Abdominal Emergency – Intestinal Obstruction

Intestinal obstruction is a condition where there is a blockage in the digestive tract, preventing food and waste from moving through the intestines. This is a medical emergency that requires prompt treatment to avoid dangerous complications.

I. Symptoms:

1. Functional symptoms:

• Abdominal pain:

• Usually cramping, continuous, and severe.

• Pain radiates from the area around the navel, down the flanks, and throughout the abdomen.

• With strangulation obstruction: Continuous pain, not cramping, no pain relief with posture change.

• Nausea and vomiting:

• Vomiting does not relieve pain.

• Vomiting food, bile, and stool.

• Determining the location of the obstruction:

• High intestinal obstruction: Frequent vomiting, early onset.

• Low intestinal obstruction: Late onset of nausea.

• Constipation:

• No bowel movements or only passing small, hard stools.

2. Systemic symptoms:

• Electrolyte imbalance:

• Early: Usually asymptomatic.

• Late: Thirst, sunken eyes, dry mucous membranes, wrinkled skin, decreased urine output.

• Shock:

• Commonly seen in strangulation obstruction, sepsis, and blood loss.

II. Clinical Examination:

1. Inspection:

• Abdominal distension:

• Soft abdomen, distension starting around the navel and spreading to the entire abdomen.

• In high jejunal obstruction: No abdominal distension.

• Uniform distension: Complete obstruction.

• Uneven distension: Strangulation.

• Visible bowel loops: Visible bowel loops beneath the skin.

• “Snake-like” appearance: Bowel loops contract to form a snake-like appearance beneath the skin.

2. Palpation, Percussion, Auscultation:

• Palpation: Pain on palpation, potential palpable bowel wall abnormalities.

• Percussion:

• Tympany in the middle of the abdomen: Due to the presence of gas in the bowel.

• Dullness in the lower abdomen: Due to the presence of fluid.

• Auscultation:

• Bowel sounds: May hear increased bowel sounds, decreased bowel sounds, or even no bowel sounds at all.

III. Diagnostic Tests:

• Abdominal X-ray:

• Shows dilated bowel loops above the obstruction.

• Fluid-air level:

• Complete obstruction: More fluid than gas, thin walls, wide base, low dome.

• Strangulation: More gas than fluid, narrow base, high dome, prominent bulge on the edge of the bowel.

• No colon is seen => No gas below the obstruction.

• Abdominal Ultrasound (AUS): Shows dilated bowel loops, fluid in the abdomen.

• Magnetic Resonance Imaging (MRI): Shows the location of the obstruction, condition of the bowel wall, and severity of the obstruction.

• Barium enema: Helps to determine the location and cause of the intestinal obstruction.

• Blood and biochemical tests: Assess electrolyte imbalance, infection, and liver and kidney function.

IV. Causes:

1. Mechanical intestinal obstruction:

• In the lumen of the bowel: Bowel worms, food residue, gallstones, tumor.

• At the bowel wall: Left colon cancer, scar tissue from inflammation (Crohn’s disease), intussusception.

• Outside the bowel: Adhesion of bowel loops after surgery.

• Bowel volvulus:

• Small intestine: Obstruction in the upper small intestine due to adhesions to the base and apex.

• Large intestine: Due to its length, the two limbs are close together and twisted downwards.

2. Functional intestinal obstruction:

• Reflex: Ureteral stones, spinal injury, pelvic injury (hematoma after surgery), peritonitis, gastric perforation.

• Acute ischemia + mesenteric artery thrombosis: Due to insufficient blood supply to the bowel.

• Pseudo-obstruction: Impaired digestive function, medication, systemic disease.

Notes:

• Intestinal obstruction is a serious condition that can lead to dangerous complications such as peritonitis, sepsis, shock, and death.

• Seek medical attention immediately if you experience any unusual symptoms of intestinal obstruction.

• Diagnosis and treatment of intestinal obstruction should be performed by a specialist.

• Treatment for intestinal obstruction depends on the cause, severity of the obstruction, and the patient’s health status.

• In some cases, surgery is necessary to resolve the intestinal obstruction.

Additional Information:

• Intestinal obstruction in children: Usually due to intussusception, bowel worms.

• Intestinal obstruction in the elderly: Often due to colon cancer, obstruction due to scar tissue, bowel loop adhesions.

• Intestinal obstruction in pregnant women: Often due to bowel volvulus, intussusception, obstruction due to tumors.

• Intestinal obstruction can occur at any age and in any gender.

• Preventing intestinal obstruction can be done by: Eating a healthy diet, maintaining personal hygiene, and promptly treating any digestive disorders.