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Intestinal obstruction

Overview

Intestinal obstruction refers to a blockage that prevents the normal movement of contents through the intestines. This condition can be partial or complete and can occur in the small intestine or large intestine (colon). Intestinal obstruction is a medical emergency, as it can lead to complications such as bowel ischaemia (decreased blood flow), perforation, and infection.

  • Mechanical obstruction: This occurs when something physically blocks the intestines. Causes include:
    • Adhesions: Scar tissue from previous surgeries that can form between the intestines and other abdominal organs.
    • Hernias: Parts of the intestine protrude through a weak spot in the abdominal wall.
    • Tumours: Cancer or benign tumours can obstruct the intestine.
    • Volvulus: Twisting of the intestines that can lead to obstruction.
    • Intussusception: One segment of the intestine "telescopes" into an adjacent segment.
    • Foreign Bodies: Ingested objects or material that obstruct the intestinal passage.
  • Functional obstruction (Ileus): This type is not caused by a physical blockage but rather by a disruption in the normal function of the intestines. Causes include:
    • Post-surgical Ileus: A temporary paralysis of the bowel after surgery.
    • Electrolyte imbalances: Changes in blood levels of sodium, potassium, or calcium.
    • Infections: Certain infections, such as peritonitis, can interfere with normal bowel function.

  • Abdominal pain: Often crampy or colicky, and it may come and go.
  • Distension: The abdomen may become swollen or bloated due to the buildup of gas and fluids.
  • Nausea and vomiting: Typically, vomiting occurs after the development of abdominal pain. The content may become feculent in severe cases.
  • Constipation: Incomplete obstruction may still allow some gas or stool to pass, but full obstruction will prevent any passage.
  • Inability to pass gas: Often an important sign of obstruction.

  • Physical examination: The healthcare provider may listen to bowel sounds with a stethoscope. Increased or absent bowel sounds can help identify the nature of the obstruction.
  • Imaging studies:
    • X-ray: An abdominal X-ray can show signs of obstruction (such as dilated loops of intestine or air-fluid levels).
    • CT scan: A more detailed imaging method that can help identify the cause and location of the obstruction.
    • Ultrasound: Particularly useful in diagnosing intussusception (more common in children).
  • Laboratory tests: Blood tests may reveal electrolyte imbalances, dehydration, or signs of infection.

Treatment depends on the type and severity of the obstruction:

  • Conservative management:
    • Nasogastric Tube (NGT) Decompression: A tube inserted through the nose into the stomach can help remove fluids and air, relieving pressure and discomfort.
    • Fluid resuscitation: Patients often need intravenous fluids to address dehydration and electrolyte imbalances.
    • Monitoring: In less severe cases or with partial obstructions, close observation with supportive care may be sufficient.
  • Surgical intervention:
    • Exploratory Surgery: If the obstruction is caused by a mechanical issue such as a hernia, volvulus, or tumour, surgery may be required to remove or correct the blockage.
    • Resection: In cases of bowel ischaemia or necrosis (tissue death), part of the intestine may need to be removed.
    • Laparoscopy: A minimally invasive approach may be used in some cases to relieve adhesions or other blockages.
    • Endoscopic Procedures: In certain cases, endoscopy (using a flexible tube with a camera) can be used to remove objects or treat conditions such as a volvulus.

While not all causes of intestinal obstruction can be prevented, some measures can reduce the risk:

  • Surgical care: Proper management of adhesions following surgery.
  • Healthy diet: Adequate fibre intake to prevent constipation.
  • Early detection: Regular screenings for colon cancer in high-risk populations.
  • Prompt treatment of abdominal issues: Seeking medical attention at the first signs of severe abdominal pain, vomiting, or constipation can prevent the escalation of symptoms.
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