Obstructive intestinal obstruction is a pathology that is accompanied by a violation or a complete stop of the movement of intestinal contents through the gastrointestinal tract (on the segment from the stomach to the anus). Such a disease is one of the most dangerous surgical pathologies in the abdominal cavity.
Classification
According to the factors that cause this pathology, they distinguish:
- Mechanical intestinal obstruction.
- Dynamic variety of disease.
Dynamic variant of obstruction appears when there are obstacles in the way of intestinal contents, and mechanical - is a consequence of a violation of intestinal motility and, in turn, is divided into partial or complete, as well as obstructive or strangulation obstruction. Mechanical intestinal obstruction can form anywhere in the gastrointestinal tract, although it is most common in the small intestine.
In case of complete or partial disruption of the movement of intestinal contents due to narrowing orblockage of the intestinal lumen, this pathology is called obturation obstruction.
Causes of pathology
As a rule, mechanical intestinal obstruction develops due to the following reasons:
- Benign neoplasms in the small intestine.
- Neoplasms that are malignant and localized in the large or small intestine.
- Foreign bodies.
Regardless of the nature of the formation, it grows into the intestinal lumen, slowing down the progress of intestinal contents.
In elderly patients, intestinal obstruction may occur due to coprostasis. In this case, the intestinal walls absorb water due to prolonged stagnation of the contents. As a result, the fecal masses are significantly compacted and, as a result, fecal stones are formed that clog the lumen of the distal segments of the intestine.
Quite often the formation of obstructive intestinal obstruction is provoked by calculous cholecystitis or cholelithiasis. Moreover, large stones, lingering in the lumen, cause the formation of bedsores, and later - fistulas (localized between the bladder and intestines). Stones can migrate through fistulas, causing intestinal blockage.
More rarely, obstructive intestinal obstruction can occur with massive helminthic invasions, so with ascariasis, a ball of parasites clogs the intestinal lumen. In addition, pathology is also formed with neoplasms of the mesentery, aberrant vessels, or congenitalanomalies.
Clinic
Distinguish general and particular signs of pathology.
The first include:
- Spastic abdominal pain.
- Vomiting.
- Accelerated peristalsis that occurs at the beginning of the disease, and its complete stop at a later date.
- Short periods (several days) of symptoms after the onset of obturation.
- Inability to pass gas and feces.
It is worth noting that such signs to some extent may accompany other pathologies, for example, dysbacteriosis (lack of live bacteria for the intestines), and therefore it is important to take into account local manifestations, anamnesis, the age of the patient, and so on.
As a rule, pain is the first sign of the development of obstruction, while it has a cramping character, suddenly arises and proceeds in waves. Patients describe the pain as unbearable.
In addition, the peristalsis of the intestinal walls increases (the body tries to get rid of the obstacle that has arisen), but over time, the neuromuscular elements of the intestinal wall are depleted, as a result of which the peristalsis disappears altogether. At the same time, bouts of vomiting begin.
The nature of the vomit corresponds to the degree of obstruction:
- When the obstruction is located in the upper segments of the gastrointestinal tract, there is bile and consumed food in the vomiting.
- In case of localization of obturation in the lower sections - vomit has a very unpleasant odor and contains feces.
- If blockage occurs incolon, vomiting may be absent, but intestinal paresis and bloating are observed.
Obstruction due to neoplasms
If the obstruction is caused by a neoplasm in the intestine, the disease develops gradually and rather slowly. At the same time, against the background of anemia, intoxication and general exhaustion, intermittent cramping pain and swelling occur, alternating with periods of temporary well-being. If the intestine is greatly swollen, this can lead to ulcers and necrosis. Sometimes the first symptom of intestinal blockage due to neoplasms may be bleeding.
Obturation due to abnormal location of the mesenteric artery
As a rule, this pathology occurs in young patients. During the intake of food, the small intestine descends and is clamped between the spine and the abnormally located mesenteric artery. In this case, spastic pains appear in the abdomen and reflex vomiting occurs.
The knee-elbow position brings significant relief, as the artery descends and stops squeezing the intestines. The disease can progress in waves.
Obstruction due to gallstones
Bilestones are the cause of obstructive intestinal obstruction in only 2% of cases. Moreover, this phenomenon occurs, as a rule, in the thinnest segment of the intestine, which leads to complete blockage of its lumen. In calculous chronic cholecystitis as a result of decubitus ulcers of the bladder wall, damaged tissuesget drunk with the colon or duodenum.
As the bedsore increases, duodenal-vesical or colonic-vesical fistulas are formed, through which the calculus falls into the intestine. In this case, the blockage of the latter occurs under the condition of a sufficiently large size of the stone (3 cm or more). Contributes to obturation secondary spasm of the intestine. As a rule, gallstone blockage occurs in the terminal ileum, due to its small diameter.
The clinic is pronounced and acute: patients complain of severe cramping pains, repeated bouts of vomiting, in which there is bile. During fluoroscopy, loops of the small intestine swollen from gas are found, which have a characteristic "spiral" pattern of the mucosa. In addition, gas is often determined in the bile ducts.
