Bowel Obstruction: Overview and More

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Intestinal obstruction occurs when part of the small or large intestine is partially or completely blocked. Symptoms include abdominal pain, fever, constipation, and vomiting. It can be a dangerous condition that potentially increases the risk of a serious infection or perforation (holes) in the intestine. Certain medical conditions, such as Crohn's disease, increase the risk of intestinal obstruction .

Symptoms of intestinal obstruction

Bowel obstruction can start suddenly or progress gradually over several weeks or days. Before a complete bowel obstruction develops, you may have some warning signs caused by a partial bowel obstruction.

Symptoms that often precede partial or complete bowel obstruction include:

  • Decreased appetite
  • Colic or discomfort
  • Bad breath
  • Changes in bowel movements

The most common consequences of a bowel obstruction include:

Complete obstruction of the intestine prevents the passage of stool and gas. This situation is known as constipation.

Although less common, you may experience overflow diarrhea due to partial bowel obstruction if a small amount of loose stool is allowed to pass past the point of obstruction.

When to seek medical help

Because some of the symptoms of an impending bowel obstruction are minor, it can be difficult to determine when you need medical attention.

  • If you know that you are at risk for intestinal obstruction due to a previous intestinal obstruction or surgery, call your doctor as soon as you feel symptoms, even if they seem mild.
  • If you're not at risk, be sure to call your doctor if you have persistent constipation or cramps.
  • Seek emergency medical attention if you have severe or persistent abdominal pain, bloating, or vomiting.

Complications

Bowel obstruction can lead to serious problems. A serious infection can develop when bacteria build up in the intestines. In some cases, areas of the intestine may become necrotic (dead tissue). Necrosis leads to serious infections and / or gangrene .

Intestinal perforation can occur, leading to leakage of intestinal contents and / or blood. Symptoms of intestinal perforation include severe pain, bloating, fever, hypotension (low blood pressure), and loss of consciousness.

Piercing is a medical emergency that requires immediate surgery .

Causes

The obstruction can affect any part of the small or large intestine and can occur near the stomach, near the anus, or somewhere in between.

With mechanical bowel obstruction, movement of stool through the intestines is physically impossible. It can be caused by a structural change in the intestine (such as a twist), something inside the intestine that blocks the passage of stool, or a tight narrowing outside the intestine.

Previous abdominal surgery or a history of intestinal obstruction increases the chances of developing a sudden intestinal obstruction. And there are several other causes and risk factors for intestinal obstruction.

Hernia

A hernia, such as an inguinal hernia or an epigastric hernia, is a weakness in the lining of the abdomen that holds the intestines in place. Part of the intestine can get stuck in the opening, and the intestines can shrink and become inflamed, preventing stool and gas from passing through.

Intestinal mass

Edema, cancer (such as colon cancer ), or infection can grow within the lumen (opening) of the intestine, making it difficult for the contents of the intestine to pass.

Large object

Large, hard stools or a non-food product that has been ingested can lock in place, preventing anything from happening.

Intussusception

This is a condition that occurs when part of the intestine slides inward, reducing the size of the lumen.

Adhesions

Scar tissue that can form after injury, surgery, or radiation therapy can cause a tight, ribbon-like constriction around the intestines. This type of scar can develop immediately after a bowel injury or surgery and years later can cause obstruction.

Cramp

Volvulus is a volvulus or twisting of the intestines that can occur due to inflexible scar tissue or gastrointestinal (GI) disease. It may start gradually, with occasional spasms, but then it can quickly get worse and require urgent care, usually surgery.

Bowel movement disorder

Sometimes myopathy (a disease of the muscles) can interfere with bowel movements, resulting in the collapse of the lumen, abnormal movements, and obstruction.

Ischemia

In rare cases, the intestine can become ischemic (lose blood supply) due to a blood clot. This can occur due to a blood clotting disorder.

Diagnostics

A bowel obstruction is diagnosed based on your medical history, physical exam, and diagnostic tests. In particular, if you have severe abdominal pain, you should get tested right away.

After your medical exam, you may be scheduled for an urgent imaging test. Depending on the results, your healthcare team may also recommend an invasive diagnostic test.

Physical exam

The intestines often make sounds, such as gurgling and popping, which can be heard with a stethoscope placed on the abdomen. If you have a blockage, your healthcare provider may hear high-pitched sounds when listening to your abdomen. If the obstruction is present for some time, the intestinal murmurs may be completely absent .

