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Intestinal Obstruction (Occlusion) : Definition, Causes, Symptoms, Diagnosis and Treatment

Friday, August 17th 2012. | Digestive System

Digestive System Anatomy

There are different types of anatomical intestinal obstruction

The digestive system consists of the mouth, esophagus, stomach, small intestine divided into duodenum, jejunum and ileum, colon or “large intestine” divided into right colon, transverse colon, descending colon and sigmoid colon and ends with the rectum and anus. 

The walls of the small intestine and colon are composed of smooth muscle fibers that ensure progression of the bolus from the stomach to the rectum.

Called flange intestinal scarring associated with intra-abdominal surgery, whatever the technique used (laparoscopy or open surgery) and sometimes an intra-abdominal infection (eg infection of the fallopian tubes in women, called salpingitis). Thus, anyone who has had an intra-abdominal surgery, so anyone with scars on the abdomen, is likely to do in life is occluded by “occlusion clamp” or by “strangulated hernia”.

Called hernial parts of the abdominal wall naturally weaker, this muscle weakness is related to the natural insertion of the abdominal muscles: we distinguish the hernial inguinal and femoral at the groin and umbilical hernia orifice at the navel. Hernias are favored by the physical efforts that increase intra-abdominal pressure (load carrying heavy, chronic cough).

Called eventration of viscera exit through an opening in the abdominal wall unnatural that develops on a scar associated with a surgical incision or an abdominal wound.

We speak of “strangulated hernia” or “strangled hernia” when part of intestine is “stuck” in the hernial orifice or in the disembowelment and the digestive and blood circulation are compressed by the collar at the base with risk of ischemia (lack of oxygen) or necrosis (death) of the intestine into the hole infatuated.

Called volvulus that part of the intestinal tract, usually the colon, loops over itself choked at its base which interrupts the progression of the bolus (occlusion) and vascularization of the segment forming the loop, making it the gravity.

acute intestinal obstruction

intestinal obstruction types (img thanks to medicotips.com)

Intestinal Obstruction Definition

The acute intestinal obstruction is defined as a cessation of the exhaust gas and stool, usually abrupt onset.

Occlusions are, in most cases related to barriers on the small intestine or colon.

Before an acute intestinal obstruction is accurate:

  • Location:
    • Barrier of the small intestine
    • Obstacle of colon
  • The mechanism
    • Functional , that is to say not related to an obstacle as such, but consecutive to mechanisms “chilling” or “staggering” the gut: intestinal motility disorders, abnormal smooth muscle of the intestine, metabolic disorders, certain medications, etc. …
      • Organic , that is to say a barrier related to true:
        • We speak of strangulation or torsion when a segment of bowel is wrapped with a flange goshawks (sequelae of an old surgery) it is the occlusion clamp-on or incarcerated in a hernial orifice or a hernia (hernia or strangulated hernia). This breaks the one hand the progression of the bolus at the strangulation (which gives signs of occlusion) but also, and it’s all gravity, it interrupts the blood supply to the bowel segment involved with risk of necrosis segment.
        • There is talk of obstruction when the obstruction is related to obstruction of the lumen by an intraluminal obstacle (that is to say, located within the intestinal lumen), parietal (that is, ie moving the expense of the intestinal wall – eg a tumor) or extrinsic (that is to say an obstacle related to compression of the intestine with an abdominal mass independent of the intestine).

Occlusion Causes

Among the organic causes of occlusion include:

The small bowel obstruction due to strangulation

This is the most common mechanism of acute small bowel obstruction. Occlusive syndrome settles abruptly:

  • Occlusion clamp + + +
  • Strangulated hernia or eventration + + +

Both situations require urgent surgical treatment because the vitality of the intestines is compromised beyond 6 hours of arrest with risk of vascular necrosis.

