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Intestinal Obstruction, Ileus : Defintion, Causes, Symptoms, Diagnosis, Complication and Treatment

Tuesday, July 24th 2012. | Abdomen Health, Disease

Ileus Definition

Intestinal obstruction is a major abdominal emergencies. It can affect the small intestine or large intestine. In cases of intestinal stricture, intestinal obstruction is incomplete when in cases of ileus, intestinal obstruction is complete. In the latter case, the food can not grow in the digestive tract. In some cases, there is a loss of peristalsis of the bowel.

The main complication is suffering tissue of the intestinal wall, which can cause perforation of the wall with passage of intestinal contents and bacteria into the peritoneal cavity. This can lead to peritonitis (generalized infection of the abdomen) or septicemia with septic shock.

There are two forms of intestinal obstruction: Mechanical bowel obstruction and paralytic ileus. Infant and toddler (up to 2 years), intussusception is the leading cause of intestinal obstruction. During this accident, a part of the intestine turns like a thimble against himself. At older ages, the intussusception is rare.

Intestinal obstruction is a medical emergency that requires immediate care. In most cases, surgery is needed to relieve the obstruction and avoid necrosis of too much of the intestine. Without proper treatment, the evolution can result in death.

Ileus Causes

Mechanical intestinal obstruction

Thanks to the peristaltic movements of the intestine, the bolus is fed progressively from the upper part of the digestive tract to the rectum. In case of mechanical ileus following an obstacle, the peristaltic movements of the intestine is disrupted, causing severe pain or cramping in the upper or lower abdomen.

Intestinal Obstruction, Ileus

Intestinal Obstruction, Ileus (img : health.allrefer.com)

Forms and causes of mechanical ileus :

  • Shutter response to obstacles lying inside the intestine, the intestinal lumen narrows more and more to a complete blockage of the intestine. Causes: worms, foreign bodies, gallstones, meconium (stool of the newborn)
  • Obstruction : narrows the lumen after compression from the outside by a tumor or as a result of pathological proliferation of the intestinal mucosa. Causes tumors, significant edema of the intestinal mucosa in chronic inflammatory diseases of the intestine (ulcerative colitis)
  • Strangulation : following a strangulation of mesenteric blood vessels, irrigation of the bowel is interrupted. This is a surgical emergency because the relevant part of the intestine may become necrotic within hours. Causes: the presence of flanges or adhesions as sequelae of surgery or a chronic inflammatory disease such as Crohn’s disease, hernias (inguinal hernia), intussusception in the newborn, twisting a portion of the tube tract (volvulus), gallstones, piles of feces or inflammation.

Paralytic ileus or functional

In paralytic ileus, there is a cessation of peristalsis of the bowel. Even in the absence of intestinal obstruction, the bolus can not expand due to the absence of peristalsis. Spasms of the intestinal musculature can be observed.

As in mechanical ileus, the bolus can not advance to the rectum. After suffering tissue of the intestinal wall, germs and intestinal contents can enter the peritoneal cavity. The result is the occurrence of an acute abdomen, which may be followed by inflammation of the peritoneal cavity with onset of peritonitis.

Potential causes of paralytic Ileus:

  • Concomitant presence of peritonitis, pneumonia, pancreatitis, myocardial infarction
  • Metabolic disorders, electrolyte disturbances (eg after heavy peristantes diarrhea), renal failure
  • After surgery, in case of colic, after some abdominal trauma by blunt objects (eg neck fist boxing neck or feet)
  • Intestinal perforation
  • After myocardial nutritive blood vessels of the intestine, mesenteric vessels)
  • After lead poisoning or poisoning by opioid
  • In certain blood diseases such as porphyria
  • Intestinal parasites (worms)

Ileus mixed

All mechanical ileus changes over time in paralytic ileus. Indeed, over time, the peristalsis of the bowel eventually diminish and then disappear completely. In this context, the clinical picture is dominated by two types of symptoms of ileus – mechanical ileus and paralytic ileus. However, the intensity of symptoms can vary.