Abdominal pain (pain in response to touch or pressure) can also give your healthcare team an idea of the severity of your problem. If your abdomen looks swollen or enlarged, this can also help diagnose.

Diagnostic tests

Various imaging techniques and tests can be used to diagnose intestinal obstruction.

  • X-rays (x-rays of the abdomen) : X-rays are usually the first test used to determine if there is an obstruction. It is a non-invasive test that can be performed relatively quickly. Your x-ray may show small, narrow areas or an enlarged intestine, and sometimes even a mass.
  • CT scan of the abdomen : Abdominal CT is done in the same way as X-rays, and the contrast solution must be taken orally, through an enema (through the anus), or intravenously (intravenously). CT scan can show a more detailed picture of the abdomen than X-rays.
  • Colonoscopy : This is an invasive test in which a tube (tube with a camera) is inserted into the rectum to look inside the colon. Colonoscopy can be very helpful to your healthcare team, but it carries risks (especially if you have a bowel obstruction or perforation), so it is not always the right option. It is only used after safety has been established through non-invasive imaging tests .
  • Endoscopy : an invasive test in which a probe is placed in the mouth; Endoscopy is used to evaluate the upper parts of the gastrointestinal system: the esophagus, the stomach, and the upper part of the small intestine. As with colonoscopy, there are some risks involved and the use of this test is based on preliminary information from your non-invasive imaging tests.

Watch out

Bowel obstruction is a serious medical condition that requires urgent treatment within days of diagnosis and sometimes even hours.

Treatment may include medications and intestinal decompression. Surgery can also be used, although in some cases, bowel obstruction can be treated without it. However, surgery is usually the safest and most definitive option.

If you are predisposed to this condition, you should work with your doctor to develop a prevention plan.

Medicine

In some cases, a stool softener may be considered to ease the blockage. This approach may be considered if you have a partial bowel obstruction.

Because complications from untreated bowel obstruction are serious, your healthcare team may consider moving to an interventional procedure if medical treatment does not resolve your obstruction.

Sometimes an antibiotic, usually intravenous (intravenous, into a vein), is needed to treat or prevent an infection. Antibiotics will not relieve a blockage in your intestines, but they can help clear the infection.

Intestinal decompression

In some cases, the intestines can be decompressed with a nasogastric tube . This procedure involves inserting a nasogastric tube through the nose into the gastrointestinal tract; Your imaging tests will help your healthcare team choose the correct location.

The rectal tube can be used in conjunction with the NG tube to decompress the intestines. The rectal tube is a narrow gauge rubber tube that draws air out of the colon. In some cases, a stent, which is an open tube, is placed inside the intestinal region to keep it open.

This treatment approach will be considered if your obstruction is caused by an object (such as a chair) that can be safely removed from the road.

Operation

Surgery may be necessary to relieve intestinal obstruction, and complications such as intestinal leakage sometimes need to be treated.

There are several types of surgery for intestinal obstruction, including removal of a neoplasm or tumor in the intestine, resection (cutting) of scars and adhesions, and repair of blood vessels. Sometimes it is necessary to cut an area of inflamed or necrotic intestinal tissue.

Recovery

It takes time to recover from a bowel obstruction. Your healthcare team will likely check on you frequently to make sure your pain is relieved and that you can move the gas before you are allowed to eat and drink. In the meantime, you will need IV fluids to maintain nutrition.

Once you can eat safely again, your diet will gradually improve. This will allow your intestines to adjust to the food and quickly detect any signs of recurring obstruction.

As you recover, you will need to avoid taking certain medications, such as opioids (which can cause constipation, increasing the risk of blockage) and non-steroidal anti-inflammatory drugs (NSAIDs), which can increase the risk of bleeding.

Colostomy

After surgery to treat a bowel obstruction, you may need a temporary or permanent colostomy or ileostomy. Basically, it is a procedure in which the intestines are opened to the skin and the waste is collected in a bag on the outside. Often times, a colostomy or ileostomy can be attached to the rest of the intestine later .

Get the word of drug information

Bowel obstruction is not uncommon. Although treatment is urgent and recovery can be a slow process, most people can safely follow a healthy diet afterward.

However, if you are at risk for recurrent bowel obstruction, try to avoid foods and habits that predispose you to constipation . Be sure to seek medical attention if you experience symptoms of a bowel obstruction.

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