Partial intestinal obstruction. Intestinal obstruction of the small intestine Obstruction of the small intestine treatment

Intestinal obstruction is a syndrome that causes a violation of the passage of a food lump or feces along the tract. Always a severe course and a large percentage of death makes it dangerous, so every person should be able to identify the first signs of the disease.

Symptoms

The syndrome begins with sudden pain, severe and intolerable, similar to labor pains. The patient, trying to find a position that can alleviate the condition, tries to squat or bend, touching his knees with his elbows.

Symptoms of intestinal obstruction develop very quickly: by the end of the first day, the pain brings the person into state of shock, the skin becomes pale, the heartbeat quickens, cold sticky sweat comes out, an “ileous moan” escapes from the mouth. Then there is vomiting. According to its contents, the doctor can determine where the “congestion” has arisen. The higher it is, the stronger the urge. Eversion of the contents of the stomach does not bring obvious relief.

Frequent vomiting causes dehydration of the body, peristalsis does not work, putrefactive processes form a large number of toxins. Increasing intoxication makes the blood thick, against this background leukocytosis develops. Gases accumulate in the affected area, the abdomen increases in size, the contour of a strongly swollen intestine is clearly defined through the abdominal wall. If you shake it with your hands, you will hear a noise resembling a splash of water. It is created by the digestive juice that has accumulated "in the standing" intestine.

On the second day after the onset of malaise, other signs of intestinal obstruction appear: the patient stops excreting urine, the body temperature rises (it indicates an increase in the amount of toxins), breathing quickens, peritonitis or sepsis develops, the patient's condition becomes critical. If left untreated, death occurs within three days. That is why it is so important to deliver the patient as soon as possible to the surgical hospital.

Causes of the disease

cause a delay or complete absence the passage of the contents of the digestive tract can be the following factors:

Treatment tactics are developed taking into account the causes of obstruction, as well as the specifics of the clinical picture.

Types and features

Depending on where the “congestion” of the food bolus or feces has formed, two forms of the disease are distinguished: upper (obstruction of the small intestine) and lower (obstruction in the large intestine).

Sharp cramping pains that occur in the upper abdomen help to recognize a dangerous disease of the small intestine. They appear immediately, within two hours after the formation of a “congestion”, in parallel, vomiting occurs, in its masses one can see the remains of undigested food of an unpleasant yellow-green color.

The second form develops more slowly, it is associated with the non-passage of already formed feces, it is preceded by prolonged periods of constipation.

There are pains, but they are not expressed, they are localized in the lower abdomen. Nausea appears 10 hours after the formation of intestinal obstruction. It causes vomiting, its mass has a gray or brown color and a fetid odor of feces.

According to the features of the clinical picture, three types of the course of the disease are distinguished. Classification helps to differentiate the pathology from others that have similar symptoms.

Acute obstruction

It proceeds in three stages. In the first phase, a rapid violation of the intestinal passage occurs. During the first two hours, there is severe pain and local symptoms from the abdomen. After 10 hours, intoxication of the body begins, a period of apparent well-being begins. The patient feels better, but the disease progresses.

The peritoneum swells, becomes asymmetrical, peristalsis weakens or stops altogether, sound accompaniment and signs of dehydration occur. Three days later, in the absence of treatment, functional disorders of hemodynamics begin to appear, peritonitis develops.

The phases of the course of AIO are conditional, but it is precisely such a chain of states that makes it possible to make an accurate diagnosis. Examination of the patient makes it possible to identify increased intestinal noise, tympanitis and dullness, protective tension abdominal wall, pronounced asymmetry and involvement of breathing.

Partial

This is a syndrome in which there is a slow movement of feces. Its appearance in children is associated with a violation of the dynamic contractions of the intestinal walls, provoked by spasm or paralysis of smooth muscles.

In older people, stool retention or incomplete obturation can be provoked by weakening of the muscles of the abdominal wall, diverticula, polyps, the presence of a fecal blockage or a ball of worms. Such provocateurs reinforce the effect and aggravate the severity of the condition.

Partial obstruction is manifested by characteristic symptoms: bloated belly, iridescent pain, constant nausea and vomiting. There is a chair, but it is rare.

Chronic

Diagnosed in violation of the output of the contents of the intestinal tract, which is accompanied by prolonged constipation, followed by diarrhea. This phenomenon is associated with an increase in the activity of processes leading to fermentation and rot in places where the feces “get up” and do not move.

Blockage of the intestines provokes cramping pain. It occurs at the moment of the wave of contraction of the walls of the tract, between the intervals of peristalsis comes relief. Another characteristic sign of the chronic course of the disease is the presence of false urges to defecate. The accumulation of gases leads to bloating.

If the feces are blocked in the small intestine, the peritoneum is symmetrical; with colonic obstruction, it swells asymmetrically. There are several reasons that can provoke such processes: adhesions, cicatricial strictures, tumors inside the lumen, oncology of neighboring organs (in women of the uterus, in men of the prostate).

Treatment of the disease

Since tract obstruction is a severe form of complications of various pathologies, there is no single therapeutic regimen. But general principles have been formulated, taking into account which therapeutic measures are built. They are as follows.

All patients with suspected obstruction of the lumen of the intestinal tract should be immediately hospitalized. It is the timing of admission of such patients to the surgical hospital that determines the prognosis and outcome of the disease. The later a person enters a medical facility, the higher the risk of death.

When diagnosing dynamic obstruction, it is used conservative treatment, which is aimed at restoring peristalsis, increasing the tone of the muscle layer. The basis of therapy is medications and diet.

Preparations

Recovery motor function appointed:

Antipsychotics that inhibit the work of the central nervous system("Aminazin").
Anticholinesterase agents that activate peristalsis ("Prozerin" or "Ubretide").

In order to achieve the desired therapeutic effect, it is important to follow the sequence of taking medications: first, drugs of the first group are administered intravenously, then, after 40 minutes, the second. Half an hour later, a cleansing enema is prescribed. To consolidate the results, electrical stimulation of the intestine is performed.

In addition, patients are washed daily with the stomach and all parts of the tract. Thus, the stagnant content is removed. To do this, use three-meter probes with inflatable cuffs. In parallel with the main course, measures are taken to eliminate the symptoms of intoxication, relieve pain, restore water-salt metabolism.

Diet

The restrictive nutrition scheme is developed in each specific case, taking into account the severity of the patient's condition, the characteristics of the clinical picture of the disease. The main task is to facilitate the work of the intestines, restore its functions.

Exist general rules, they relate to the organization of the diet.

A person should eat regularly.
It is important to break the number of receptions into five parts, the size of each serving is “the size of a fist”.
Overeating can exacerbate symptoms.
The menu should not contain foods that promote gas formation, fatty foods.
Preference is given to liquid soups, treats with a slimy consistency (jelly).

When an acute obstruction occurs, an adult and a child himself refuses to eat, a zero (surgical) diet is prescribed to maintain his strength. It helps to minimize the appearance of putrefactive processes, eliminates the possibility of irritation of the mucous tract. The main emphasis is on replenishing the water-salt balance. Diluted freshly squeezed juices, decoctions of wild rose and currants, tea, boiled cereals not in milk, dietary meat, steam are allowed. lean fish, white bread crackers.

Operation

All types of obstruction and strangulation (torsion, knotting, pinching, compression of blood vessels, nerves of the mesentery), any other forms complicated by peritonitis, are subject only to surgical treatment. When it is carried out, a technique is chosen that allows to eliminate the cause of the disease. X-ray or colonoscopy, rectal examination in men and vaginal examination in women are capable of suggesting a way to solve the problem, laboratory tests urine, blood, pathological secretions.

