Intestinal obstruction (ileus)
What is an intestinal obstruction (ileus)?The symptoms of an ileus depend crucially on the type of intestinal obstruction and on its localization. The key symptom of mechanical ileus is colicky, spasmodic, abdominal pain.
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An intestinal obstruction or ileus is a life-threatening condition in which the natural function of the large intestine or the small intestine is completely interrupted in at least one passage.
The intestine has the function of guiding the porridge through the body, while depriving the food of valuable nutrients and inflicting it on the organism. The remainder is excreted as feces in a healthy system.
Through an interrupted intestinal passage in an intestinal obstruction, both the unspecified diet porridge and the masses of digestive juices accumulate in the intestinal loops and cause extreme pain. The trapped water can not be returned to the body in a bowel obstruction.
The intestinal obstruction is divided into two categories. There is a mechanical intestinal obstruction and paralytic intestinal obstruction. Paralytic bowel obstruction paralyzes intestinal activity. In most cases this happens because there is a previous inflammation in the abdomen. A common cause of this is an inflammation of the stomach.
Other causes of paralytic bowel obstruction include poisoning with debilitating effects on the organism and circulatory disturbances that arrest a section of the intestine. A mechanical intestinal obstruction can be caused by obstacles in the digestive tract. These obstacles can be of many origins, from faeces remnants, gallstones, to tumor stenosis, or as a result of Crohn's disease.
One of the most common causes of a mechanical bowel obstruction are adhesions in the abdomen. Healed, severe inflammation and internal surgical scars can lead to excess strands that wrap around the intestinal loops, kinking or pinching them, blocking the flow of the digestive system, causing the intestinal obstruction to develop.
Symptoms, complaints & signs
The symptoms of an ileus depend crucially on the type of intestinal obstruction and on its localization. The key symptom of mechanical ileus is colicky, spasmodic, abdominal pain. The intestinal musculature tries to overcome the obstacle in the intestine with an increased activity. As an expression of the increased activity, increased intestinal sounds can be detected with the stethoscope.
It is different with paralytic ileus. Since the intestinal activity has failed here, the usual bowel sounds are often completely absent and the pain symptoms are less pronounced. In both cases, however, the result is stool and wind behavior. The stomach is bloated (meteorism).
Other symptoms, especially mechanical ileus, are nausea and vomiting. The higher the occlusion in the intestine, the sooner and more violently the vomiting begins. The paralytic ileus shows similar symptoms as the mechanical ileus, but they are less dramatic in their expression.
Frequently, an accompanying hiccup occurs in the paralytic ileus. Initially, the pain in a bowel obstruction usually can be well located. In the course of it comes through the spread of bacteria in the abdomen to an inflammation of the peritoneum. This is shown by a bristly taut abdominal wall and diffuse pain throughout the abdominal area.
The typical disease course in a bowel obstruction begins with vomiting severe abdominal pain and lack of bowel movements.
In the case of a mechanical intestinal obstruction, the intestinal movement can lead to a previous overactivity, in which the loops work more strongly around the actual intestinal obstruction. In a paralytic intestinal obstruction, on the other hand, no intestinal noises can be heard in the typical course.
In the progressive course, the intestine fills with gases and the stomach becomes hard and tense and the pain increases significantly.
The non-excreted porridge can pass through the intestinal walls into the abdominal cavity and the bacteria can lead both to peritoneal inflammation, as well as to a poisoning of the body by the exiting bacteria.
An intestinal obstruction is associated with various complications. First, there is a risk that the gut or peritoneum tears and pathogens enter the intestines. This can cause fistulas, abscesses and inflammation that can lead to nausea and vomiting. Later there is a risk of chronic pain and wound healing disorders can occur.
If the secretions (gastric juice, bile) can no longer be absorbed, it comes to dehydration. Reduced urine output, shock and bloody thickening are the result. In a mechanical intestinal obstruction, it can lead to fatigue of the intestinal muscles and thus to the cessation of bowel function.
This leads to severe symptoms of poisoning if not treated and finally to multiple organ failure and circulatory shock. In less severe cases it comes to the bacterial decomposition of the intestinal contents. The intestinal wall is weakened as a result and less resistant to toxins and bacteria.
