Acute Intestinal Obstruction And Laparoscopy Video

The 3 main types of acute intestinal obstruction are paralytic ileus, mechanical obstruction, and vascular obstruction.

1.Paralytic ileus: Obstruction is due to inhibition of intestinal motility: Vomiting and intractable constipation are common symptoms. Peristalsis is markedly diminished or absent. The abdomen is distended and may or may not be tender.

2.Mechanical obstruction: The lumen of the bowel is blocked due to incarceration, strangulation, neoplasm or volvulus. Crampy abdominal pain is typical; inability to pass stools is always noted. Vomiting is usually present. The abdomen is distended with hyperactive peristalsis.

3.Vascular obstruction: The most common causes are mesenteric artery occlusion and mesenteric vein thrombosis. Patients are usually elderly. There is sudden onset of severe abdominal pain, vomiting, diarrhea, blood in stools and shock. The abdomen is tender, peristalsis diminished or absent.

Prevention Of Intestinal Obstruction

Prevention Intestinal Obstruction

Prevention depends on the cause. Treatment of conditions [such as tumors and hernias] that are related to obstruction may reduce your risk.

Some causes of obstruction cannot be prevented.

Possible Complications Of Intestinal Obstruction

Possible Complications Intestinal Obstruction


Complications may include or may lead to:

• Electrolyte imbalances
• Infection
• Jaundice
• Perforation (hole) in the intestine

If the obstruction blocks the blood supply to the intestine, the tissue may die, causing infection and gangrene. Risk factors for tissue death include intestinal cancer, Crohn's disease, hernia, and previous abdominal surgery.

In the newborn, paralytic ileus that is associated with destruction of the bowel wall (necrotizing enterocolitis) is life-threatening and may lead to blood and lung infections.

Volvulus Intestinal Obstruction Picture

Volvulus Intestinal Obstruction Picture

Intestinal Obstruction Picture

Treatment Of Intestinal Obstruction

Treatment involves placing a tube through the nose into the stomach or intestine to help relieve abdominal distention and vomiting.

Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms, or if there are signs of tissue death.

Treatment

• Nasogastric suction
• IV fluids
• IV antibiotics if bowel ischemia suspected

Patients with possible intestinal obstruction should be hospitalized. Treatment of acute intestinal obstruction must proceed simultaneously with diagnosis. A surgeon should always be involved.

Supportive care is similar for small and large bowel obstruction
nasogastric suction, IV fluids (0.9% saline or lactated Ringer's solution for intravascular volume repletion), and a urinary catheter to monitor fluid output. Electrolyte replacement should be guided by test results, although in cases of repeated vomiting serum Na and K are likely to be depleted. If bowel ischemia or infarction is suspected, antibiotics should be given [eg, a 3rd-generation cephalosporin, such as cefotetan 2 g IV]before laparotomy.

Complete obstruction of the small bowel is preferentially treated with early laparotomy, although surgery can be delayed 2 or 3 h to improve fluid status and urine output in a very ill, dehydrated patient. The offending lesion is removed whenever possible. If a gallstone is the cause of obstruction, it is removed through an enterotomy, and cholecystectomy need not be done. Procedures to prevent recurrence should be done, including repair of hernias, removal of foreign bodies, and lysis of the offending adhesions. In some patients with early postoperative obstruction or repeated obstruction caused by adhesions, simple intubation with a long intestinal tube (many consider a standard NGT to be equally effective), rather than surgery, may be attempted in the absence of peritoneal signs.

Disseminated intraperitoneal cancer obstructing the small bowel is a major cause of death in adult patients with GI tract cancer. Bypassing the obstruction, either surgically or with endoscopically placed stents, may palliate symptoms briefly.

When diverticulitis causes obstruction, perforation is often present. Removal of the involved area may be very difficult but is indicated if perforation and general peritonitis are present. Resection and colostomy are done, and anastomosis is postponed.