In the acute phase, any surgical intervention is preceded by a period of express preparation, during which time the patient's condition is carefully monitored, an experienced surgeon can independently make a preliminary diagnosis by examining the abdomen, and, based on it, draw up an operation plan.

After the surgical intervention is intensive therapy: blood substitutes are introduced to the patient with the help of droppers, saline solutions, anti-inflammatory treatment, drug stimulation of the motor function of the tract is being implemented. On the first day, fasting is indicated, then nutrition with probes and saline, after which the patient is transferred to a zero diet.

ethnoscience

Tract obstruction is a disease in which self-treatment is unacceptable. Even partial congestion can provoke dangerous complications. Therefore, "grandmother's" recipes should be taken with extreme caution and only after consulting a doctor.

official medicine actively uses some means in the fight against chronic pathologies. Sea buckthorn juice is especially helpful. It has anti-inflammatory and laxative effects. For cooking, they take a kilogram of berries, crush them in a convenient container, mix them and squeeze the juice with gauze. Take 100 grams daily, one-time, before meals for half an hour.

Dried fruits can boast a mild laxative effect that can improve fecal patency. To prepare the medicine, they take plums, dried apricots, figs and raisins in equal amounts, all ingredients are pre-mixed, washed and steamed with boiling water overnight. The next day, the water is drained, the bones are removed, the pulp is ground in a meat grinder, mixed with honey to taste. Consume in the morning before breakfast every day for a tablespoon.

Obstruction in children

Two forms of the disease are diagnosed: congenital and acquired. The first is a consequence of malformations of the digestive tract: pathological narrowing of the intestinal lumen, infringement of its loops, lengthening of the sigmoid section.

In infants, the acute phase suddenly begins with an increase in the hardness of meconium (feces). There is a blockage of the lumen of the hollow organ, the baby loses stool, gases accumulate, which inflate the tummy to a large size. The child vomits, the masses coming out are yellow. It indicates the presence of bile.

Often in newborns, another specific type of obstruction is observed - intussusception. The diagnosis is made when part of the large intestine "crawls and swallows" the final segment of the small intestine. With this phenomenon, the baby experiences a strong pain syndrome, it vomits, there is no feces, instead of it, mucus and blood are released. The anomaly is more often detected in 5–10 month old boys.

In babies under one year old, in most cases, adhesive processes are diagnosed. They can develop as a result of birth injuries, previous infections, immaturity of the digestive tract, after severe bruises and strip operations. In addition, babies three years mobile, constantly moving, during active games, the loops of the small and large intestines can wrap.

An acute attack of an adhesive nature is a complication that often leads to the death of a baby. It is extremely difficult to treat it surgically, since the walls of the intestines in children are thin, it is difficult to sew them. Medical treatment is effective only when the disease develops due to dysfunction of the tract.

Having information about the existing risks, each parent should be able to recognize the first symptoms of the described pathology:

Severe pain, children cannot talk about it, so they cry loudly, spin around, trying to take a position that reduces the intensity of the manifestation of the syndrome.
Refusal to eat.
Lack of stool and gas.
The occurrence of vomiting.
Painful urge to stool.
Discharge from the anus, purulent or bloody.

The presence of a combination of these signs is a reason to call an ambulance. If left untreated, irreversible consequences are possible.

Prevention and prognosis

It is difficult to predict the results of therapy, much depends on when it was started, to what extent it was carried out. The mortality rate in the acute phase is very high. It increases in the elderly, with a late-recognized disease, the detection of inoperable tumors. When adhesive processes are diagnosed, relapses often occur. It is possible to cure the patient, provided there are no inoperable cases (oncological tumors).

Prevention of the disease consists in observing the principles of proper nutrition, in timely treatment and elimination of processes that can provoke it. To prevent adhesions after surgery, the patient is previously restored, if there are no contraindications, physiotherapy is prescribed, physiotherapy, intake of proteolytic enzymes.

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Clinical manifestations include cramping pain, vomiting, stool retention and flatus. Diagnosis is based on clinical findings and is confirmed by x-ray of the abdominal cavity. Treatment includes fluids, nasogastric drainage, and, in most cases of complete obstruction, surgery.

Mechanical obstruction can be divided into small bowel (including the level of the duodenum) and large bowel. Obstruction can be partial or complete. Approximately 85% of cases of partial small bowel obstruction resolve without surgery, and 85% of cases of complete small bowel obstruction require surgery.

Causes of mechanical intestinal obstruction

The most common causes of mechanical obstruction are adhesions, hernias, and tumors. Other common causes are diverticulitis, foreign bodies, volvulus (torsion of the intestine on its mesentery), intussusception (penetration of one segment of the intestine into another), and fecal blockage. In certain segments of the intestine, various pathological processes develop.

Pathophysiology of mechanical intestinal obstruction

With simple mechanical obstruction, there are no initial disturbances in blood flow in the intestinal wall. Swallowed liquid, food, digestive secretions, gas accumulate above the obstruction level. The proximal part of the intestine is stretched by gases, and the distally located segment collapses. The secretory and absorption functions of the mucous membrane are depressed, the intestinal wall becomes edematous, with congestive changes. Stretching of the intestine progresses, with an increase in disorders of peristalsis and secretion and an increased risk of dehydration and strangulation obstruction.

Strangulation obstruction is accompanied by a violation of the blood supply to the intestine; it accounts for approximately 25% of cases of small bowel obstruction. As a rule, it is associated with hernia, volvulus and intussusception. First of all, venous blood flow is disturbed, then arterial occlusion occurs, which leads to the rapid development of ischemia of the intestinal wall. The ischemic intestine becomes edematous, undergoes infarct changes, which leads to gangrene and perforation.

Perforation can develop in the ischemic segment or with the development of significant dilation. The risk is high if the cecum reaches a diameter > 13 cm.

Symptoms and signs of mechanical intestinal obstruction

Small bowel obstruction is accompanied by the development of symptoms within a short time after the onset: cramping abdominal pain localized in the central part of the abdomen - around the navel, vomiting and - with complete obstruction - stool retention. With partial obstruction, diarrhea may develop. Severe pain of a permanent nature indicates the development of strangulation. In the absence of strangulation, palpation tenderness of the abdomen is not determined. Characterized by increased ringing peristaltic noises, growing on a wave of cramping pain. With the development of a heart attack, abdominal pain appears on palpation, auscultation reveals a “silent” abdomen or minimally pronounced peristaltic noises. Shock and oliguria are formidable signs indicating a far advanced stage of simple mechanical obstruction or strangulation.

Colonic obstruction, in contrast to the small intestine, as a rule, is accompanied by less vivid and gradually increasing symptoms. Increasing constipation is replaced by complete stool retention and bloating. Vomiting may develop, but it is not observed in all cases. Physical examination usually reveals abdominal distention with a low-pitched rumbling. A mass can be palpated, the location of which corresponds to the site of obstruction by the tumor. Systemic manifestations are usually moderate, water and electrolyte deficiency is not typical.

Volvulus is often characterized by an acute onset. The pain is constant, sometimes with the imposition of waves of colicky sensations.

Diagnosis of mechanical intestinal obstruction

Radiography abdominal cavity.

Abdominal x-rays should be taken and will usually show the obstruction. Although only laparotomy can definitively indicate the presence of strangulation, careful clinical observation suggests it is early stages. An increase in the level of leukocytes in the blood and acidosis may indicate the development of strangulation.