Clinic of obturation obstruction caused by fecal stones
In older patients, obstruction (in the colon) is most often provoked by fecal stones, while patients suffer from constipation or atony of the intestinal wall. In this case, fecal stones are formed due to chronic colitis or developmental anomalies (congenital membranes in the mucosa, megasigma, megacolon). In some cases, fecal calculi can pass spontaneously, but more often cause bedsores of the intestinal wall and, as a result, the development of perforation and peritonitis.
Characteristic signs of such obturation are:
- Severe cramping pain.
- Balloon-shapedswollen empty rectum.
- Gas and stool retention.
- Peristalsis is enhanced and long-lasting.
Diagnosis of intestinal obstruction
Differential diagnosis of this pathology (especially in infants) should be carried out with dysbacteriosis (absence of live bacteria for the intestine).
The most accessible and simplest methods for detecting intestinal obstruction are X-ray methods.
So, for the diagnosis of intestinal obstruction, a survey radiography of the abdominal organs is prescribed, which can reveal air arches, Cloiber cups and a (horizontal) fluid level. Similar radiological symptoms may appear several hours after the onset of the disease.
If necessary, targeted gastric x-ray or duodenal radiography (if a foreign body, gallstones in the intestine or an abnormal mesenteric artery is suspected) is used, as well as studies in the lateral or horizontal positions, on the left or right side.
If there are no obvious signs of obstruction, a contrast x-ray examination (irrigography and barium passage through the small intestine) is performed to most accurately determine the level and localization of intestinal obstruction.
MSCT and ultrasound of the intestine, which shows the presence of tumors, foreign bodies and calculi, allows you to identify the causes of obstruction and analyze the condition and blood supply of internal organs, as well as the presence / absence of peritonitis.
Moreaccurate diagnosis of pathology is carried out during endoscopic examination, which allows visualizing the damaged segment of the intestine, identifying the cause of obstruction, and also taking therapeutic measures. In addition, endoscopic examination of the large intestine (colonoscopy) allows you to remove fecal calculi or dissolve them with water and avoid surgery. If this method is effective, it is necessary to study the feces to determine the latent blood in it, thanks to which it is possible to confirm / refute perforations and pressure ulcers of the intestine.
Which doctor treats the intestines
- Urgent pathologies of the gastrointestinal tract associated with infections (salmonellosis, food poisoning, cholera, shigellosis) are treated by an infectious disease specialist.
- Acute pathologies not associated with infections (paraproctitis, acute appendicitis, obstructive intestinal obstruction, complications of ulcers: perforation, malignancy, bleeding) are treated by a surgeon.
- Chronic pathologies of the gastrointestinal tract (gastritis, colitis, duodenitis, and so on) are treated by a gastroenterologist.
- For the treatment of diseases of the rectum, you should contact a proctologist.
Regardless of the type of gastrointestinal pathology, consultations of the following specialists are required to establish the correct diagnosis:
- Endoscopist conducting, for example, EGD.
- A sonologist who conducts an ultrasound of the intestine, which shows the state of the internal organs and so on.
- Radiologist.
That is, to the question "which doctor treats the intestines"There is no definite answer, because it is worth considering not only the cause of the disease, but also its course, the patient's condition and the presence of complications.
Treatment of obstruction caused by a tumor
The choice of one or another method of treatment depends on the cause that provoked the blockage of the intestine.
In case of obstruction caused by a tumor, complex treatment can be used, including surgery, as well as radiation and chemotherapy. In neoplasms of the small intestine, the intestine is excised in parallel, forming interintestinal anastomoses.
In case of obstruction in the ascending colon or caecum, a hemicolectomy is prescribed. If the tumor is inoperable, a bypass ileotransverse anastomosis is performed. If the neoplasm is localized in the colon (its left sections), two- or three-stage interventions are performed. In cases where the tumor in these departments is inoperable, an unnatural anus is formed.
Therapy for intestinal arteriomesenteric obstruction
With this pathology, conservative treatment is first applied: fractional frequent meals, being in a horizontal position after eating (preferably on the right side). In case of ineffectiveness of such measures, surgical treatment is prescribed (formation of duodenal anastomosis).
Treatment of obturation due to gallstones
The therapy is purely surgical. This shows decompression of the intestine, enterotomy of the calculus blocking the intestine and its removal.
Subsequently subject to availabilityindications, cholecystectomy is performed.
Treatment of intestinal blockage with fecal stones
In this case, treatment begins with conservative methods: oil or siphon enemas, crushing the calculus with fingers or an endoscope, followed by its removal through the anus. If such therapy does not bring an effect, an operation is performed in which a colostomy is performed, removal of stones and the subsequent imposition of a temporary colostomy.
Forecasts
The prognosis of pathology depends on the cause that caused it, as well as the presence / absence of complications. If perforation, peritonitis, bleeding are absent, the prognosis is favorable. In case of inoperable tumors - unfavorable.
Prevention
There are no specific preventive measures for intestinal obstruction. Secondary prevention is reduced to the timely identification and elimination of the causes of this pathology.
