What is Intestinal Obstruction?

Intestinal obstruction is blockage of the inside of the intestines by an actual mechanical obstruction.
Some causes include adhesions (scar tissue), foreign bodies, intussusception, ischemia (decreased
blood supply), hernias, volvulus (twisting) or tumors. As blockage occurs gas and air distend the
bowel proximal (closest) to the blockage. As the process continues, gastric (stomach), bilious (bile
from the liver used in digestion) and pancreatic secretions (secretions from the pancreas used for
digestion) begin to form a pool. Water, electrolytes and proteins accumulate in the area. This
pooling and bowel distention decrease the circulating blood volume and the blood supply to the
bowel tissue. Strangulation of a bowel segment may cause necrosis (death of the tissue),
perforation (a hole), and loss of fluid and blood. Since intestinal contents can’t go downstream from
the stomach, nausea and vomiting occur in most patients.
Examples of Causes of Intestinal Obstruction

Obstruction due to hernia

Obstruction due to
intussusception

Obstruction due to mesenteric
occlusion

Obstruction due to volvulus

Obstruction due to tumor

Obstruction due to adhesions

What is Ileus?
Ileus is a functional rather than mechanical obstruction of the bowel. It is a lack of propulsive
peristalsis (wave-like movement) of the bowel. It stops the movement of bowel contents downward.
There is abdominal distention and an absence of bowel sounds. Ileus may be the result of
anesthesia, interruption of nerve supply to the bowel, intestinal ischemia (obstruction of circulation),
abdominal wound infections, electrolyte imbalance (loss of potassium leads to lack of intestinal
peristalsis) or metabolic diseases. The result of ileus is the distention of the bowel with gas and
fluid. The process is similar to obstruction. Your nurse or pediatric surgeon will be happy to answer
any of your questions.

Etiology

resulting in rapid ischemia of the bowel wall. and intussusception Obstruction of the duodenum: Duodenal obstruction is usually caused by cancer. Volvulus of the midgut is rare. diverticulitis usually obstructs in the sigmoid. Tumors include cancer that blocks the lumen and rare benign lesions (eg. volvulus of a malrotated gut. The normal secretory and absorptive functions of the mucous membrane are depressed. atresia. large polyps) that can lead to intussusception. leading to gangrene and perforation. Symptoms. necrosis. lipomas. hernias. bands. intussusception. congenital esophageal webs. Strangulation usually begins with venous obstruction. Obstructing cancer occurs most often at the splenic and sigmoid flexures. Obstruction of the small bowel: Small-bowel (jejunoileal) obstruction is commonly caused by incarceration in hernias or by adhesions and is less commonly caused by tumors (primary or metastatic). obturation by foreign bodies.Common causes of mechanical obstruction are adhesions. volvulus. the so-called intraluminal diverticula associated with obstruction). and volvulus. blockage occurs without vascular or neurologic compromise. congenital webs persist into adult life and lead to deformities (eg. and Diagnosis Obstruction of the small bowel: Diagnosis of simple obstruction is based on a triad of . Hirschsprung's disease. and gas accumulate in excessive amounts if obstruction is complete. perforation. In rare instances. Ingested fluid and food. foreign bodies (including gallstones). intensifying the peristaltic and secretory derangements and increasing the risks of dehydration. and vascular occlusion. and fecal impaction. and the distal segment collapses. duodenal obstruction is most commonly caused by atresia. or Crohn's disease. digestive secretions. a Meckel's diverticulum. In neonates. and the bowel wall becomes edematous and congested. primarily in the duodenum or head of the pancreas. ischemia. infarction of the bowel is most commonly associated with hernia. In infants. Severe intestinal distention is self-perpetuating and progressive. Ascaris infestation is rare in the USA but occurs in some tropical countries. volvulus. fecal impaction. tumors. it is usually caused by meconium ileus. volvulus. Signs. The bowel becomes edematous and infarcted. and annular pancreas. inflammatory bowel disease (Crohn's disease). and volvulus is most common in the sigmoid or cecum Pathophysiology In simple mechanical obstruction. In strangulating obstruction. diverticulitis. Obstruction of the large bowel: Large-bowel obstruction is caused by tumors. which may be followed by arterial occlusion. Intussusception in adolescents and adults is almost always caused by tumors. peritonitis. The proximal bowel distends. and death.