On a survey radiograph with small bowel obstruction, a cascade of dilated loops of the small intestine is determined, however, such changes can occur with obstruction of the right half of the colon. Fluid levels in the colon can be measured while standing. Similar, though less severe, radiographic changes and clinical symptoms observed with ileus (intestinal paresis without obstruction); it is difficult to distinguish between these states. Dilated loops and fluid levels may be absent in upper jejunal obstruction and strangulation obstruction of the "closed loop" type. In the infarcted colon, x-rays may show changes similar to mass lesions. The presence of gas in the intestinal wall (pneumatosis intestinalis) indicates gangrene.

Treatment of mechanical intestinal obstruction

Decompression with nasogastric tube.
intravenous fluids,
Intravenous antibiotics for suspected intestinal ischemia.

At acute obstruction therapeutic measures should be carried out simultaneously with diagnostic ones. Obligatory supervision of the patient by the surgeon.

Supportive measures for small and large bowel obstruction are similar: nasogastric drainage, intravenous fluids (0.9% sodium chloride solution or lactated Ringer's solution to replenish intravascular volume), installation urinary catheter to control fluid balance. Replacement of electrolyte losses is carried out taking into account laboratory data, although with repeated vomiting, there is a high probability of deficiency of Na and K in the serum. If bowel ischemia or infarction is suspected, antibiotics should be given before laparotomy.

specific measures. Obstruction of the duodenum in adults is an indication for resection, and if the formation cannot be removed, for palliative gastrojejunostomy.

With complete small bowel obstruction, laparotomy is preferable. early dates, although surgery in severely dehydrated patients may be delayed by 2-3 hours until fluid balance improves and urine output increases. "Guilty" education is removed if possible. If the cause of the obstruction was gallstone, it is removed by enterotomy, and there is no need for cholecystectomy. It is necessary to take measures to prevent recurrence, in particular, to suture hernias, remove foreign bodies, and carry out lysis of peritoneal adhesions. In some cases, with early postoperative obstruction or repeated episodes of adhesive obstruction, provided there are no signs of peritoneal irritation, instead of laparotomy, you can resort to the introduction of a long intestinal tube (many specialists use a conventional nasogastric tube with the same success).

Disseminated peritoneal carcinomatosis with secondary small bowel obstruction is the main cause of death in cancer of the digestive organs in adults. The imposition of anastomoses bypassing the site of obstruction - surgically or by endoscopic stenting - has a short palliative effect.

In cases of colon cancer with obstruction, a one-stage resection operation with anastomosis can be performed in some cases, with or without the formation of a temporary colostomy/ileostomy. If it is impossible to perform such an intervention, resection of the tumor is performed with the imposition of a colostomy / ileostomy; stoma closure can be done later. In some cases, a "sabotage" colostomy with delayed resection is performed.

If the obstruction is associated with diverticulitis, bowel perforation is often present. Removal of the affected area can be very difficult, but is indicated in the presence of perforation and diffuse peritonitis. A resection is performed with the imposition of a colostomy, anastomosis is carried out later.

Fecal blockage, as a rule, develops at the level of the rectum, it is eliminated manually or with the help of enemas. However, with fecal blockage, sometimes mixed with barium or antacids, in which complete obstruction develops (usually at the level sigmoid colon), laparotomy is indicated.

Basic provisions

In most cases, the causes of obstruction are adhesions, hernias and tumors.
Due to vomiting and sequestration of fluid into the third space, the volume of circulating blood decreases.
With prolonged obstruction, ischemia, infarction and intestinal perforation can develop.
Before surgery, decompression with a nasogastric tube should be resorted to and intravenous administration liquids.
With recurrent obstruction due to adhesions, it is more reasonable to first resort to decompression with a nasogastric tube, rather than urgent surgical intervention.

Content

Bowel problems are very common these days. One of them is intestinal obstruction - a serious condition, in the acute stage of which the intervention of surgeons is necessary. The earliest harbinger of an illness is pain: it begins suddenly, at any time, without apparent reason. Less often, the pain increases little by little, and after a certain period of time becomes intense.

What is intestinal obstruction

Intestinal obstruction is the impossibility of the physiological nature of the passage of stool to the anus. The process of natural emptying of the rectum becomes difficult, the discharge of gases stops, and fecal blockages form. Symptoms become more pronounced as the condition worsens. The source of problems is irregular stools: it is correct if a person empties once a day. In the event that signs appear that signal obstruction, you should consult a doctor.

Causes of obstruction

Obstruction in the intestine develops under the influence of various reasons, which are divided into two categories: functional and mechanical. The development of a disease of a mechanical type is facilitated by such factors as an increase in the length of the sigmoid colon, the presence of pockets of the peritoneum, a mobile caecum, and adhesions. Functional obstruction develops against the background of overeating after fasting, a sharp increase in fresh fruits, the transfer of newborns to adapted mixtures up to a year.

Mechanical

The mechanical causes of the disease, which noticeably poisons the existence of the patient:

hematoma;
failures in the formation of the intestine;
failures in the structure of the peritoneum;
gall and fecal stones;
vascular ailments;
inflammation;
neoplasms (cancer or benign);
oncology;
bowel obstruction;
adhesions;
hernia;
volvulus of the intestine;
cords of the peritoneum of the congenital type;
the entry of foreign elements into the intestines;
decrease in the intestinal lumen.

Functional

Functional reasons for the development of obstruction are also known. Their list usually depends on the associated problems, but a short version of it looks like this:

paralytic phenomena;
spasms;
disruptions in intestinal motility.

Symptoms and signs of bowel obstruction

According to doctors, if an intestinal obstruction is suspected, the patient should be taken to the hospital as soon as possible. So the prognosis will be favorable. Violation can be corrected without surgical intervention in some cases. Obvious signs of the onset of the disease are the impracticability of the discharge of feces and gases. In the case of partial obstruction or obstruction of the upper intestines, scanty stools and a slight discharge of flatus are observed. Symptoms such as repeated vomiting, irregular shape and bloating.

There are also specific symptoms that can only be detected by a specialist, which is why the patient's early hospitalization is so important. If you do not start treating the patient on time, then the risk of developing dangerous consequences increases, including cardiac disorders, liver and kidney failure, and death. In the case of squeezing of the vessels, necrosis of the intestine develops. Even an operation (if the case is advanced) may not save the patient.

The most dangerous conditions include intestinal obstruction in infants. Therefore, it is important for moms and dads to know the symptoms that should cause concern:

significant weight loss due to fluid loss,
vomiting with an admixture of bile that appears after eating,
grayish skin tone of a child,
temperature,
swelling of the upper abdomen.

A calm baby may refuse to eat, become restless and moody. Then you need to immediately call a doctor.

Types of intestinal obstruction and how they manifest themselves

Intestinal obstruction is divided into two types according to the nature of the course: it is chronic and acute. In addition, the disease can be partial or complete. By origin, the disease is divided into acquired and congenital, the latter is caused by blockage of the intestine with dense meconium, anomalies in its development. Depending on the causes, the disease can be mechanical and dynamic.

Adhesive obstruction

Adhesive obstruction is a violation of the passage through the intestines, which is provoked by the adhesive process of the peritoneum. Strands and adhesions develop after limited, acute diffuse peritonitis, hemorrhages, and abdominal trauma. This type of intestinal obstruction can occur at any level of the intestine. In most cases, there is an adhesion of the omentum with a postoperative scar of the peritoneum or organs that were injured during the operation.

