Intestinal obstruction, intestinal occlusion, intestinal pseudo-obstruction, intestinal volvulus or intestinal ileus is a total or partial blockage of intestinal transit which prevents feces, gases and digestive secretions from being evacuated. If left untreated, it can cause intestinal perforation with even fatal consequences. It is a very common cause in emergency surgical admissions.
There are several causes that have been identified for the appearance of intestinal obstruction such as:
- Intestinal adhesions formed by fibrous or scar tissue that forms after abdominal or pelvic surgery.
- Colon cancer.
- Invagination of one segment of intestine into another.
- Congenital defect
- A hernia.
- Have received radiotherapy.
- Intestinal strangulation. The blood supply to the intestine is interrupted.
- Narrowing or absence of a part of the intestine (intestinal atresia).
- Inflammatory intestinal diseases such as Crohn's disease.
- Intestinal volvulus (torsion of the colon).
- Fecal retention.
- Diverticulitis. Inflammation or infection of balloon-shaped sacs (diverticula) that form in the intestine.
There are three basic types of intestinal obstruction:
- Mechanical occlusion (hernias, flanges, volvulus, invaginations, tumors, inflammatory diseases, gallstone ileus, fecalomas, bezoar and foreign bodies).
- Paralytic ileus (post-surgery, peritonitis, metabolic alterations, spinal cord injury, lead poisoning and porphyrias). Paralytic pseudo-obstruction ileus causes symptoms of intestinal obstruction but does not imply total blockage. What happens is that the coordinated muscle contractions in the intestines are interrupted, stopping or reducing the transit of food, liquids, feces and intestinal secretions.
- Vascular (arterial embolism, venous thrombosis and mesenteric ischemia).
The main symptoms of intestinal obstruction are:
- Colicky abdominal pain. It is usually intermittent.
- Loss of appetite.
- Constipation.
- Nausea and vomiting.
- Inability to evacuate or eliminate gases.
- Inflammation of the abdomen.
Physical examination and abdominal x-rays are usually the basic tests to confirm obstruction. Abdominal computed tomography (CT), opaque enema (x-ray of the colon and rectum), and esophagogastroduodenal transit radiographs (x-rays of the esophagus, stomach, and small intestine) may also be performed. If there is strangulation, an exploratory laparatomy (surgical exploration of the abdomen) will be necessary. In the case of children, the usual thing is to perform an ultrasound.
Intestinal obstruction requires hospital admission with the placement of an intravenous line to administer fluids and electrolytes (sodium, chloride and potassium) to rehydrate and replace salts after vomiting. Antibiotics will be administered intravenously if there is a risk of intestinal ischemia or infarction.
A nasogastric tube will be placed to remove air and fluids to relieve swelling in the abdomen. If the cause is an adhesion or a scar, surgery may not be necessary. In children with intussusception, only a barium or air enema may be necessary.
If the obstruction is total, there are several possible techniques such as:
Place a self-expanding metal stent in the colon. It is inserted with an endoscopy through the mouth or colon and is used in cases of colon cancer or when surgery may present other complications.
Bowel resection. Repair or removal of the damaged part of the intestine.
Colostomy or ileostomy. One end of the intestine is brought out through an opening in the abdominal wall and the contents of the colon or ileus are evacuated to an external bag. It may be temporary.
A healthy and balanced diet rich in fiber, avoiding alcohol and tobacco and doing regular exercise in addition to correct fluid intake are preventive measures against intestinal transit blockage. However, if you have suffered an intestinal obstruction, it is recommended to follow a liquid diet with broths and gelatins during the first days after recovery of transit. Afterwards you can add milk, yogurts, purees and fruit smoothies.
The next phase, and as a usual dietary measure, should include a dietary guideline that reduces the residual volume in the intestines such as cooked fruits and vegetables (spinach, pumpkin, carrots, asparagus and potatoes); and cooked meats and fish. You should avoid fats, fried foods, sausages, spicy and sweet foods.
