Intestinal obstruction, or ileus, is a life-threatening acute bowel condition. It involves obstruction of the large intestine or small intestine so that digested food cannot be transported further. In most cases, functional or meschanic disorders are the cause. Typical signs of obstruction are severe abdominal pain and vomiting. In addition, the affected person is unable to empty his stool.
What is intestinal obstruction (ileus)?
Intestinal obstruction, or ileus, is a life-threatening condition in which the natural function of the large intestine or small intestine is completely interrupted in at least one passage. The intestine has the function of passing the food pulp through the body, extracting valuable nutrients from the food and adding them to the organism. The rest is excreted as feces in a healthy system. Due to an interrupted intestinal passage in an intestinal obstruction, both the food pulp that is not passed on and the masses of digestive juices collect in the intestinal loops and cause extreme pain. The trapped water cannot be released back into the body during an intestinal obstruction.
Causes
Intestinal obstruction is divided into two categories. There is mechanical intestinal obstruction and paralytic intestinal obstruction. In paralytic bowel obstruction, intestinal activity becomes paralyzed. In most cases, this happens because there is a previous inflammation in the abdomen. A common cause of this is peritonitis. Other causes of paralytic intestinal obstruction are poisoning with paralyzing effects on the organism and circulatory disorders that cause a section of the intestine to stop working. Mechanical intestinal obstruction can be caused by obstructions in the digestive tract. These obstructions can be of many origins, from fecal debris, to gallstones, to obstruction caused by tumors, or as a result of Crohn’s disease. One of the most common causes of mechanical bowel obstruction is adhesions in the abdomen. Healed, severe inflammation, as well as internal surgical scars, can lead to excess strands that wrap around the intestinal loops, causing them to kink or constrict, blocking the flow of the digestive system and causing bowel obstruction.
Symptoms, complaints, and signs
The symptomatology of ileus depends critically on the type of bowel obstruction and its location. The leading symptom of mechanical ileus is colicky, or cramping, abdominal pain. The intestinal musculature tries to overcome the obstruction in the intestine with increased activity. As an expression of the increased activity, increased bowel sounds can be detected with the stethoscope. The situation is different in paralytic ileus. Since intestinal activity is absent in this case, the usual bowel sounds are often completely absent and the pain symptoms are less pronounced. In both cases, however, there is subsequent retention of stool and wind. The abdomen appears distended (meteorism). Other symptoms, especially of mechanical ileus, are nausea and vomiting. The higher the obstruction in the intestine, the earlier and more violent the onset of vomiting. Overall, paralytic ileus shows similar symptoms to mechanical ileus, but they are less dramatic in their severity. Frequently, paralytic ileus is accompanied by hiccups. Initially, the pain of intestinal obstruction can usually be well localized. In the course, the spread of bacteria in the abdominal cavity leads to an inflammation of the peritoneum. This is manifested by a board-hard stretched abdominal wall and diffuse pain in the entire abdominal area.
Course
The typical course of disease in intestinal obstruction begins with vomiting severe abdominal pain and absence of bowel movements. In mechanical intestinal obstruction, bowel movement may lead to antecedent hyperactivity in which the loops around the actual intestinal obstruction work harder. In paralytic bowel obstruction, on the other hand, no bowel sounds are heard during the typical course. As it progresses, the bowel fills with gas and the abdomen becomes hard and tense, and pain increases significantly. The non-excreted food pulp can pass through the intestinal walls into the abdominal cavity and the bacteria can lead to peritonitis as well as to poisoning of the body by the escaping bacteria.
Complications
Intestinal obstruction is associated with various complications. First, there is a risk that the bowel or peritoneum may rupture and pathogens may enter the intestines. This can result in fistulas, abscesses, and inflammation, leading acutely to nausea and vomiting. Later, there is a risk of chronic pain and wound healing problems may occur. When secretions (gastric juice, bile) can no longer be absorbed, dehydration occurs. Decreased urine production, shock, and blood thickening result. Mechanical intestinal obstruction can lead to fatigue of the intestinal muscles and consequent cessation of intestinal function. If left untreated, this leads to severe symptoms of poisoning and eventually multiple organ failure and circulatory shock. In less severe cases, bacterial decomposition of the intestinal contents occurs. As a result, the intestinal wall is weakened and less resistant to toxins and bacteria. The increased pressure on the intestinal wall may result in an undersupply of the intestine. As a result, peritonitis may occur and parts of the intestine may die. Frequently, adhesions of intestinal loops and other abdominal organs also occur. As a result, further intestinal obstruction may occur.
When should you see a doctor?