The basis of the disease is a violation of peristalsis, which is caused by the formation of adhesions. Adhesive obstruction occurs in several types:

Obturation type- the disease begins acutely and proceeds quickly. Sometimes patients may suffer from chronic intermittent obstruction, which later flows into the acute phase.
strangulation type- occurs when a section of the intestine is infringed with the involvement of the mesentery. The disease proceeds acutely and rapidly, hemodynamic disorders appear early, leading to the development of peritonitis and necrosis of the intestine.
mixed form is a combination of dynamic and mechanical form of the disease.

Partial

A partial form of this disease can be chronic: the patient periodically experiences pain, suffers from vomiting, gas and stool retention. In most cases, such symptoms are not acute, they disappear after conservative measures in the hospital or on their own. The disease can last for a long time, decades. In case of obstruction due to a tumor that grows inside the intestinal lumen or from the outside, the symptoms gradually increase. Sometimes there are constipation, vomiting, flatulence. As the tumor grows, the symptoms become more frequent.

Stages of partial obstruction are replaced by periods of resolution, which are characterized by diarrhea. The feces come out liquid, plentiful, with a putrid odor. A feature of partial obstruction is that it can at any time flow into complete obstruction of the acute type.

Small intestine obstruction

Small bowel obstruction occurs anywhere in the small intestine. The part of the intestine located above the localization of the obstruction continues to work and swells as it fills with food. by the most common causes disease occurrence are obstruction of the small intestine. Symptoms of obstruction are flatulence, aversion to food, vomiting, dehydration, severe pain epigastric region.

large intestine

Violation of the passage of contents through the large intestine (obstruction) is manifested in the delay or absence of stools, bloating, difficulty in passing gases, cramping pains, distension of the abdomen, vomiting, nausea, and loss of appetite. Such obstruction can be complete or partial, more often observed in the case of lesions of the colon of an organic nature.

With the progression of disorders in the intestine, symptoms of intoxication, metabolic disorders, bloating, and signs of inflammation of the peritoneum increase. Partial obstruction is characterized by incomplete periodic discharge of flatus and stool, diarrhea changing to constipation, long-term or short-term remissions, temporary cessation of swelling and pain.

Find out what it is, how to treat this disease.

Treatment of the disease in adults and children

At the beginning of the treatment of an ailment that affects the intestines in children, adults, the elderly, emergency measures are taken to relieve pain shock, replenish fluid losses, X-rays are taken,. With the help of a probe, the upper sections of the digestive tract are released, and with the help of siphon enemas, the lower sections.

Drugs (antispasmodics) are introduced that relax the muscular walls of the intestine, stopping the increased peristalsis. In some cases, such measures and drugs are enough to restore functioning. If not, then resort to surgical intervention in the clinic.

Surgical intervention

The volume of the operation performed in surgery for intestinal obstruction will be justified individually, taking into account the characteristics of the organism, the anatomical features of the focus and the history of the disease. You should also determine the causes of the pathology. In the following cases of the course of the disease, surgery is the only way to treat:

with volvulus of the small intestine;
with blockage by gallstones;
with nodulation of the intestine, when one intestine is wound on the axis of the other;
when immersing one intestine into another.

Diet

Depending on the course of the intestinal disease and the patient's condition, a diet is prescribed. After surgery for intestinal obstruction, you can not eat or drink for twelve hours. Nutrition occurs parenterally: the patient is injected intravenously with nutrient solutions into the rectum. Five days later, nutrient mixtures are introduced through an umbrella in the mouth. The probe is removed if the patient can eat on his own. Sour-milk products, nutrient mixtures are allowed ( children food) in frequent small portions.

A few days after the operation on the intestines, a transition to a zero diet is carried out, designed to maximize the sparing of the digestive tract. Easily digestible liquid foods are introduced, and salt intake is limited.

Gradually they switch to a diet close to diet No. 4, which is designed to maximize the chemical and mechanical sparing of the intestines, reducing fermentation processes in it. The amount of fats, carbohydrates, smoked meats, spices, pickles, fiber, milk is limited. Dishes are boiled, steamed, ground.

Gradually, the dietary menu is expanding, there is a complete transition to diet No. 4, which is designed for patients with intestinal diseases at the stage of recovery and rehabilitation, including obstruction. provides complete nutrition that is gentle on the intestines. The diet is more varied, food is not rubbed.

Dishes are boiled or steamed, which is good for the patient's intestines. The diet for chronic and acute obstruction prevents the development of putrefactive, fermentative processes. Simple carbohydrates and fats are limited, mechanical, chemical and thermal irritants are excluded.

Folk remedies

With a partial form of obstruction, treatment with methods from the arsenal of traditional medicine helps:

Pour 0.5 kg of pitted plums with a liter of water, boil for an hour, cool and drink half a glass three times a day.
Crush 1 kg of sea buckthorn, pour 0.7 l of boiled chilled water, mix. Squeeze the juice and take half a glass once a day.
Mix 20 pieces of dried apricots, 10 tbsp. raisins, 10 pieces of figs and prunes. Pour boiling water, rinse, twist. Eat a tablespoon on an empty stomach.
Heat half a glass of milk, add 20 g of butter. Lie on your left side and inject the solution like a regular enema. Do the procedure three days in a row a couple of hours before bedtime.

Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.

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Bowel obstruction- this is a condition in which the movement of intestinal contents through the gastrointestinal tract is disturbed, partial or complete blockade of the small or large intestine, which prevents the normal passage of digested food through the intestinal tract and the excretion of feces, and in case of complete blockage, even gases. Symptoms depend on the location of the blockage and whether it is partial or complete. Small bowel obstruction causes severe stomach pain and vomiting, which can lead to dehydration and shock. If the colon is blocked, the symptoms (severe constipation and pain) develop more slowly. Small bowel obstruction is much more common than colonic ileus.

A partial obstruction in which only fluid passes can lead to diarrhea. The most obvious sign of a bowel obstruction is increasing bloating as the stomach accumulates gas, fluid, and feces. If the obstruction restricts blood supply to the intestines, there is a great risk of tissue death or perforation (rupture) of the intestine (both life-threatening conditions). Complete obstruction of the small intestine, left untreated, can lead to death within one hour to several days.

Symptoms

Alternating attacks of painful spasms.

Increasingly painful bloating.

Progressive constipation that results in an inability to pass feces or sometimes even gas.

Uncontrollable hiccups or belching.

Diarrhea (with partial obstruction).

Weak fever (temperature up to 38 ° C).

Weakness or dizziness.

Bad breath.

The reasons

Adhesions (internal scars) from previous surgery.

Strangulated hernia (part of the small intestine protrudes through a weak spot in the abdominal wall, preventing blood from entering it).

Rectal cancer.

Diverticulitis.

Volvulus (twisting or knot in the intestine).

Invagination (putting one part of the intestine over another, like a telescopic tube).

Compaction of food or feces.

Stones in the gallbladder.

Occasionally, a swallowed object gets stuck in the digestive tract.

In paralytic ileus, the intestine is not blocked, but it stops contracting and moving its contents. This is almost always seen after gastric surgery and lasts for a few days and then resolves on its own (unlike bowel obstruction that occurs for other reasons).

Violations of immune mechanisms and the importance of the microbial factor in the development of acute intestinal obstruction

From a modern standpoint, the gastrointestinal tract is considered as the most important organ that performs the anti-infective protection of the body, and as an essential component of the general immune system. The vast surface of the gastrointestinal tract is a field where the primary contact of organic and inorganic antigens with immunocompetent cells occurs. In addition, adequate secretory and motor function of the gastrointestinal tract ensures the inclusion of a number of important non-specific defense mechanisms at this stage. From this it is quite clear that a gross violation of the functional state of the gastrointestinal tract, which accompanies the development of acute intestinal obstruction, significantly affects the effectiveness of the anti-infective defense of the body as a whole. A vivid confirmation of this situation is the rate of postoperative infectious complications in this group of patients, significantly higher than similar rates in other acute surgical diseases of the abdominal cavity. Thus, according to studies reflecting the experience of the last two decades, infectious complications in patients with acute intestinal obstruction account for 11-42% and include peritonitis, suppuration of the surgical wound, pneumonia, and septic shock.

