Intestinal Obstruction

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Intestinal Obstruction

 

(also called ileus), interference with the passage of the intestinal contents. A distinction is made between acute (ileus) and chronic intestinal obstruction and, according to the form of the obstruction, between mechanical and dynamic, or hyperdynamic, ileus; each of these may be partial or complete.

Mechanical ileus is caused by a variety of hindrances inside or outside the intestine that constrict the intestinal lumen (occlusive, or obturation, ileus owing to tumor, ascariasis, or other causes); it is also caused by disturbances of the innervation of the intestine that result in volvulus, intussusception, or nodulation (strangulated intestinal obstruction). If obturation of the intestine is incomplete, symptoms appear and disappear from time to time, and the intensification of peristalsis leads to hypertrophy of the intestinal wall over the obstruction. If obturation is complete, gases distend the intestinal loops above the site of obstruction while the loops below remain collapsed. Engorgement of the intestine causes reversed peristalsis, which helps discharge the contents through the stomach (by vomiting). Changes in the intestinal wall eventually cause infected fluid to transude from the intestinal lumen into the abdominal cavity and give rise to peritonitis.

The symptoms of mechanical ileus are recurrent crampy pains in the abdomen, distention of the intestine, constipation and flatulence (there may be stools at the beginning of an attack), vomiting, tensing of the abdominal wall, and, in peritonitis, irritation of the peritoneum. In partial intestinal obstruction, the above symptoms abate after an enema (cleansing, hypertonic, or siphon enemas), but they soon recur. A rapid intensification of the symptoms and intestinal intoxication are characteristic of mechanical ileus. Death may result from peritonitis or acute metabolic disorders. Mechanical ileus is treated by surgical means.

Dynamic, or hyperdynamic, ileus is based on neurovascular disturbances (spasm, aftereffects of surgery). Spastic ileus results from functional disorders, sometimes toxic influences. It is characterized by total intestinal spasm, usually transient but sometimes protracted, which interferes with the blood supply of the intestinal wall, causing necrosis and severe systemic disorders. Paralytic, or adynamic, ileus is always secondary and often complicated by peritonitis. Symptoms include acute pain in spastic ileus, and slowly increasing pain, absence of peristalsis, and, later, clapotement in paralytic ileus. The symptoms of intoxication intensify as the disturbance progresses.

Correct diagnosis of the form of intestinal obstruction is of decisive importance in treatment. The treatment of dynamic ileus is mostly conservative: in the spastic form, subcutaneous injections of atropine and paranephric Novocain block; in the paralytic form, intubation of the stomach for constant aspiration of accumulations and administration of ganglionic-blocking agents. It is sometimes necessary to resort to surgery, using various methods of relieving the intestine (gastrostomy, ileostomy, cecostomy).

REFERENCE

Komarov, F. I. , V. A. Lisovskii, and V. G. Borisov. Ostryi zhivot i zheludochno-kishechnye krovotecheniia vpraktike terapevta i khirurga. Leningrad, 1971. (Contains a bibliography.)

K. S. SIMONIAN

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