Intestinal obstruction (ileus)

An acute intestinal obstruction (ileus) is an emergency, as it can be immediately life-threatening. A distinction is made between paralytic and mechanical ileus. Paralytic ileus is caused by a failure of the nervous system that controls the movement of the bowel.

This leads to paralysis of the affected intestinal segment and the passage of stool is interrupted. In mechanical ileus, the intestinal lumen is displaced by a foreign body, large amounts of stool or an intussusception (invagination of one section of the intestine into another). As a result, the intestinal passage can no longer be maintained.

This leads to severe, cramp-like abdominal pain, as the intestine contracts strongly immediately before the narrowing to push the obstacle away. In addition, nausea, vomiting (also vomiting of faeces), a bloated abdomen and stool retention frequently occur. Finally, an ileus can lead to multiorgan failure, which is why it must be treated as an emergency.The appendicitis, as it is called in the vernacular, is typically accompanied by stabbing, right-sided lower abdominal pain.

Actually, it is not the appendix itself (caecum) that is inflamed, but only its appendage, the appendix. Typically, the pain begins in the upper abdomen and migrates over time to the right lower abdomen. Fever, nausea and vomiting may also occur.

The diagnosis can be made by means of an ultrasound examination, among other things. However, the inflammation is not always clearly visible. During the clinical examination various tests can support the diagnosis of appendicitis.

For example, there are two points in the right lower abdomen (McBurney’s and Lanz’s point), which can be very painful when pressure is applied. The contralateral release pain (Blumberg’s sign) can also be positive in appendicitis. To do this, the doctor presses in the left lower abdomen and then suddenly lets go, causing pain in the right lower abdomen in appendicitis.

Furthermore, the large intestine can be spread out from end to end, which can also cause pain (Rovsing sign). The flexion and internal rotation of the right leg, as well as lifting the right leg against resistance can be painful (obturatorius and psoas test). In acute appendicitis, the appendix must be surgically removed early on. Otherwise, the appendix may break through (perforate) with emptying of intestinal contents into the free abdominal cavity, resulting in inflammation of the peritoneum (peritonitis) and possibly blood poisoning (sepsis). The operation is now a routine procedure and is generally considered to be low-risk.