Ileus Symptoms

Often the symptoms are uncharacteristic early. For this reason, a detailed history and careful examination of the patient are essential. Abdominal pain of unknown origin obscure and require, especially as infants or the elderly, a diagnostic management.

In the presence of severe abdominal pain, sudden onset, or of undetermined origin in case of vomiting and gas accumulation in the abdominal cavity, the diagnosis of intestinal obstruction should be considered. This is a medical emergency that requires immediate care.

Ileus Symptoms in case of mechanical ileus

The following symptoms may occur alone or in combination, depending on the exact location of bowel obstruction.

  • Abdominal cramps or “oliques” high intensity
  • Vomiting, possibly vomiting stool
  • Very tense and distended abdomen (meteorism)
  • No stool and gas
  • Peristaltic movements strengthened, audible and visible

Ileus Symptoms in functional ileus

  • Abdominal pain, especially after meals
  • Nausea and vomiting
  • Impairment of general condition
  • Soft belly, distended with gas; in inflammatory stomach becomes stretched and hardens
  • Absence of bowel sounds

Ileus mixed results in a mixture of both types of symptoms of ileus, of varying intensity.

Ileus Symptoms of intussusception in infants

  • Abdominal pain of sudden onset, colicky, high intensity
  • Vomiting
  • Pallor, cold sweats
  • The child is restless and anxious
  • Period of calm followed by the reappearance of pain
  • Lack of bowel movements, sometimes bloody mucus removal
  • Swollen abdomen

Ileus Diagnosis

  • Taking Into account history of symptoms. Questioning about medical history (eg, gastric ulcers, inflammation of the intestine); information on the kind of pain Can Be very useful for diagnosis, eg. if the pain is kind of stings, sudden onset, felt Mainly in the abdomen or lower the abdomen, etc. .. Information on the color and Consistency of stools, as well as data on vomiting, can Be invaluable for the physician.
  • Palpation: wall tension, bread is palpation
  • Auscultation: bowel sounds metallic, no noise
  • DRE: return the index of the hand history doctor palpates the terminal portion of the intestine (rectum)
  • Radiography of the abdomen, with contrast Possibly
  • Ultrasound
  • CT
  • Blood tests: red blood cells, white blood cells, hemoglobin, platelets, inflammation parameters

Ileus Treatment Options

When suspected bowel obstruction, appropriate therapy should be initiated promptly, treatment depends on the type and location of the occlusion.

In some cases, treatment is conservative, that is to say non-surgical. In most cases, treatment is surgical.

If underlying conditions (eg peritonitis, perforation of a peptic ulcer, hernia, etc..), It should be treated properly.

Ileus Emergency – conservative treatment

  • Establishment of a gastric tube to aspirate secretions
  • Setting up a drip to give fluids and electrolytes

Ileus Medical Drugs Treatment

  • Antibiotics to prevent the spread of pathogens.
  • Medications or enemas to stimulate intestinal peristalsis (only in case of paralytic ileus).

Ileus Surgery Treatment

The type of intervention depends on the cause of ileus:

  • Remove adhesions
  • Remove obstacles (eg tumor) or strictures (narrowing)
  • Eventually, the non resect viable intestine
  • Optionally, set up a bypass or ostomy
  • Maintenance or restoration of blood flow in all intestinal segments

Ileus Measurements in infants

At the beginning of the invagination, massages and enemas with opaque product visible on the radio can often suppress the blocked intestine. If unsuccessful, we will resort to surgery.

Ileus Possible Complications

Without proper treatment, any time lag increases the risk of death.

When the causes of intestinal obstruction have been diagnosed and that the obstacle has been eliminated, the chances of recovery are good. If appropriate treatment, the prognosis of intussusception is also good.

Potential serious complications :

  • Disorders of the bowel irrigation with cellular lesions, alterations of the intestinal wall and functional disorders, in severe cases, bowel perforation.
  • Localized or generalized infection (septicemia) due to a spread of germs in the abdominal cavity. The occurrence of sepsis is a medical emergency. (see sepsis).
  • State of shock resulting from the absence of absorption of fluids and electrolytes in the intestine. Without treatment, it leads to patient death.
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