If the ileocecal valve is competent. In the absence of strangulation. but diarrhea may be present with partial obstruction. the abdomen is not tender. adhesions rarely obstruct the colon. high-pitched peristalsis with rushes coinciding with cramps is typical. Fluid levels in the bowel can be seen in upright views. it is manifested by steady. However. distention increases. Obstruction of the large bowel: Symptoms usually develop more gradually than with small-bowel obstruction. Shock and oliguria are serious signs that indicate either late simple obstruction or strangulation and must be treated promptly. A barium enema can usually rule out colonic lesions. There is no tenderness. Sometimes. colonoscopy sometimes can supplement rectal and pelvic examinations. endoscopy . the radiologist may find no distended loops but may find a mass suggesting infarcted bowel. If the site of obstruction is unclear. fluid and electrolyte deficits are uncommon. the danger of rupture is high and immediate operation is indicated. oral barium can be given but is contraindicated if obstruction is believed to be in the colon. if cramps become severe and steady. (2) Vomiting starts early with small-bowel and late with large-bowel obstruction.symptoms: (1) Abdominal cramps are centered around the umbilicus or in the epigastrium. the abdomen becomes tender. vomiting may occur (usually several hours after onset of symptoms). In strangulation. and auscultation reveals a silent abdomen or minimal peristalsis. However. If used. If the cecum is dilated to a diameter of 13 cm. only laparotomy can definitively diagnose strangulation. Unlike in small-bowel obstruction. if it allows reflux of colonic contents into the ileum. A mass corresponding to the site of the obstructing tumor may be palpable. (3) Obstipation occurs with complete obstruction. there may be no vomiting. Lower abdominal cramps unproductive of feces are present. Physical examination typically shows a distended abdomen with loud borborygmi. obstruction may lead to marked distention and cecal rupture. A ladderlike series of small-bowel loops usually is typical but also occurs with an obstructing lesion of the right colon. Distended loops may be absent with an obstruction of the upper jejunum. In questionable cases of small-bowel obstruction. severe abdominal pain from the outset or beginning a few hours after the onset of crampy pain. Preliminary endoscopy or barium enema should be performed for precise location of the obstruction. Increasing constipation leads to obstipation and abdominal distention. Strangulating obstruction occurs in nearly 25% of cases of small-bowel obstruction and can progress to gangrene in as little as 6 h. and the rectum is usually empty. With closed-loop strangulating obstructions (as may occur with volvulus). Hyperactive. a mass is palpable. strangulation probably has occurred. Systemic symptoms with large-bowel obstruction are far less serious than with small-bowel obstruction. Strangulation (except with volvulus) is rare. Abdominal x-ray in both the supine and upright positions usually confirms diagnosis. abdominal x-ray shows distention of the colon proximal to the lesion. Perforation of a tumor or of a diverticulum also may occur at the obstruction site. If the obstructing lesion is cancer or diverticulitis.

Obstruction of the small bowel: A nasogastric tube is inserted and placed on suction. IV fluids and electrolytes. Sigmoidal volvulus usually occurs in the elderly. An inlying bladder catheter helps monitor urinary output. Bezoars. Obstructing cancers of the colon can often be treated by a single-stage resection and anastomosis. In cases of repeated vomiting. IV fluids (preferably lactated Ringer's solution) and electrolytes are started. diverting colostomy with delayed resection is required. Treatment of obstruction of the duodenum in adults consists of resection or. rather than surgery. Obstructing gallstones are removed by lithotomy. Treatment Every patient with possible intestinal obstruction should be hospitalized. and serum electrolytes should be determined at least daily. and complete lysis of adhesions. can be removed endoscopically. a central venous pressure line is helpful. removal of foreign bodies. Surgery removes the offending lesion whenever possible. Cecal volvulus can be diagnosed on abdominal x-ray by a large gas bubble in the midabdomen or the left upper quadrant. Treatment of acute intestinal obstruction must proceed simultaneously with diagnosis. including repair of hernias. dehydrated patient. Most surgeons favor early laparotomy. serum Na and K are likely to be depleted and must be replaced. Any attempt to bypass an obstruction is likely to help only briefly. With both cecal and sigmoidal volvulus. another cause of obturation. these are removed by enterotomy at laparotomy. and a urinary catheter are needed before emergency operation. Therapy must be based on the fact that surgery is necessary to definitively diagnose strangulating obstruction. palliative gastrojejunostomy Obstruction of the large bowel: Treatment is essentially the same as for small-bowel obstruction.should precede barium studies. In dehydrated patients. may be attempted in treating early postoperative obstruction or repeated obstruction caused by adhesions in the absence of peritoneal signs. cholecystectomy can be performed either simultaneously or later. a barium enema shows the site of obstruction by a typical bird-beak deformity at the site of the twist. Other options include a diverting colostomy and anastomosis. although often it is delayed 2 or 3 h to improve the status and obtain a urine output in a very ill. if the lesion cannot be removed. When diverticulitis causes . Nasogastric suction. Procedures to prevent recurrence should be performed. More often. Simple intubation with a long intestinal tube. Disseminated intraperitoneal cancer involving the small bowel is a major cause of death from intestinal obstruction in adults. Volvulus often has an abrupt onset. Fluid balance charts must be maintained continuously. Potential strangulation of blood supply and gangrene are always present. Rarely.

a fecal concretion alone or a mixture with barium or antacids that produces complete obstruction (usually in the sigmoid) requires laparotomy. Resection and a colostomy are performed. and anastomosis is postponed.obstruction. . Removal of the involved area may be very difficult but is indicated if perforation and general peritonitis are present. it may be associated with perforation. The endoscope or a long rectal tube can usually decompress the loop. In sigmoidal volvulus. Treatment of cecal volvulus consists of either resection and anastomosis of the involved segment or fixation of the cecum in its normal position by cecostomy. a typical distended loop of the sigmoid can be seen on the abdominal x-ray. However. recurrence is almost inevitable. Without a resection. Fecal impaction usually occurs in the rectum and can be removed digitally. and resection and anastomosis may be deferred for a few days.