bowel obstruction

Quick Overview

• What is a bowel obstruction? complete or partial blockage of the intestinal passage; Technical term: ileus
• Causes: Mechanical obstacles such as tumors, scarring, intestinal entrapment in inguinal hernia etc., paralysis or cramping of the intestinal wall
• symptoms: depending on cause and severity slightly different, but usually abdominal pain, nausea and vomiting, bloated abdomen
• Treatment: Intestine emptying intestine, supply of nutrients and liquid via infusion, medication (analgesics, nausea and vomiting medication, antibiotics, etc.); if necessary surgical removal of the obstacle, artificial intestinal exit
• investigations: Patient interview (anamnesis), physical examination, imaging (X-ray, ultrasound, if necessary computer tomography)
• Forecast: Bowel obstruction is always an emergency! The sooner he is treated, the better the chances of survival.

Intestinal obstruction: description and causes

In intestinal obstruction (ileus), the passage through the small intestine or large intestine is completely interrupted. The precursor of the ileus is subileus called. It is a clinically not yet fully developed intestinal obstruction.

If the intestine can no longer pass through its contents as usual, it forms an optimal breeding ground for bacteria. If they enter the bloodstream, septicemia (sepsis) is at risk. Due to the accumulation of food particles and the formation of gas, the intestine expands strongly. Its wall becomes thin and prone to cracks and holes. Escaping intestinal contents can cause peritonitis (peritonitis).

At the same time, the intestine can no longer release important blood salts (electrolytes) and fluids into the bloodstream when the body is closed. It develops a defect that can be dangerous.

Bowel obstruction: causes and risk factors

An intestinal obstruction can have various causes. In principle, one differentiates the following main groups of an ileus:

• mechanical intestinal obstruction: Intestinal obstruction by a mechanical obstacle; most common form of ileus
• functional intestinal obstruction: Intestinal obstruction due to a disorder of the intestinal musculature. This counts primarily the paralytic ileus (Cause: paralysis of the intestinal musculature). Rarely occurs spastic ileus (Cause: Spasm of the intestinal musculature).

A mechanical ileus can pass without treatment into a combined mechanical-paralytic intestinal obstruction.

Mechanical ileus

For example, a mechanical bowel obstruction can be caused by a Constriction of intestinal blood vessels (strangulation) arise. This can happen, for example, in a hernia, if a piece of intestine is trapped in the Bruchpforte (incarceration). Strangulationileus can also result if the intestine turns around its own axis (Volvulus) or a piece of intestine inverts over the subsequent intestinal section (invagination).

In other cases, a mechanical intestinal obstruction is caused by a Transfer of the intestinal lumenFor example, by a foreign body, worms or a tumor (such as colon cancer). Even hard feces can clog the intestine (more specifically: large intestine). In rare cases, a large gallstone is the obstacle: In the so-called gallstone ileus breaks the wall of the gallbladder in the adjacent small intestine. This creates a direct connection (fistula) with the intestine. A large gallstone can break through these and block either the small intestine itself or the transition from the small to the large intestine (ileocecal valve).

Sometimes a mechanical intestinal obstruction is based on one Narrowing of the intestinal lumen from the outside, One possible cause is adhesions in the abdomen as a result of inflammation or surgery. Such adhesions are called “Briden”, which is why one speaks here of a Bridenileus. Even tumors in the abdomen can press on the intestine so that the intestinal passage is obstructed or interrupted. This can happen, for example, in the case of extensive cancer of the peritoneum (peritoneal carcinomatosis).

Often sounding bowel sounds, also called Durchspritzperistaltik, can be heard when the intestine is strongly pressed from the outside. They arise when the porridge is pressed with pressure through the reduced intestinal lumen.

Pathological processes in the intestinal wall such as in chronic inflammatory bowel disease (Crohn’s disease, ulcerative colitis) or inflamed intestinal protuberances (diverticulitis) are also possible reasons for a mechanical intestinal obstruction.

Paralytic ileus

In contrast to the mechanical intestinal obstruction, paralytic ileus does not obstruct the further transport of the chyme but a paralysis of the intestinal musculature.

This paralysis can be the result of vascular occlusions, for example, by locally formed blood clots (thrombi). In this case, experts speak of one primary paralytic ileus, More common is the secondary paralytic ileusHere, the intestinal muscles are paralyzed by mechanical stimuli, for example, by surgery or severe abdominal diseases (such as peritoneal or appendicitis).

More about causes, signs and treatment of intestinal obstruction due to paralysis of the intestinal wall can be found in the article Paralytic ileus.

Spastic ileus

An intestinal obstruction due to a spasm of the intestinal wall is rare. It can be the result of lead poisoning. Certain metabolic disorders, which are summarized under the term porphyria, come as a cause in question. Sometimes a spastic intestinal obstruction is also caused by an infection with roundworms (ascariasis).

Intestinal obstruction in the infant

Even babies can get a bowel obstruction. On the one hand, a bowel section can be closed from birth (intestinal atresia). On the other hand, the first tenacious chair of the newborn (meconium) can clog the intestine. Doctors here speak of a meconium ileus. The meconium is, among other things, in the uterus swallowed hair, skin and mucosal cells.

A meconium ileus is usually an early indication of a congenital metabolic disease called cystic fibrosis.

Intestinal obstruction: symptoms

Bowel obstruction is not the same as intestinal obstruction. Not only the causes are different, the symptoms also vary depending on the cause and severity of the intestinal obstruction.