A correct understanding of the role of intestinal obstruction in the weakening of the antimicrobial defense of the body is impossible without knowledge of the basic provisions that characterize the participation of the gastrointestinal tract in this protection. Discussing common anti-infective mechanisms digestive system, R. Bishop (1985) identifies the following components:

1) acidic environment in the proximal gastrointestinal tract, which is detrimental to most microorganisms;

2) secretory activity of the small intestine with its protective and enveloping (mucus), antimicrobial (lysozyme) and proteolytic (digestive enzymes) actions;

3) the motor function of the intestine, which prevents the fixation of microorganisms on its walls;

4) immune mechanisms of the intestinal wall;

5) the normal state of the intestinal microbiological ecosystem.

Most of these factors are significantly affected in acute intestinal obstruction.

Microorganisms, contained in large quantities in the intestine, are in a state of constant interaction with each other and with the macroorganism. This interaction constitutes a special ecosystem, the violation of which drastically changes the living conditions of both the host organism and microorganisms. One of the important conditions for the stability of the ecosystem is the ratio of microorganisms in different parts of the intestine. Normally, the intra-intestinal habitat is inhabited by stable communities of autochthonous (non-alien) microorganisms, the species composition of which varies somewhat depending on the diet and age of a person, but is generally quite constant for certain parts of the gastrointestinal tract.

Allochthonous (alien) microorganisms, as a rule, are present in any habitat, but with a fairly stable composition of the autochthonous flora, they do not affect the structure of the ecosystem.

With the development of intestinal obstruction, the existing ecosystem is destroyed.

Firstly, due to a violation of the motor activity of the intestine, there is a "stagnation" of the contents, which contributes to the growth and reproduction of microorganisms.

Secondly, a violation of constant peristalsis leads to the migration of the microflora characteristic of the distal intestines to the proximal ones, for which this microflora is allochthonous.

Thirdly, the developing circulatory hypoxia of the intestinal wall creates conditions for rapid reproduction and development of anaerobic (mainly non-spore-forming) microflora in the intestine, which "colonizes" the sections of the intestine involved in the process.

The ecosystem is destroyed, microbes are freed from the action of factors that regulate their number, composition and localization. The consequence of this is the proliferation of microbes, the acquisition by a number of opportunistic microorganisms of pronounced pathogenic properties, the release of enterotoxins by microbes that aggressively affect the intestinal wall. Under the conditions of developing intestinal obstruction, the process of destruction of the ecosystem is greatly aggravated by the violation of the antimicrobial defense mechanisms inherent in the unchanged intestinal wall.

Circulatory hypoxia and the associated degeneration of the structural and functional elements of the mucous membrane and submucosa of the intestinal wall inevitably affects all manifestations of the secretory function, including mucus secretion, the release of bactericidal lysozyme by Paneth cells.

An essential role in antimicrobial protection belongs to intestinal proteolytic enzymes, the decrease in secretory activity of which in acute intestinal obstruction was mentioned in the corresponding section.

Finally, it is impossible not to pay attention to the "secretory" immune system of the intestine in intestinal obstruction. The structural basis of this system is represented by intestinal lymphoid elements, the function of which is ambiguous. B-lymphocytes of the intestine produce IgA, which blocks the adhesive antigenic complexes of microbes, promotes their phagocytosis by macrophages and leukocytes, and prevents the penetration of aggressive immune complexes through the mucosal barrier. This explains the damage to the anti-infective defense of the body, which is associated with the failure of the "secretory" intestinal immune system. And such a failure is quite obvious in conditions of hypoxic dystrophy of the structural and functional elements of the intestinal wall and, above all, the mucous membrane.

Freed from regulation by nonspecific and immune factors, allochthonous microorganisms manifest their aggressive function through the enterotoxic action of exo- and endotoxins. Exposure to exotoxins is preceded by the adherence of microbes to the mucosal surface. The exotoxin causes metabolic changes in the epithelial cells, disrupting the ratio between excretion and absorption of fluid. For exotoxins of a number of opportunistic microorganisms that acquire the possibility of intensive reproduction during stagnation (E. coli), a cytotoxic effect is characteristic, i.e., the ability to destroy membranes epithelial cells. Along with hypoxic destruction of the epithelium, this contributes to the invasion of microbes into the intestinal wall, as well as their penetration into the abdominal cavity and the development of diffuse or delimited peritonitis.

The penetration of microbes into the intestinal wall is accompanied by the death of many of them. In this case, endotoxin is released, which, depending on the type of microorganism, causes a complex and ambiguous pathological effect in terms of strength and nature. For endotoxins of the majority of non-spore-forming anaerobes that inhabit the distal intestines, this action is reduced to inhibition of intestinal motility, systemic microcirculation disorders, regulatory disorders of the central nervous system, and metabolic disorders.

Thus, a decrease in the effectiveness of the protective antimicrobial mechanisms of the intestine not only increases the risk of developing infectious complications, but also contributes to the deepening of local and general disorders characteristic of acute intestinal obstruction.

Pathogenetic mechanisms of impaired motor function of the intestine

Over the past 10 years, ideas about the mechanism of the motor function of the digestive tract have become much more complicated. It became clear that, in addition to the central neurotropic inhibitory and stimulating effect, which is carried out due to sympathetic and parasympathetic innervation, great importance belongs to the endocrine regulation of intestinal motility and, perhaps most importantly in the modern concept, both of these regulatory systems are, as it were, superimposed on the system of their own intestinal motor automatism. At the same time, the motor function of each section of the intestine is closely associated with its specific functional tasks in the digestive system, as well as with secretory-resorptive and protective anti-infective functions.

The order of inclusion of pathogenetic mechanisms that violate intestinal motility, with various forms intestinal obstruction is ambiguous, but all these mechanisms ultimately affect two main types of intestinal motor activity: the so-called "hungry" peristalsis, carried out during the interdigestive period, and the "digestive" peristalsis that accompanies the flow of contents into the gastrointestinal canal.

The first type of peristalsis is regulated by an autonomous myotropic mechanism, in which an important role is played by a pacemaker located in the duodenum and referred to in the literature as basic electrical rhythm (BER), "slow waves", generator potential (GP), pacemaker potential. In this peculiar form of intestinal motor activity, caused by the action of a pacemaker and called the "migrating myoelectric complex" (MMC), in contrast to cardiac automatism, not every impulse is realized, which creates an extremely complex unstable picture.

A purposeful study of MMC allowed the authors to distinguish 4 phases (periods) of the complex: the resting phase, the phase of tonic irregular contractions, the phase of frontal activity (successive propulsive contractions throughout the intestine) and the phase of gradual attenuation. The main one, reflecting the functional essence of the complex, is the phase of frontal activity. Each subsequent MCM occurs only after the decay of the previous one.

The second type of peristalsis, which is primarily characteristic of the small intestine, is "digestive" peristalsis, which is irregular segmental peristaltic contractions. Its occurrence is always accompanied by the termination of MMK. This type of peristalsis is regulated mainly by central neuroendocrine mechanisms, and not by the system of its own intestinal automatism.