A persistent feeling of pressure or fullness in the abdomen that lasts for several days should be examined and clarified by a doctor. If there is no bowel movement for a prolonged period of time despite adequate intake of fluids or consumption of foods that promote evacuation, there is cause for concern. A doctor must be consulted to rule out other illnesses. Bloating, pain in the abdomen or stomach, and vomiting of feces are unusual and need to be evaluated by a physician. If the symptoms persist or increase in intensity, a visit to the doctor is urgently needed. Because an intestinal obstruction is a medical emergency, an emergency physician must be called immediately if there is severe pain, cramping or bleeding. If there are unusual sounds in the stomach or intestines, they should be checked by a medical professional. If the circulation fails, the available energy in the body dwindles and the usual performance level drops, a doctor should be consulted. If sleep disturbances occur, everyday tasks can no longer be performed or the body temperature rises, this is considered a cause for concern. A doctor should be consulted as soon as the malaise lasts for several days or increases continuously. If there are problems with locomotion due to existing symptoms, a comprehensive medical examination is needed.
Treatment and therapy
In the case of intestinal obstruction, hospitalization is inevitable. The first method of treatment is to ensure that the bowel is relieved. A gastric tube is placed through the nose to drain the food pulp and excess gastric acid to the outside. Addition of food must be stopped immediately, but intravenous addition of fluids and electrolytes must be given. In most cases, intestinal obstruction requires surgical treatment. In the case of intestinal obstruction in the large intestine and especially in the case of mechanical clamping of an area, immediate emergency surgery of intestinal obstruction must be performed, as it is an acute life-threatening situation. Surgical intervention for intestinal obstruction is performed via laparotomy, a large abdominal incision. In mechanical bowel obstruction, the individual loops are controlled and strands are removed. In the case of a paralytic bowel obstruction caused by inflammation, part of the bowel may need to be removed if it could not resume its function after the bowel obstruction.
Outlook and prognosis
Intestinal obstruction (ileus) is a life-threatening condition that leads to death without immediate treatment. However, the prognosis also depends on how large the affected section of intestine is, what form of ileus is present, and when treatment was started. Overall, about 25 percent of patients suffering from intestinal obstruction die. However, with successful treatment, the consequences of intestinal obstruction usually heal completely. However, survival or healing without consequences cannot always be guaranteed despite immediate emergency treatment. If the food pulp in the intestine can no longer be transported further, there is a dangerous increase in pressure on the intestinal wall.This increase in pressure causes injuries in the mucosa, which can eventually lead to necrosis (death) of entire areas of the intestine. If parts of the intestinal mucosa die, the intestine may rupture. The digested food pulp interspersed with bacteria then migrates into the abdominal cavity. As a result, a life-threatening peritonitis develops. On the one hand, this leads to a dangerous loss of fluids and electrolytes and, on the other hand, to a flooding of the abdominal cavity with bacteria and their toxins. The loss of fluid can lead to dangerous circulatory shock, which is triggered by a rapid drop in blood pressure. Furthermore, bacterial toxins can enter the blood and cause septic shock. Without treatment, this development quickly leads to death due to multiorgan failure.
Follow-up
After acute therapy (surgery) for intestinal obstruction has been performed, it is essential to pay attention to nutrition during follow-up care. The patient first receives infusions immediately after surgery to slowly regulate his or her fluid, nutrient, and energy needs. Then, slowly and gently, a reconstruction of the normal diet is started with pasty food, low-fiber and easily digestible food. It is helpful if normal foods are initially pureed. Furthermore, the following behaviors should be considered after an intestinal obstruction, such as eating slowly and chewing thoroughly. Preference should be given to several small meals per day (five to six), whereas flatulent foods (lentils, beans, cabbage) should be avoided. This also applies to avoiding nuts, fibrous fruits (pineapples, oranges, mangoes). Vegetables and fruits should be peeled before eating. A food diary helps to find out which foods are particularly well or particularly poorly tolerated. After some time, when the intestinal system has recovered, it is possible to start trying foods that are more difficult to digest. A balanced and controlled diet is the best aftercare and also prevention for intestinal obstruction. Attention should be paid to regular bowel movements. Once the bowel has recovered, high-fiber foods help the digestive system keep going. Likewise, always ensure adequate fluid intake – at least 1.5 liters daily, water, tea (unsweetened); if the diet is very high in fiber, the amount of fluid should be increased even more.
What you can do yourself
Intestinal obstruction is basically a medical emergency that can be fatal in the worst case. Once an intestinal obstruction has occurred, the affected person needs intensive medical intervention as quickly as possible so that defecation can function again and, in the worst case, perforation does not occur. In this respect, self-help in everyday life is unfortunately absolutely not possible in the case of an intestinal obstruction. If complaints such as severe abdominal pain, a feeling of pressure and at the same time no longer digestion or only small amounts of mucus-fermented stool are strong, one should not try to cure oneself with home remedies. Waiting or conventional laxatives are useless in case of intestinal obstruction. The intestinal passage is blocked and may need to be treated surgically. Stalling for time or eating high-fiber foods may rather aggravate the situation. In this respect, the only thing left to do in the area of self-help when it comes to intestinal obstruction is, on the one hand, to make sure at an early stage that digestion remains in a state of flux. On the other hand, a doctor should be consulted immediately in the event of symptoms that make intestinal obstruction appear possible. If symptoms such as vomiting occur, an emergency physician should be alerted immediately.