Mechanical intestinal obstruction: symptoms

Bowel obstruction symptoms in the mechanical type are:

• severe, spasmodic (colicky) abdominal pain, which increases and decreases in a wave-like manner
• acute wind and stool behavior
• Nausea and vomiting
• bloated stomach
• increased intestinal wind (flatulence)
• burping
• accelerated heartbeat
• fever

In Strangulationsileus the affected intestinal tract is no longer supplied with blood. The pain is then permanent. In addition, the blood pressure drops, the pulse accelerates and sufferers vomit heavily – in extreme cases even feces (vomiting vomits).

Paralytic intestinal obstruction: symptoms

Bowel obstruction symptoms in the paralytic type are less pronounced and delayed. Nausea and vomiting Although torment in this form the patient. However, since the intestine is paralyzed no bowel sounds to listen. Doctors speak in this context too Grave or dead silence, The pain is not relapsing like the mechanical intestinal obstruction. Instead, they are persistent and diffuse – sufferers can not clearly describe where it hurts. Particularly pronounced is the distended belly, which can become a hard, tense “drum belly” with an additional peritonitis. Later on, it may be that the affected person vomits liquid intestinal contents.

Location of the ileus influences symptoms

Furthermore, the symptoms differ according to where the intestinal obstruction occurs. The higher he sits in the intestine (such as in the beginning of the small intestine), the sooner and stronger the person vomits. In a deep-seated intestinal obstruction, the symptoms begin slower (creeping) with loss of appetite, bloating, nausea and growing belly circumference. In the further course it can come to Koterbrechen.

Bowel obstruction is an acute emergency! Whatever the symptoms – sufferers must go to the doctor immediately. Without therapy, the ileus almost always ends fatally!

Intestinal obstruction: treatment

An intestinal obstruction is an acute emergency and must be treated in the hospital!

The therapy depends on what caused the intestinal obstruction and where it occurs in the intestine. Often enough conservative measures, In any case, the patient has to forgo eating and drinking for the time being. He usually gets a gastric tube to derive the backlogged intestinal contents. In addition, an infusion is placed to introduce nutrients, liquid and possibly also medication (such as nausea and vomiting) directly into the bloodstream. To control the urine output, the doctor may place a bladder catheter.

Other conservative measures that may be useful in a bowel obstruction, for example, enemas, warm and moist abdominal wrap and the administration of drugs to stimulate the intestinal peristalsis.

A surgery is absolutely necessary for a Strangulationsileus and a colon closure. If surgery is not possible, he places an artificial intestinal outlet (anus praeternaturalis, stoma).

After the operation, the patient receives an infusion over several days. Only after the first bowel movement does one slowly start to move the intestine – first with tea, then with liquid and later also with passed food. After about ten days, finally, easily digestible food in the form of rusks, bananas or potatoes is allowed.

Bowel obstruction: examinations and diagnosis

If you suspect a bowel obstruction, the doctor interviewed the person concerned in detail to his medical history (Anamnesis): Among other things, he asks, since when the complaints exist, where exactly the pain occurs, when the last time bowel and bowel wind has gone off and if the patient has any abdominal surgery behind him.

Then one follows physical examination: The doctor scans the abdomen of the patient and checks whether the abdominal muscles are reflexively tense due to the touch (defense tension). In addition, the abdominal cavity is tapped with a stethoscope. This can provide clues as to what type of intestinal obstruction is involved. If bowel sounds are heard, this indicates a mechanical bowel obstruction. In the absence of bowel sounds (“grave / dead silence in the abdominal cavity”), it is likely to be a paralytic ileus.

For physical examination of intestinal obstruction also includes that the doctor scans the rectum over the anus with a finger (rectal examination).

An ileus can be visualized with the help of a X-ray, Already four to five hours after the start, the intestinal loops, which are distended on the X-ray images, show liquid. If a colon closure is suspected, the patient often receives an enema with a contrast agent before the X-ray. On the recordings you can see exactly where the shutter is located.

Also per Ultrasonic The doctor can often discover the exact location of the intestinal obstruction. It shows standing intestinal loops and sometimes free fluid in the abdominal cavity and large gas collections.

In certain cases, one can Computed tomography (CT) be useful, for example, in suspected tumors or as preparation for surgical treatment.

Bowel obstruction: disease course and prognosis

The sooner a bowel obstruction is detected, the better he can be treated. Without treatment, it can become life-threatening, for example, when the intestinal wall breaks through (perforation), an inflammatory reaction (sepsis) occurs by bacterial toxin in the bloodstream and triggers a circulatory or multi-organ failure, or the lack of fluid and electrolyte in the body leads to shock.

Because the chyme remains in the intestine, the pressure on the intestinal wall increases dangerously. The sensitive mucous membrane can be injured (mucosal erosions). As a result, even parts of the intestinal wall can die off (Darmwandnekrosen). Then bacteria can walk through them and trigger peritonitis – also a life-threatening complication of the ileus.

The mortality in the intestinal obstruction is five to 25 percent. Every hour that passes without treatment increases the risk of death by about one percent.

Intestinal obstruction: prevention

If you want to prevent a bowel obstruction, should pay particular attention to a regular bowel movement. It is recommended a high-fiber diet in the form of lots of fruits, vegetables and Vollkonrprodukten. Dietary fiber causes intestinal activity. Also, a sufficient hydration (1.5 to 2 liters per day) as well as regular exercise are important for a controlled digestion.

After abdominal surgery, adhesions sometimes form in the abdomen, which can trigger an ileus. Anyone who has an abdominal op should therefore pay particular attention to possible signs of one bowel obstruction Pay attention (abdominal pain, lack of bowel movements, etc.) and if necessary go to the doctor early.