INTESTINAL OBSTRUCTION

 

INTRODUCTION: Intestinal obstruction occurs when blockage prevents the flow of contents through the intestinal tract. Large bowel obstruction results in an accumulation of intestinal contents, fluid, and gas proximal to the obstruction. Obstruction in the colon can lead to severe distention and perforation unless gas and fluid can flow back through the ileal valve. Dehydration occurs more slowly than in small bowel obstruction. If the blood supply is cut off, intestinal strangulation and necrosis occur; this condition is life threatening. Necrosis

CLINICAL MANIFESTATIONS: Symptoms develop and progress relatively slowly. Constipation may be the only symptom for months for obstruction in sigmoid colon or rectum.  Blood loss in the stool, which may result in iron-deficiency anemia. The patient may experience weakness, weight loss, and anorexia. Abdomen eventually becomes markedly distended, loops of large bowel become visibly outlined through the abdominal wall, and patient has crampy lower abdominal pain. Fecal vomiting develops; symptoms of shock may occur. Shock

ASSESSMENT AND DIAGNOSTIC METHODS: Symptoms plus imaging studies including; abdominal x-ray and abdominal CT scan or MRI; barium studies are contraindicated in this case.

MEDICAL MANAGEMENT: Restoration of intravascular volume, correction of electrolyte abnormalities, and nasogastric aspiration and decompression are instituted immediately. Colonoscopy to untwist and decompress the bowel, if obstruction is high in the colon. Cecostomy may be performed for patients who are poor surgical risks and urgently need relief from the obstruction. Rectal tube to decompress an area that is lower in the bowel. Usual treatment is surgical resection to remove the obstructing lesion; a temporary or permanent colostomy may necessary; an ileoanal anastomosis may be performed if entire large bowel must be removed.

RELATED;

1.  ULCERATIVE COLITIS  

2.  CONSTIPATION

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