Diagnosis
The suspicion of an intestinal obstruction is initially based on the main symptoms mentioned above. In order to further differentiate between possible other diseases with a similar appearance, the abdominal cavity is first listened to (auscultation). A blood sample generally clarifies an inflammatory reaction of the body or some possible causes and other consequences (hypokalemia, uremia, hyonatremia).
Ultrasound can be used to make an initial diagnosis of the cause of the disease by observing the occlusion itself and its cause, or typical movement phenomena of the intestine and its filling state, while an X-ray of the abdomen can provide the phenomenon of fluid levels, which is typical of the ileus situation. Ultimately, computed tomography offers the possibility of spatially imaging the intestine and visualizing the occlusion, while many of the above mentioned methods lead to a suspected diagnosis of intestinal obstruction through the combination of symptoms and the associated, lower-technique examination procedures, which, however, due to its explosiveness, also leads to the indication for surgery. This topic might also be of interest to you: Inflammation levels in the blood
Therapy
Among the therapeutic options, surgery is the most important, which is usually performed quickly due to the potential life-threatening nature of the clinical picture, especially if there is an expected risk of rupture of the intestinal wall or an already existing peritonitis. During the operation, invaginations of the intestine, adhesions or any tumours that were responsible for the ileus are removed. It may be necessary to open the bowel and remove the stagnant stool or already undersupplied and dying intestinal sections.
In the latter, severe case, it may be necessary to create an artificial bowel outlet for a period of a few months until the two interrupted bowel ends are joined. If an infection of the abdominal cavity (peritonitis) has already occurred, the abdominal cavity is rinsed with antibiotics, which may become necessary again a few days later. To avoid subsequent blood poisoning (sepsis), antibiotics are also administered intravenously during and after the operation.
Further treatment measures include the application of a stomach tube to relieve the ileus situation and to prevent the patient from vomiting. Infusions can be given to compensate for electrolyte and water imbalances and medication can be administered to normalise intestinal activity or to combat nausea and pain. Depending on the cause, the intestinal obstruction must be treated surgically.
This procedure is performed under general anaesthesia. Basically, only the mechanical intestinal obstruction is usually operated on, so that normal intestinal passage can be restored early (emergency!). Paralytic intestinal obstruction is usually first treated with drugs that are intended to stimulate the natural movement of the intestine again.
An incomplete intestinal obstruction (subileus) does not usually require surgery. When operating on mechanical intestinal obstruction (so-called intestinal decompression), the exact cause is first determined. If there are adhesions in the abdominal cavity, these are removed.
If the intestine has merely twisted or otherwise become trapped, it is brought back into the correct position. If the intestinal obstruction is caused by hardened intestinal contents, it may be necessary to cut open the intestine and aspirate the corresponding contents. In some cases, however, there is also a narrowing in a certain section of the intestine which cannot be resolved by simply moving the intestine or by suction, for example in the case of tumour infestation.
In this case, this part must be cut out. The two free ends of the intestine are then sewn together again after the diseased part has been removed, so that digestion can take place normally again. When removing parts of the intestine, it may be necessary to temporarily create an artificial intestinal outlet, which can usually be moved back again after a few months.
To prevent infections during the procedure, an antibiotic is given. Since some people suffer from multiple intestinal obstructions, this can be prevented by overstitching the suspension of the intestinal loops in the abdomen (so-called Childs-Philipps-operation). In this operation the intestinal loops are pulled together like an accordion.
The risk is that large vessels in the surrounding area are injured. This method does not always prevent a further intestinal obstruction; in 20% of cases another one occurs. Another preventive measure to prevent further intestinal obstruction is the insertion of a small intestinal probe after the operation.
This so-called Dennis probe fixes the small intestine in its correct position for about one week. This prevents the bowel from kinking and, in its optimal position, it can grow together with the abdominal wall and its surroundings. The risk of suffering another intestinal obstruction after this procedure is about 10%.
Since intestinal obstruction can have very different causes, requires a different extent of surgery and can take either a favourable or a complicated course of healing, it is not possible to make a general statement about how long one has to stay in hospital after an operation. However, one week is usually the minimum time that one must spend in hospital. In some cases, a stay in intensive care unit is necessary after a complex operation, so that one has to stay in hospital for several weeks. Likewise, complications such as a wound healing disorder can occur after an operation, which can then also extend the length of stay in hospital.