With the development of intestinal obstruction, first of all, the ability to develop "digestive" peristalsis is reflexively suppressed, but the main changes in the motor function of the intestine are associated with a violation of the MMC. The appearance of a mechanical obstacle to the passage of intestinal contents interrupts the spread of MMC in the distal direction and thereby stimulates the emergence of a new complex.

Thus, peristaltic movements in the adductor loop are shortened in length and time, but occur more often. The central nervous system also takes part in this process. In this case, the excitation of the parasympathetic nervous system while maintaining the obstacle can lead to the occurrence of antiperistalsis. Then comes the inhibition of motor activity as a result of hypertonicity of the sympathetic nervous system.

A similar violation of the relationship between the sympathetic and parasympathetic links of the neurocrine regulation of peristalsis underlies a number of forms of primary dynamic obstruction, for example, persistent progressive postoperative intestinal paresis. At the same time, the function of the pacemaker is completely preserved, however, MMC induction either does not occur at all, or the ability to reproduce the third phase of the complex, the phase of frontal activity, is lost.

In the future, both with primary dynamic and mechanical obstruction, more persistent mechanisms are activated that cause the progression of paresis. The basis of these mechanisms is the increasing circulatory hypoxia of the intestinal wall, as a result of which the possibility of transmitting impulses through the intramural apparatus is gradually lost. Then, the muscle cells themselves are unable to perceive impulses to contract as a result of deep metabolic disorders and intracellular electrolyte disturbances. Metabolic disorders are aggravated by increasing endogenous intoxication, which in turn increases tissue hypoxia and closes this vicious circle. Finally, under conditions of already developed paresis, the structure of the intestinal microbiological ecosystem is destroyed, as a result of which individual allochthonous microorganisms that grow in the intestine (E. coli) penetrate the intestinal wall and die there, releasing endotoxins that contribute to the suppression of the contractility of the intestinal muscles.

Thus, in the pathogenesis of violations of the motor function of the intestine in acute obstruction, the following main pathogenetic mechanisms can be distinguished.

1. The occurrence of hypertonicity of the sympathetic nervous system, due to the appearance of a focus of excitation in the form of a pathological process in the abdominal cavity and a pain reaction to this process.

2. Hypoxic damage to the intramural conducting apparatus of the intestinal wall due to circulatory disorders, which prevents the autonomous and central regulation of intestinal motor activity.

3. Metabolic disorders in the muscular tissue of the intestinal wall, caused by circulatory hypoxia and increasing endogenous intoxication.

4. The inhibitory effect on the muscle activity of endotoxins of a number of microorganisms that, under conditions of obstruction, acquire the ability to invade the intestinal wall.

Diagnostics

Medical history and examination.

X-ray to locate the blockage.

Colonoscopy (use of a flexible, lighted tube to look at colon).

X-ray after a barium or hypac enema, which provides a clear image of the colon.

Treatment

Intestinal obstruction is a disease that requires immediate treatment from a specialist. Don't try to treat the blockage on your own with enemas or laxatives.

First, the doctor reduces the pressure in distended abdomen, removing liquid and gases with a flexible tube inserted through the nose or mouth.

In most cases, surgery is needed to remove the mechanical intestinal blockage. Preparation for surgery often takes six to eight hours to restore fluid and electrolyte balance to prevent dehydration and shock.

Bowel resection may be necessary. After removal of the blocked part of the bowel, the separated ends may be reattached, although an ileostomy or colostomy (surgery in which an opening is made in the abdomen so that the waste products of the bowels can be expelled into an external sac) may be required.

Features of anesthetic support for the treatment of intestinal obstruction

Complex multicomponent anesthetic management of surgical intervention for acute intestinal obstruction is a direct continuation of therapeutic measures initiated in the preparatory period, against which anesthesia itself is carried out.

draw Special attention during the initial period of anesthesia. Introductory anesthesia should be carried out as quickly as possible. Immediately before the administration of anesthetics (eg, barbiturates), 5 mg of tubocurarine chloride or another non-depolarizing relaxant is administered intravenously to eliminate regurgitation associated with muscle fibrillation and increased intragastric pressure, which are observed in the case of the use of depolarizing relaxants. For the same purpose, auxiliary ventilation at this stage is carried out with oxygen through the mask of the anesthesia machine only with obvious oppression of external respiration and extremely carefully, and after the introduction of depolarizing relaxants immediately before intubation, the authors recommend performing the Sellick maneuver. For this purpose, the esophagus is pressed by pressing the larynx against the spine. After tracheal intubation, the cuff on the tube is immediately inflated, then the probe is reintroduced into the stomach to empty the proximal gastrointestinal tract.

The choice of the main inhalation anesthetic is determined by the material support and experience of the anesthesiologist, however, in elderly debilitated patients with signs of cardiovascular or hepatic insufficiency, it is preferable to use halothane and avoid the use of ether.

Non-inhalation types of anesthesia are used extremely rarely for AIO, since the surgical aid requires wide access, good visibility, and sufficient relaxation of the muscles of the abdominal wall. Only in the event that in sharply weakened patients the operation is obviously palliative and is not accompanied by an extensive revision of the abdominal cavity, other types of anesthesia (local, intravenous) can be used. In the hands of an experienced anesthesiologist, in the presence of a highly qualified surgical team and with a short duration of the disease, epidural anesthesia or combined types of anesthesia are effective. In our clinic in recent years, out of 977 operations, inhalation endotracheal anesthesia was used in 754 patients (77.2%), local anesthesia- in 77 (7.9%), epidural - in 18 (1.8%), intravenous anesthesia - in 7 (0.7%) and combined anesthesia - in 121 patients (12.4%).

During the entire anesthesia and during recovery from anesthesia, the main parameters of life support are monitored based on clinical criteria or monitoring data.

Regurgitation of acidic gastric contents into the tracheobronchial tree is justifiably considered the most formidable complication of anesthesia. More often this happens when entering anesthesia, but it can also occur at the final stage, after disintubation of the trachea. In this case, if the contents of the stomach have a pH below 2.5, there is an acute widespread bronchospasm (Mendelssohn's syndrome).

If, despite all preventive measures, regurgitation has occurred, it is necessary to perform a thorough sanitation of the tracheobronchial tree by washing it with isotonic sodium chloride solution, 1 2% sodium bicarbonate solution. Additionally, eufillin is administered intravenously (5-10 ml of a 2.4% solution), glucocorticoids are used (up to 300 mg of hydrocortisone) and antihistamines(tavegil, suprastin) in standard doses.

Preoperative preparation for the treatment of intestinal obstruction

The volume and content of preoperative preparation in patients with AIO are determined primarily by the duration of hospitalization and the severity of general condition. In all cases, the training program is set by the anesthesiologist, surgeon and therapist. In this case, it is permissible to single out and consider two typical variants of the development of the disease. In the first variant, the rapid onset of the disease, severe pain and frequent vomiting make the patient seek medical attention. medical care in the early stages, and the consequence of such treatment is an early referral to hospitalization. In these patients, the duration of the disease is usually short, the effects of dehydration and endotoxicosis are not pronounced.

In the second variant, more typical for elderly and senile patients, clinical picture develops gradually, gradually, without a bright manifestation, which, however, does not indicate a lesser severity of the pathological process. Late treatment and late hospitalization, along with more pronounced pathomorphological consequences, lead to decompensation of important vital functions, metabolic disorders, dehydration and endotoxicosis. The most difficult situation arises at that stage of the process, when the developing peritonitis with its complex and formidable superimposes on the disorders caused by acute intestinal obstruction. pathogenetic mechanisms.