Occlusions of the colon obstruction

This is the most common mechanism of acute occlusion of the colon. The intestinal obstruction is generally more gradual installation as obstructive mass grows:

  • Colorectal tumors + + +
  • Extrinsic compression of the colon by a large intra-abdominal mass: tumor of the urinary tract, bladder, prostate, internal genitalia, etc. …

The bowel obstruction due to strangulation

  • Volvulus of the sigmoid colon favored by anatomical predisposition and chronic constipation
  • Volvulus of the cecum or right colon (rare)

The small bowel obstruction by obstruction (rare)

  • Stenosis of the small intestine, that is to say luminal narrowing of the small intestine that may be secondary to inflammatory bowel disease, in an ischemic bowel or a bowel wall hematoma
  • Small bowel tumors (rare)
  • Foreign intra-small bowel (rare)

Among the functional occlusions (common) are:

  • The functional occlusion of the small intestine (called “  paralytic ileus  ”): disorders of intestinal motility, which may be related to metabolic disorders (hypokalemia, hypocalcemia), taking certain drugs, in the aftermath of abdominal surgery or intra pathologies -abdominal pain (renal colic, biliary colic, acute pancreatitis, etc …), certain neurological diseases (multiple sclerosis, Parkinson’s disease, etc …), diabetes with advanced
  • The functional occlusion of the colon: the retention of significant stool called “fecal impaction” syndrome, colonic pseudo-obstruction called Ogilvie’s syndrome which is common in elderly patients.

Intestinal Obstruction Symptoms

Pain is the center of symptoms

We talk about bowel obstruction before a combination of signs that include:

  • Abdominal pain, always present installation more or less abrupt depending on the mechanism of occlusion. This pain is more central.
  • Nausea with vomiting, more or less early according to the level of the obstacle (hail or colon).
  • Judgment of transit that is to say, absence of bowel movements, and especially gas .
  • Abdominal distension (feeling gases accumulated in the abdomen), reflecting the accumulation of gas and intestinal distension upstream of the obstacle.

Occlusions Expert

Occlusion is an emergency medical-surgical .

Front of a suspected bowel obstruction, the GP then guide the patient to the emergency department nearest to where the patient may benefit from additional tests in an emergency.

Experts are concerned the digestive surgeons or the intensivists .

Occlusions Diagnosis

Traditional radio and scanner can usually diagnose

Before a bowel obstruction, you realize:

  • A radiograph of the abdomen called abdomen without preparation (ASP) : review of easy access and quick to run to search what are called “hydro-aériques levels” that reflect the occlusion and can give an idea the location of the obstacle.
  • An abdominal CT scan to view the obstacle, locate, determine the mechanism and evaluate its impact on the gut (ischemia / necrosis of a segment of intestine).
  • blood test looking for standard metabolic complications of occlusion which are a sign of severity that may require treatment in intensive care.

Occlusions Treatment

The treatment of the obstacle can be surgical or medical

The choice of treatment depends on the location of the occlusion, the installation mechanism and elements of clinical severity and non-clinical services provided by the additional tests:

  • The organic occlusions are often of immediate surgical treatment or deferred emergency given the risk of necrosis of intestinal segments beyond 6 hours of ischemia: occlusion clamp, strangulated hernia, bowel obstruction by a colorectal tumor.
  • The type of surgery company is the exclusive responsibility of the digestive surgeon, who informs the patient of risks associated with anesthesia and surgery but also risks related to the lack of timely management (potentially fatal serious complications).
  • The functional occlusion are of a medical treatment . As appropriate: correction of metabolic disorders, drug withdrawal occlusions favoring functional syndromes Ogilvie exsufflation by establishing a rectal probe, fecal impaction removal by washing, etc.

Occlusions Complication

Complications occlusions are potentially very serious. The life is involved:

The main complications are:

  • Perforation of the intestine or superinfection of a portion of intestine may already necrotic with peritonitis or septic shock of that is to say, very serious and widespread infection in the body.
  • Severe metabolic disorders that can evolve pejoratively which requires care in intensive care: acute dehydration, acute renal failure, cardiac arrhythmias, acute heart failure, etc …

The prognosis is related to the cause of the occlusion but also to rapid diagnosis and management.

 

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