Symptoms of intestinal obstruction
Acute intestinal obstruction (ileus) initially manifests itself as an “acute abdomen” with the unspecific symptoms of rapidly onset of severe abdominal pain, an abdominal wall that is hard as a board and sometimes bloated, nausea and vomiting, possibly also fever and circulatory shock. High intestinal obstructions in the area of the upper intestine can also lead to vomiting of bile. Due to the delayed transport of food, the vomit may be accompanied by digested food from deeper sections of the intestine.
Stool and wind evacuation come to a standstill, which may have already begun in the few days before the main symptoms appear and should be checked in retrospect. In addition, altered bowel sounds become apparent when listening with a stethoscope: The mechanical ileus (intestinal obstruction) produces a sound similar to a jet of water through its bottleneck, which is often described as water dripping onto a tin roof. The paralytic ileus is characterized by the fact that nothing, not even the usual bowel sounds, can be heard.
If the intestinal obstruction is not treated quickly enough, the collapse of the intestinal barrier or the rupture of the inflamed intestine can lead to colonisation of the abdominal cavity with intestinal germs (peritonitis), which causes septic shock and is fatal with subsequent multi-organ failure. A gradual onset with a preceding, incomplete ileus (subileus) is also possible. In most cases, intestinal obstruction is not manifested by the occurrence of diarrhoea.
In most cases, the slow closure of the intestinal tube results in a decrease in stool frequency which finally leads to constipation. However, if bloody diarrhoea occurs with the corresponding symptoms of an intestinal obstruction, a specialist should be consulted immediately. This phenomenon is a potentially life-threatening emergency situation.
Depending on the underlying disease, the intestinal obstruction must be treated surgically. This is particularly the case if peritonitis develops or there is a risk of the intestinal wall breaking through. Depending on the extent of the intestinal obstruction, the affected intestinal parts must be completely removed during the surgical procedure.
However, this therapeutic measure can impair the passage of the food and the absorption of certain food components. In addition, depending on the length of the removed intestinal parts, the reabsorption of water from the intestinal lumen may be restricted in the long term. For this reason, the affected patients suffer from recurrent diarrhoea after the operation (sometimes for life).
Strict regulation of the daily fluid intake can help to reduce the risk of diarrhoea. Especially partial resections of the colon cause diarrhoea in many of the affected patients in the long term, which is very difficult to treat. Pain in the abdomen is typical for an intestinal obstruction and almost always occurs.
Nevertheless, a slowly developing intestinal obstruction that does not cause pain cannot be ruled out. Particularly in old or seriously ill, bedridden patients, intestinal obstruction can occur insidiously without pain being expressed. However, at least other symptoms then occur, such as vomiting, lack of bowel movement and a significant increase in the circumference of the abdomen.
