Intestinal Obstruction: Treatment and Complications

During bowel obstruction, complications can occur, some of which can be life-threatening. Therefore, an obstructed bowel must always be treated immediately. As a first measure, the patient is supplied with fluid via a drip. If it is not possible to open the blocked intestine with the help of medication or enemas during further treatment, surgery must be performed. What the surgery looks like depends on the cause of the bowel obstruction.

Complications of intestinal obstruction

The following complications may occur with bowel obstruction:

  • Volume deficiency: any ileus deprives the patient of fluid because the secretions released into the intestinal lumen (gastric juice, bile, pancreatic and small intestinal secretions) are not reabsorbed. This is compounded by losses due to vomiting. The result is a lack of volume (dehydration), which can lead to blood thickening, decreased urine production and shock.
  • Secondary intestinal paralysis: In mechanical ileus, there is initially peristalsis beyond normal. As the intestinal muscles become fatigued, the initially increased peristalsis decreases in intensity to fail completely after hours or days.
  • Transmigratory peritonitis: if ileus persists for a long time, bacterial decomposition (autolysis) of the stagnated intestinal contents occurs, making the intestinal wall permeable to toxins and bacteria. Toxin leaching into the circulation and peritonitis occur, drastically worsening the prognosis.

First aid for intestinal obstruction

Sudden onset, dull or cramping violent abdominal pain, altered stool behavior, nausea and vomiting can indicate an intestinal obstruction, so that the family doctor or emergency medical service should be notified immediately. Abdominal pain that occurs after eating should also be clarified, as it may be due to reduced blood flow in the abdominal arteries, especially in older people.

If the family doctor or emergency physician is called and diagnoses ileus, he or she will perform the following emergency measures: A gastric tube can be used to aspirate stagnant secretions from the stomach and small intestine with a large-volume syringe. This relieves some of the massive pressure that has built up due to the obstruction. Fecal contents of the small intestine can be recognized by their brown color and fecal odor. An IV is started as soon as possible.

Family physicians or emergency physicians will arrange for immediate hospitalization.

Intestinal obstruction: rapid therapy needed

Intestinal obstruction must treat cases surgically as soon as possible, otherwise the clinical picture will lead to death. Mechanical ileus is an absolute indication for immediate surgery.

The surgical procedure depends on the cause of the ileus:

  • In the most favorable case, only adhesions are loosened (adhesiolysis or bride solution).
  • In strangulated ileus, partial bowel removal is usually required.
  • If the narrowing can not be removed surgically, for example, because a tumor that can not be operated on is the cause of the closure, a bypass operation (bypass operation, the narrowing is bypassed by another section of intestine) or the discharge of the intestine as an artificial intestinal outlet (stoma) comes into question.

During the surgical procedure, an antibiotic is given to prevent the spread of intestinal bacteria into the abdominal cavity. If there is only a preliminary stage of paralytic bowel obstruction, an attempt can be made to start the movement of the intestine with medication.

Treatment of the underlying disease important

If peritonitis is responsible for the paralytic bowel obstruction, the underlying disease must be treated. For example, in the case of a perforated gastric or small bowel ulcer, the hernia site must be sutured or surgically excised if possible.