Obstructing colon cancers can often be treated by a single-stage resection and anastomosis. Other options include a diverting ileostomy and distal anastomosis. Occasionally, a diverting colostomy with delayed resection is required.

Fecal impaction usually occurs in the rectum and can be removed digitally and with enemas. However, a fecal concretion alone or in a mixture (ie, with barium or antacids) that causes complete obstruction (usually in the sigmoid) requires laparotomy.

Treatment of cecal volvulus consists of resection and anastomosis of the involved segment or fixation of the cecum in its normal position by cecostomy in the frail patient. In sigmoidal volvulus, an endoscope or a long rectal tube can often decompress the loop, and resection and anastomosis may be deferred for a few days. Without a resection, recurrence is almost inevitable.

Diagnosis Exams And Investigation Of Intestinal Obstruction

While listening to the abdomen with a stethoscope your health care provider may hear high-pitched bowel sounds at the onset of mechanical obstruction. If the obstruction has persisted for too long or the bowel has been significantly damaged, bowel sounds decrease, eventually becoming silent.

Early paralytic ileus is marked by decreased or absent bowel sound.

Tests that show obstruction include:

* Abdominal CT scan
* Abdominal x-ray
* Barium enema
* Upper GI and small bowel series

Abdominal series

Supine and upright abdominal x-rays should be obtained and are usually adequate to diagnose obstruction. Although only laparotomy can definitively diagnose strangulation, careful serial clinical examination may provide early warning. Elevated WBCs and acidosis may indicate that strangulation has already occurred.

On plain x‑rays, a ladderlike series of distended small-bowel loops is typical of small-bowel obstruction but may also occur with obstruction of the right colon. Fluid levels in the bowel can be seen in upright views. Similar, although perhaps less dramatic, x‑ray findings and symptoms occur in ileus differentiation can be difficult. Distended loops and fluid levels may be absent with an obstruction of the upper jejunum or with closed-loop strangulating obstructions (as may occur with volvulus). Infarcted bowel may produce a mass effect on x‑ray. Gas in the bowel wall (pneumatosis intestinalis) indicates gangrene.

In large-bowel obstruction, abdominal x‑ray shows distention of the colon proximal to the obstruction. In cecal volvulus, there may be a large gas bubble in the mid-abdomen or left upper quadrant. With both cecal and sigmoidal volvulus, a contrast enema shows the site of obstruction by a typical “bird-beak” deformity at the site of the twist; the procedure may actually reduce a sigmoid volvulus. If contrast enema is not done, colonoscopy can be used to decompress a sigmoid volvulus but rarely works with a cecal volvulus.

X-Ray Picture Small Bowel Obstruction

Small Bowel Obstruction Upright View

Small Bowel Obstruction Supine View

Signs And Symptoms Of Intestinal Obstruction

Signs And Symptoms Intestinal Obstruction

Obstruction of the small bowel causes symptoms shortly after onset abdominal cramps centered around the umbilicus or in the epigastrium, vomiting, and in patients with complete obstruction obstipation. Patients with partial obstruction may develop diarrhea. Severe, steady pain suggests that strangulation has occurred. In the absence of strangulation, the abdomen is not tender. Hyperactive, high-pitched peristalsis with rushes coinciding with cramps is typical. Sometimes, dilated loops of bowel are palpable. With infarction, the abdomen becomes tender and auscultation reveals a silent abdomen or minimal peristalsis. Shock and oliguria are serious signs that indicate either late simple obstruction or strangulation.

1. Abdominal Distention
2. Abdominal Fullness, Gaseous
3. Abdominal pain and cramping
4. Breath odor
5. Constipation
6. Diarrhea
7. Vomiting

Volvulus often has an abrupt onset. Pain is continuous, sometimes with superimposed waves of colicky pain

Obstruction of the large bowel usually causes milder symptoms that develop more gradually than those caused by small-bowel obstruction. Increasing constipation leads to obstipation and abdominal distention. Vomiting may occur [usually several hours after onset of other symptoms] but is not common. Lower abdominal cramps unproductive of feces occur. Physical examination typically shows a distended abdomen with loud borborygmi. There is no tenderness, and the rectum is usually empty. A mass corresponding to the site of an obstructing tumor may be palpable. Systemic symptoms are relatively mild, and fluid and electrolyte deficits are uncommon.

