Small Bowl Obstruction. Intestinal Obstruction Types
Small Bowl Obstruction. Intestinal Obstruction Types

Intestinal Obstruction: Types, Causes, Pathophysiology, Clinical Manifestation, Diagnosis, Management

Intestinal Obstruction, also known as bowel obstruction, is a disorder caused due to blockage of the normal flow of intestinal contents, disrupting food or liquid from passing through your intestine. The obstruction may be in the small intestine or large intestine, complete or partial obstruction and may be due to mechanical or paralytic ileus. However, bowel obstruction is common in the small intestine.

Some common signs and symptoms of bowel obstruction include vomiting, bloating, constipation, abdominal pain, fecal vomiting, swollen abdomen, and so on.

A study conducted in 2015 by Disease And Injury Incidence and Prevalence Collaborators found 3.2 million cases of intestinal obstruction, among which 2,64,000 patients died of the condition![1] Now it’s clear that not being able to take a dump for days is a big deal and can also be a symptom of serious illnesses like cancer, hernias, endometriosis, tuberculosis, appendicitis and so on.

Types and Causes of Intestinal Obstruction

Intestinal Obstruction might occur due to several reasons. The Obstruction can be partial, which might resolve without any surgery. Whereas, a complete blockage is more likely to need surgery. There are two types of Intestinal Obstruction, Mechanical Obstruction, and Non-Mechanical Obstruction:

Mechanical Obstruction

When the bowel is physically blocked, and its content cannot get a pass in a usual way causes bowel obstruction. A mural obstruction or intraluminal obstruction forms a pressure on the intestinal wall. It may be acute or chronic.

Mechanical Obstruction Causes

Common causes of mechanical obstruction are:

  • Hernias: A hernia is a split in the muscle wall which causes a portion of intestine stick up outside or into another part of the body.
  • Adhesions: Adhesions are fibrous tissue that can develop after abdominal or pelvic surgery and after severe inflammation.
  • Tumor within your intestine.
  • Volvulus: twisting of bowel upon itself usually at least full 180 degree
  • Intussusception: prolapse of one part of the intestine into the lumen
  • Crohn’s disease: Crohn’s disease is an Inflammatory Bowel Disease which causes inflammation of your digestive tract, which leads to intestinal obstruction.
  • Ischemic strictures: Ischemic Strictures are extremely rare sequelae of Inflammatory Bowel Disease in which injury and inflammation of the significant intestine result from the inadequate blood supply.
  • foreign bodies like gall stones
  • Intestinal atresia: commonly known as Small Bowel Atresia is a broad term to describe blockade of obstruction anywhere in the intestine.
  • Ovarian Cancer: Ovarian Cancer, is one of the types of cancer that begins in the ovaries. Bowel Obstruction is a common sequela of ovarian cancer. A report suggests that from 5.5 to 51 percent of ovarian cancer patients with stage III or stage IV develop bowel obstruction.[2]
  • Colon Cancer: It is one of the types of cancer that begins in the large intestine. The colon typically affects older adults. However, it can happen at any age.
  • Volvulus: Volvulus occurs when a loop of intestine twist around itself creating a blockade to pass solids, liquids, and bowel gas, resulting in bowel obstruction.
  • Stenosis: Stenosis refers to the partial obstruction that results in a narrowing of the opening of the intestine.
  • Intussusception: Intussusception is the most common form of intestinal obstruction in children between the ages of 3 months to 3 years old. This occurs when the intestine folds like a telescope which results blocked colon.
  • Neoplasm:  Neoplasm is a type of excessive abnormal growth of tissue[3].
  • meconium plugin newborns
  • Other causes of mechanical obstruction: fecal impaction, gallstones, inflammatory bowel disease

Non-Mechanical Obstruction

Also known as paralytic ileus because of impairment of intestinal paralysis activity and common after surgery. Your small intestine and large intestine works in a coordinated system. When any one of them is interrupted, these coordinate contracts, causing intestinal obstruction. The abdominal musculature cannot propel the contents along the bowel.

Non-Mechanical Obstruction Causes:

  • Muscular dystrophy
  • Infections
    – Such as Gastroenteritis or appendicitis
  • Electrolyte imbalances
  • Endocrine disorders such as
    Diabetes mellitus
  • Neurological disorder
    – Parkinson’s Disease
    – Multiple Sclerosis
    – Diabetes Mellitus

The intestinal obstruction can be one of two types, partial or complete. Intestinal obstructions occur in your small intestine. Bowel obstruction depends on especially the degree to which the vascular supply to the bowel is disturbed, the region of the bowel that is affected, and the degree to which the lumen is occluded. The most common cause of small intestinal obstruction is Adhesion, followed by hernias and neoplasms.

Signs and Symptoms

The symptoms of bowel obstruction will depend on how bad the blockage is. But every obstruction will have abdominal cramps and pains. The intestinal obstruction causes a wide range of uncomfortable symptoms.

Clinical manifestations of intestinal obstruction depend on the level and length of bowel involved, the extent to which the obstruction interferes with the blood supply, the completeness of the obstruction, and the type of lesion.