In the first case, the tasks of the anesthesiologist to participate in preoperative preparation are greatly simplified.

Measures to empty the gastrointestinal tract may be limited to a single insertion of a thick tube and gastric emptying. In the operating room, the probe is re-introduced to empty the stomach from the contents accumulated in it during the preparation period. After that, the probe is removed.

Also, the bladder is emptied immediately before the operation. If, against the background of a pronounced pain syndrome, there is a reflex urinary retention, the bladder is emptied with a catheter.

Conducting infusion therapy for 1.5-2 hours in this group of patients also does not cause any particular difficulties. The rate of infusion can be quite high, providing the introduction of up to 1-2 liters of liquid during this period. At the same time, to prevent transcapillary migration, G. A. Ryabov (1983) recommends administering 12–13 g of dry matter of albumin or 200 ml of plasma for each 1 liter of solutions. Before the operation, hygienic preparation of the skin in the area of the proposed intervention is also carried out.

In the second variant of the development of AIO, the tasks of preoperative preparation become much more complicated. This applies to all of its components. Emptying the gastrointestinal tract with a probe inserted into the stomach is carried out constantly. Also, the catheter is constantly kept in place during the entire preparatory period. bladder for the purpose of hourly (and sometimes minute) control of diuresis during infusion therapy.

Infusion therapy is designed to provide several tasks. First of all, this is the elimination of volemic disorders, the degree of which is determined by the indicators of the bcc and its components. The complexity of this task is associated with limited preparation time and, at the same time, with the need to be careful in increasing the rate of infusion (especially in elderly patients) against the background of cardiopulmonary decompensation. The main criteria for assessing the sufficiency of infusion therapy and its rate are CVP, hematocrit, pulse rate, hourly diuresis. Many authors recommend measuring CVP every 15-20 minutes or after the introduction of 400-500 ml of a solution. With a rapid increase in CVP up to 200 mm of water. Art. and above the rate of infusion must be reduced.

No less difficult is another task of infusion therapy - the elimination of tissue hypohydration. This task cannot be performed within the scope of preoperative preparation. Its implementation continues, during the anesthetic support of the operation, later in postoperative period. This often requires a very significant amount (up to 70-100 ml or more per 1 kg of the patient's body weight) and enough complex composition injected infusion media. However, more often the anesthesiologist has to use those media that are at his disposal, combining the introduction of solutions of electrolytes, glucose, polyglucin and low molecular weight dextrans.

Often, during preoperative preparation, it becomes necessary to regulate the rate of fluid administration, use cardiotonic, antiarrhythmic drugs, or use hormonal preparations(prednisolone, hydrocortisone) to stabilize hemodynamics at a level that allows the start of surgery.

In this regard, in the course of preoperative preparation, along with the determination of CVP and hourly diuresis, it is necessary to constantly monitor the heart rate, their rhythm, the level of systolic and diastolic blood pressure adequacy of external respiration. For a comprehensive assessment of these indicators, it is advisable to use monitoring observation.

Decompression of the upper digestive tract and rational infusion therapy are the means by which the patient's body is detoxified during preoperative preparation. Naturally, a complete solution to this problem can only be associated with adequate surgical intervention and the implementation of special measures to combat endotoxicosis in the postoperative period.

Preventive antibiotic therapy occupies a special place among the activities of the preoperative period. Its meaning in OKN is determined by the high risk of purulent postoperative complications. According to many authors, the frequency of infectious postoperative complications in intestinal obstruction ranges from 11 to 42%. This is due to a number of circumstances, the most important of which are dysbacteriosis and movement of microflora unusual for them into the proximal sections of the intestine, a decrease in secretory immunity and barrier function gastrointestinal tract, as well as general immunosuppression. It is quite obvious that against such a background, additional tissue trauma and mechanical destruction of biological barriers (peritoneum, intestinal wall), inevitable during the intervention, create additional prerequisites for the development of an infectious process. In this regard, the creation of the necessary therapeutic concentration of antibacterial drugs in the tissues by the time of surgery can be a useful and decisive factor in the postoperative course of the disease.

This question was specially studied in the clinic in relation to two antibiotics: kanamycin sulfate and cefazolin. The choice of antibiotics was determined by the breadth of their spectrum of action, high activity against most pathogens of infectious complications in acute diseases of the abdominal organs.

In an experimental and clinical study of the pharmacokinetics of these drugs in strangulation and obturation AIO, it was found that the peak of their concentration in the tissues of the abdominal organs and intraperitoneal exudate occurred by the end of the 1st hour after intramuscular injection, and the decrease in effective concentration occurred after 3-4 hours. This determined the method of preventive antibiotic therapy in patients with AIO. The use of this technique, since 1979, has reduced the incidence of severe postoperative infectious complications in all forms of acute intestinal obstruction from 19.3 to 13.2%.

It should be emphasized that the above program of preoperative preparation can only be regarded as indicative. The specific volume and content of therapeutic measures are determined individually depending on the form of AIO, the severity of the process, the age of the patients and the presence of concomitant diseases. However, with individual differences in the training program, its installation requirements must be observed, and the total period of the preoperative period with an established diagnosis and indications for surgery should not exceed 1.5–2 hours.

The results of surgical treatment of the intestine

According to the data, out of 978 patients with a confirmed diagnosis, small bowel obstruction was detected in 872. Of these, 856 were operated on. In 303 patients, bowel resection became necessary during the operation. In 13 patients, the resection was extensive (50–70% of the total length of the small intestine) and in 12 patients it was subtotal (70–80% of the total length of the small intestine).

Postoperative complications developed in 332 (40.1%) of the operated patients with small bowel obstruction. Of this group, in the vast majority of cases (52.6%), complications were represented by suppuration of the surgical wound. In 6.7% of patients there was a failure of the sutures of the interintestinal anastomosis after resection of the intestine in the conditions of developing peritonitis. In 10.7% of cases, the progression of the existing peritonitis without suture failure was noted, and in 4.7% - the development of late delimited intraperitoneal abscesses. In other cases, complications were due to concomitant diseases. of cardio-vascular system(16.2%) or the development of pneumonia in the postoperative period in debilitated patients. After operations for acute small bowel obstruction, 123 (14.37%) patients died. In 56.2% of them, the cause of death was infectious complications in the abdominal cavity. 33.7% - acute complications from the cardiovascular system. 8.3% had pneumonia and 1.8% had other complications.

In 30.8% of patients in this group, death occurred in the first 3 days after surgery, in 17.2% - on days 4-10, and in other cases - in a later period.

The analyzed group consisted only of those patients in whom the diagnosis of acute small bowel obstruction with the obligatory inclusion of the pathogenetic component of intraparietal hemocirculation disorders was not in doubt. Excluded from the analysis were patients with episodic intestinal obstruction, which proceeded as intestinal colic and was quickly eliminated by the use of simple therapeutic measures. Thus, if we focus on the true, held acute small bowel obstruction, then it remains an urgent problem of emergency abdominal surgery, the solution of which requires further intensive efforts of researchers and practical surgeons.

Prevention

Eat foods rich in dietary fiber.

Prostate Prostates (Greek) - standing in front. Our health is a state of delicate balance, which is provided by many body systems.

The first thing to pay attention to is the condition of the teeth. If the teeth react painfully to cold or hot,

Acute intestinal obstruction - pathological condition, which is characterized by a violation of the movement of incoming food through the human gastrointestinal tract. The causes of the disease can be dynamic, functional and mechanical. Blockage of the intestine is most often provoked by foreign bodies, neoplasms, spasms or hernias. But really causal factors quite a lot and the pathogenesis of acute intestinal obstruction is complex.

