrhea
• Nausea

CAUSES AND RISK FACTORS

The causes of intestinal obstruction include:

• Diverticulitis, a condition in which small bulging pouches (diverticula) present in the digestive tract which may become inflamed or infected
• Parkinson’s disease, multiple sclerosis, and other nerve and muscle disorders
• Hirschsprung’s disease, in which sections of the large intestine lack of nerve supply
• Hernias, in which a part of the intestine protrude into adjacent part of your body
• Disorders that cause nerve damage, such as diabetes mellitus
• Inflammatory bowel diseases, such as Crohn's disease
• Hypothyroidism, Tumors located in small intestine
• Twisting of the colon (volvulus)
• Gall stones
• Impacted feces

In adults, Intestinal adhesions that develop after surgery and colon cancer are the most common causes of intestinal obstruction. In children, intussusception (also called as telescoping of intestine), is major cause of intestinal obstruction.

COMPLICATIONS

Timely diagnosis and treatment of intestinal obstruction are important to avoid life threatening complications. Some of the complications include:

• Sepsis, (Infection of the blood)
• Electrolyte imbalances
• Multiple organ failure
• Intestinal perforation
• Kidney failure
• Dehydration
• Death

DIAGNOSIS

Physical examination: The doctor would collect a detailed history of the patient and perform a physical examination to check swelling, lumps or tenderness in abdomen and may listen to bowel sounds using stethoscope. The following tests are useful to confirm the presence of obstruction:

X-ray: The doctor may recommend abdominal X-ray to view the intestinal obstruction.

Computerized tomography (CT): These images obtained from CT scanning are more precise than the regular X-rays and are more helpful to determine the details of the intestinal obstruction.

Ultrasound: It is the most preferred type of imaging in children, especially in diagnosis of intussusceptions that typically appear as bull's eye, which indicate that the intestine coiled within intestine.

Air or barium enema: It is done in the suspected cases of obstruction. In this procedure, the doctor inserts air or liquid barium into the colon through the rectum.

TREATMENT

The treatment is based on the cause and severity of the patient’s condition.

Treating intussusceptions: A barium or air enema is known to treat intussusceptions along with its use in diagnosis, in some cases it clears the obstruction and no further treatment isrequired.

Treatment for partial obstruction: The doctor may advice special low fiber diet in case of partial obstruction and wait for the obstruction to get cleared. However, the doctor may plan surgery if the obstruction persists.

Treatment for complete obstruction

Surgical treatment: It involves surgical removal of the obstruction along with any section of intestine that is damaged.

Stents: Surgery maybe risky in some people, in such cases stents are the choice of treatment. The obstruction is treated with a self-expanding metal stent. The wire mesh tube is inserted from the patient’s mouth in to colon via an endoscope which forces the colon to open and clear obstruction.

Treatment for pseudo-obstruction

The patient may be given food through a nasal tube or an IV to prevent malnutrition.The doctor may give medication to induce intestinal muscle contractions, to enhance movement of food and other gastric contents. Surgery is rarely recommended to treat this condition. Surgical Decompression is indicated to treat enlarged colon.

PREVENTION

As it is caused by adhesions, hernias, cancers, and medicines its prevention is difficult.However, with early screening and proper treatment it is possible to minimize discomfort and complications.