Here are some of the possible signs you might encounter if you have a bowel obstruction:[4][5]

  • Nausea/vomiting: This occurs due to accumulated abdominal contents. Nausea and vomiting is usually the first sign and characteristic of bowel obstruction. Vomiting may be different, this is as per the location of the obstruction. Sometimes vomiting with bile which may be orange-brown in color and foul smelling because of bacterial growth.
  • Abdominal Distension: Abdominal distension is related to a building up of gas and fluid above the obstruction. The distension may become extremely firm, tender, and rigid.
  • Abdominal cramp is related to vigorous contraction proximal to the obstruction as bowel attempts to move luminal content
  • Colicky abdominal pain
  • Inability to pass flatulence and constipation
  • Fever
  • Tachycardia, hypotension or shocks
  • Hypokalemia, hypernatremia
  • Change in the stooling pattern may range from constipation (prolong or absence of defecation) are an early sign intestinal obstruction,
  • decreased appetite
  • Respiratory distress, this is due to upward pushing of diaphragm related to abdominal distension
  • severe bloating

If you have any of these mentioned symptoms, contact your doctor or physician immediately. They will let you know whether or not you have emergencies.

How Is It Diagnosed?

When you go to the doctor, firstly, the doctor will ask you about your medical history whether or not you have cancer, constipation, and the symptoms that you are facing. Then the doctor will have a physical exam to see whether or not you have abdominal pain if you can pass gas of lumps in your abdomen to make sure whether an obstruction exists. Depending on your case, the doctor will recommend further test; the tests include blood tests, CT scanning, endoscopy, colonoscopy, and X-rays of the abdomen and ultrasound. Under the identification of a mass, a biopsy is suggested to identify the nature of the mass. Diagnosis helps to know whether the obstruction is partial or complete.

X-ray and barium enema

During x-ray, your doctor may give you barium enema. This is a special kind of liquid containing barium, a whitish-silver metal. This liquid will be inserted into your rectum, which will spread into your bowels and appears on an X-ray as a bright area.

CT scan

Computerized Tomography scan, scans and combines a series of X-ray images taken from different angles to produce cross-sectional images. As its combination of x-ray images, CT scans are more detailed than the standard image.

Ultrasound

Ultrasound is a type of image processing that uses high-frequency sound waves to look inside the body. The machine used during pregnancy to view fetus is ultrasound. Doctors use ultrasound to diagnose intestinal obstruction in children.

Colonoscopy

Colonoscopy is a process in which a doctor uses a colonoscope to look inside your large intestine, colon, and rectum for any blockades.

When to See a Doctor?

When the complications start to become severe like dehydration, electrolyte imbalance, kidney failure, excruciating abdominal pain, constipation, and then it’s essential to go and see a doctor immediately.

Treatment

Patients with possible bowel obstruction should be hospitalized to avoid complications. The procedure may include surgery to open up the blockage. However, a patient with partial obstruction resolves without surgery. An endoscope which is a flexible viewing tube is inserted through the anus which inflames large intestine, which may treat twisted intestine.

Medical management (Without surgery)

Some blockades may open up on their own, so, it would be good to avoid surgery and proceed the medical treatment. Surgery can sometimes create more complication as it may cause scarring. However, If your condition gets worse, your doctor or surgeon will continue the surgical method.

Treatment method for medical management:

  • Treatment is directed towards decompression of intestine by removal of gas and fluid, correction, and maintenance of fluid and electrolyte balance.
  • NG- tube insertion for drawing fluid from the abdomen
  • Keep patient nil per orally
  • Analgesic and antispasmodic drugs used to relieve pain and to provide comfort
  • Antibiotic drugs to treat and prevent infection
  • Administration of fluid and electrolytes by IV infusion
  • A rectal tube may be used to decompress an area that is lower in bowel

Surgical management

Surgery will be performed to relieve the mechanical obstruction if conservative efforts are failed. The operative procedure will be varied with the condition of the patient. It depends on an underlying condition, such as:

  • Resection of the bowel is done for obstructing lesion or strangulated bowel; along with end to end anastomosis
  • Cutting of Ladd’s band and lengthening of roots of the mesentery if malrotation of gut
  • Enterotomy is performed to remove the foreign body from the intestine

Furthermore, intestinal obstruction is also common in infants as the infection can arise inside the womb through diseases and condition like decreased blood flow inside the intestines, and so on. Some even experience this condition after stomach flu. However, any type of bowel obstruction is difficult to diagnose in infants because symptoms can go unnoticed as young ones can describe the symptoms[6].

To sum up, intestinal obstruction is a severe form of digestive disorder, and it can be a major sign of other possible deadly diseases that might need immediate medical attention.

Also Read: Bowel Incontinence: Causes, Symptoms, Diagnosis, Prevention, and Treatment

Prevention of Bowel Obstruction

A healthy lifestyle is the best way to lower the risk of intestinal obstruction[7]. There are products in the market like, laxatives and stool softeners that might help you.

  • Breaking down your meal and eat a small portion of your meal often. For example, if you eat three times a day, break it into six small meal and eat it throughout the day.
  • Exercise more; exercising helps to burn calories more,
  • Chew your food well, chewing at least 30 times will help the food digest better,
  • Avoid eating a large amount of high-fiber fruits and vegetables,
  • If you had your surgery recently, rather than eating solid food, eat high-calorie drinks, or you can prepare your own high-calorie soup, you can even cook your food until it softens,
  • Drink liquids often, you can drink, 3-4 liters of water each day to detoxify your body. If you have disease related to kidney, liver, and heart where you have to limit your fluid intake, consult with your doctor,
  • Caffeine can irritate the bowel so avoid too much caffeine intake,
  • Quit smoking and drinking.

 

Reference

https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/GI-complications-pdq#section/_22

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388903/

[2] https://link.springer.com/article/10.1007%2Fs11916-001-0040-z

[3] https://www.ncbi.nlm.nih.gov/pubmed/391493

[4] https://www.mayoclinic.org/diseases-conditions/intestinal-obstruction/symptoms-causes/syc-20351460

[5] https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/intestinal-obstruction

[6] https://www.nicklauschildrens.org/gastrointestinal/intestinal-obstruction

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1465238/

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