To date medical statistics is such that it is diagnosed in nine percent of the total number of patients admitted to a medical institution with acute surgical pathology organs located in the abdominal cavity. Most often, the disease is detected in people from the older and middle age categories (from 25 to 50 years). But it is possible that the symptoms of acute intestinal obstruction will also appear in children. They are more often diagnosed with mechanical obstruction due to the overlap of the intestinal lumen with a foreign body that the baby could swallow, or intussusception. In general, representatives of the strong half of humanity are more likely to suffer from pathology. According to ICD-10 (International Classification of Diseases), acute intestinal obstruction has its own code - K56.6.

Acute intestinal obstruction refers to emergency conditions, so it is important to diagnose it as soon as possible and immediately provide assistance to the victim. It is worth noting that conservative methods of effect do not bring, therefore, the disease can be treated only with the help of surgery. Otherwise, there is a great risk not only of developing serious complications but also fatal.

Classification

The classification of acute intestinal obstruction is based on the causes that provoke its occurrence, as well as on pathogenesis. Depending on this, pathology is divided into two large groups:

dynamic acute intestinal obstruction. It is divided into several subgroups depending on what causes provoked blockage of the intestine. Most often, this type of obstruction develops as a result of a violation of the functioning of other organs in the human body. For example, it often happens that the clinic of acute intestinal obstruction manifests itself after an operable intervention, as a reflex reaction of the body to damage to the spinal cord or brain, etc. It should be noted that older people are more susceptible to this type of disease;
mechanical acute intestinal obstruction. It is divided into two types - obstructive obstruction and strangulation. The pathogenesis of acute intestinal obstruction of the first type is manifested due to the overlap of the intestinal lumen with foreign bodies, fecal stones, accumulation of worms, gallstones. The strangulation form is characterized by wrapping and infringement of the intestine, which causes a violation of microcirculation in it and the development of foci of necrosis.

Reasons for development

The clinic of acute intestinal obstruction develops most often due to the following reasons:

the formation in the lumen of the intestine of a neoplasm of a benign or malignant nature. In this case, acute intestinal obstruction treatment involves surgery, but the plan may also include radiation therapy and chemotherapy;
infringement of a hernia;
volvulus of the intestines or the formation of nodes;
overlapping of the intestinal lumen with adhesions that were formed as a result of previous surgical intervention on the abdominal organs;
intussusception of the intestinal walls. This pathological condition is characterized by the fact that a certain section of one intestine is drawn into another;
overlapping of the intestinal lumen with fecal and gallstones, foreign objects, or an accumulation of worms.

As mentioned above, the dynamic form of obstruction often develops as a result of previously performed operable intervention, peritonitis, and poisoning of the body.

Several other etiological factors can contribute to the progression of the disease:

anatomically elongated sigmoid colon;
open or closed injury of the abdominal cavity;
diverticular disease of the large intestine;
formation of a hernia of the anterior abdominal wall;
flow in the organs localized in the abdominal cavity, inflammatory processes.

Clinical picture

The clinic of the acute form of obstruction manifests itself very clearly - a gradual increase in the intensity of symptoms for the disease is not typical. The disease is expressed by symptoms of intestinal dysfunction:

nausea and vomiting;
intense pain syndrome;
flatulence and increased peristalsis (the intestine tries to push through the barrier itself, which blocks its lumen);
impaired excretion of feces and gases. The person usually has constipation.

The pain syndrome in acute intestinal obstruction is very intense. The pain is localized in the navel, but does not radiate. It has a gripping nature. At the time of the attack, the person takes a forced position, which allows him to slightly reduce the manifestation of pain. The patient may show signs of shock during this period - an increase in heart rate, pallor skin, allocation of cold and sticky sweat, etc. Already when this symptom is expressed, it is required to deliver the patient to the doctor and conduct a diagnosis, which will make it possible to determine the true cause of the condition.

The second symptom is vomiting. By its nature, the doctor can even tell at what level the intestinal lumen was blocked. For example, if vomiting is plentiful and particles of food that a person consumed the day before are visible in it, then in this case the small intestine is affected. But it also happens that vomit with food particles is first released, then they turn yellow due to the admixture of bile, and then dark green - fecal vomiting. This indicates damage to the large intestine.

Violation of the allocation of feces and gases. At first, this process may not be disturbed, since the lower sections of the intestine are emptied reflexively. But after that, persistent constipation and bloating are formed. Visual examination reveals that the patient's abdomen is enlarged, but asymmetrically. In addition, it can be noted enhanced peristalsis.

When expressing such signs, one cannot hesitate - it is required to deliver the patient to a medical institution to a surgeon who can carry out a full diagnosis and treatment of acute intestinal obstruction.

Diagnostic measures

Qualified doctor to identify the presence of intestinal obstruction in acute form won't be difficult. It is possible to assume such a diagnosis already during the initial survey and examination of the patient. It is important for the doctor to clarify exactly when the symptoms first appeared, how intense they are, and whether an operable intervention on the abdominal cavity was previously performed. Next, a physical examination is performed. Due to the severe pain syndrome, it is not always possible to carry out a full palpation of the abdomen.

The standard diagnostic plan for suspected intestinal obstruction includes the following tests and examinations:

general clinical blood and urine analysis;
blood biochemistry;
plain radiography of the abdominal cavity. It can be performed with or without a contrast agent. If the doctor has a suspicion of a possible perforation of the intestine, then in this case the standard barium mixture is replaced with a water-soluble contrast agent;
ultrasound examination of the abdominal organs;
CT scan;
sigmoidoscopy or colonoscopy (if the patient is a child, then this kind of diagnostic intervention is performed under general anesthesia).

Based on the results obtained, a diagnosis is made, and the doctor selects the most effective way to eliminate the obstruction.

Treatment

Treatment of acute intestinal obstruction is carried out in three stages. At the first, it is important to normalize the patient's condition and replenish the water balance in his body. For this purpose, isotonic solutions are administered intravenously. During this period, additional medicines especially antibiotics.

The second stage is the evacuation of the contents from the digestive tract. It is important to completely cleanse the intestines from the contents accumulated in it. For this purpose, a special nasogastric tube is used.

The third stage is surgery. It is performed under general anesthesia. A laparotomy is used. The surgeon, after opening the anterior abdominal wall, eliminates the intussusception, if any, as well as the immediate cause of the obstruction - the adhesions are dissected, removed benign neoplasms, a foreign object is removed. If there are foci with necrotic tissues, then their resection is mandatory.

After the operation for several weeks, there is a possibility of postoperative complications. During this period, the patient is prescribed certain drugs to stabilize his condition. In addition, it is very important to follow the diet prescribed by your doctor. For several days after the intervention, parenteral feeding may be required. Gradually, the person will be transferred to a normal diet. It is worth noting that the diet will need to be observed not only in the postoperative period, but also for some time after it. From the diet are completely excluded:

alcoholic drinks;
carbonated drinks;
coffee and strong tea;
spicy, salty and fatty foods;
spices;
marinades and pickles;
mushrooms;
rich pastries, sweets;
fatty meat and fish, etc.

Instead, include in your diet:

dietary meat and fish, steamed, in the oven or boiled;
baked fruits and vegetables;
decoctions and compotes;
soups with vegetable broth;
low-fat dairy products and more.

The exact diet that the patient will need to follow should be prescribed by his attending physician. He will also tell you how long you need to keep it. A person who has been operated on for intestinal obstruction will need to be observed periodically (twice a year) by a gastroenterologist.