Causes Of Intestinal Obstruction

Obstruction of the bowel may due to

-A mechanical cause, which simply means something is in the way
-Ileus,a condition in which the bowel doesn't work correctly but there is no structural problem

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:

• * Chemical, electrolyte, or mineral disturbances (such as decreased potassium levels)
• * Complications of intra-abdominal surgery
• * Decreased blood supply to the abdominal area (mesenteric artery ischemia)
• * Injury to the abdominal blood supply
• * Intra-abdominal infection
• * Kidney or lung disease
• * Use of certain medications, especially narcotics

In older children, paralytic ileus may be due to bacterial, viral, or food poisoning [gastroenteritis], which is sometimes associated with secondary peritonitis and appendicitis.

Mechanical causes of intestinal obstruction may include:

• * Abnormal tissue growth
• * Adhesions or scar tissue that form after surgery
• * Foreign bodies (ingested materials that obstruct the intestines)
• * Gallstones
• * Hernias
• * Impacted feces (stool)
• * Intussusception
• * Tumors blocking the intestines
• * Volvulus (twisted intestine)

Pathophysiology Of Intestinal Obstruction

Pathophysiology

In simple mechanical obstruction, blockage occurs without vascular compromise. Ingested fluid and food, digestive secretions, and gas accumulate above the obstruction. The proximal bowel distends, and the distal segment collapses. The normaly secretory and absorptive functions of the mucosa are depressed, and the bowel wall becomes edematous and congested. Severe intestinal distention is self-perpetuating and progressive, intensifying the peristaltic and secretory derangements and increasing the risks of dehydration and progression to strangulating obstruction.

Strangulating obstruction is obstruction with compromised blood flow it occurs in nearly 25% of patients with small-bowel obstruction. It is usually associated with hernia, volvulus, and intussusception. Strangulating obstruction can progress to infarction and gangrene in as little as 6 h. Venous obstruction occurs first, followed by arterial occlusion, resulting in rapid ischemia of the bowel wall. The ischemic bowel becomes edematous and infarcts, leading to gangrene and perforation. In large-bowel obstruction, strangulation is rare[except with volvulus].

Perforation may occur in an ischemic segment [typically small bowel] or when marked dilation occurs. The risk is high if the cecum is dilated to a diameter ≥ 13 cm. Perforation of a tumor or a diverticulum may also occur at the obstruction site.

Etiology Of Intestinal Obstruction

Etiology Intestinal Obstruction

Overall, the most common causes of mechanical obstruction are adhesions, hernias, and tumors. Other general causes are diverticulitis, foreign bodies (including gallstones), volvulus (twisting of bowel on its mesentery), intussusception (telescoping of one segment of bowel into another and fecal impaction. Specific segments of the intestine are affected differently.

Definition Intestinal Obstruction

Definition of Intestinal Obstruction [Bowel Obstruction]

Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.

Alternative Names

Paralytic ileus, Intestinal volvulus, Bowel obstruction, Ileus, Pseudo-obstruction - intestinal, Colonic ileus

Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine. Symptoms include cramping pain, vomiting, obstipation, and lack of flatus. Diagnosis is clinical, confirmed by abdominal x‑rays. Treatment is fluid resuscitation, nasogastric suction, and, in most cases of complete obstruction, surgery.

Mechanical obstruction is divided into obstruction of the small bowel [including the duodenum] and obstruction of the large bowel. Obstruction may be partial or complete. About 85% of partial small-bowel obstructions resolve with nonoperative treatment, whereas about 85% of complete small-bowel obstructions require operation