The increased pressure on the intestinal wall can lead to an undersupply of the intestine. As a result, peritonitis may occur and parts of the intestine may die. It often comes to adhesions of intestinal loops and other abdominal organs. This can cause another intestinal obstruction.
When should you go to the doctor?
A persistent pressure or bloating in the abdomen that lasts for several days, should be examined by a doctor and clarified. If there is no defecation despite a sufficient intake of fluids or the consumption of food for a long time, there is cause for concern.
A doctor must be consulted to rule out further illnesses. Flatulence, abdominal or stomach pain, vomiting and vomiting are uncommon and must be examined by a doctor. If the symptoms persist or increase in intensity, a doctor's visit is urgently needed. Since a bowel obstruction is a medical emergency, an emergency doctor must be called immediately in case of severe pain, cramping or bleeding. If there are unusual noises in the area of the stomach or intestines, they should be checked by a physician.
If the circulation fails, the existing energy in the body dwindles and the usual level of performance goes down, a doctor is to be consulted. If sleep disorders occur, everyday tasks can no longer be performed or body temperature rises, this is considered to be alarming. A doctor should be consulted as soon as the discomfort persists for several days or increases continuously. If there are problems with locomotion due to existing complaints, a comprehensive medical examination is needed.
Treatment & Therapy
In the case of intestinal obstruction, admission to the hospital is unavoidable. As a first treatment, care must be taken to relieve the bowel. A nasogastric tube is placed through the nose, which directs the porridge and the excess stomach acid outwards. Nutritional supplementation must be stopped immediately, but intravenous fluid and electrolyte must be added. In most cases, a bowel obstruction must be treated surgically.
In the case of bowel obstruction in the colon, and especially in the case of mechanical closure of a region, immediate emergency surgery of the intestinal obstruction must be carried out, as it represents an acute life-threatening situation. The surgery for a bowel obstruction is done via a laparotomy, a large-scale abdominal incision. In a mechanical intestinal obstruction, the individual loops are controlled and strands removed.
In a paralytic intestinal obstruction, which has been caused by inflammation, if necessary, a part of the intestine must be removed if this could not resume its function after the intestinal obstruction.
Outlook & Forecast
Intestinal obstruction (ileus) is a life-threatening condition that leads to death without immediate treatment. The prognosis, however, also depends on how large the affected intestinal section is, what form of the ileus is present and when the treatment has begun. Overall, about 25 percent of patients with intestinal obstruction die. However, if successful, the consequences of intestinal obstruction usually heal completely.
However, survival or immediate healing can not always be guaranteed despite immediate emergency treatment. If the chyme can no longer be transported in the intestine, there is a dangerous increase in pressure on the intestinal wall. This increase in pressure causes mucosal injuries, which can eventually lead to necrosis (death) of entire areas of the intestine. If parts of the intestinal mucosa die off, it can lead to the breakthrough of the intestine. The bacteria-infused digested chyme then migrates into the abdominal cavity.
As a result, a life-threatening peritonitis develops (peritonitis). On the one hand, this leads to a dangerous fluid and electrolyte loss and on the other to a flooding of the abdominal cavity with bacteria and their toxins. Loss of fluid can cause a dangerous circulatory shock, triggered by a rapid drop in blood pressure. Furthermore, bacterial toxins can enter the blood and cause a septic shock. Without treatment, this development quickly leads to death through multiple organ failure.
After the acute therapy (OP) of the intestinal obstruction, it is essential to pay attention in the aftercare to the diet. The patient receives infusions immediately after the surgery so that his fluid, nutrient and energy requirements are slowly restored. Slowly and gently with pasty food, low-fiber and easily digested foods, a rebuilding of the normal diet is started.
It helps to normalize normal foods in the beginning. Furthermore, the following behaviors after bowel obstruction should be considered, such as slow eating and thorough chewing. Preference should be given to several small meals a day (five to six), whereas flat foods (lentils, beans, cabbage) should be avoided. This also applies to the abandonment of nuts, fibrous fruit (pineapple, oranges, mangos).
Vegetables and fruits should be peeled before consumption. A food diary helps to find out which foods are particularly good or badly tolerated. When the intestinal system has recovered, it may take some time to try out more digestible foods. A well-balanced and controlled diet is the best aftercare and prevention of bowel obstruction.
It should be paid attention to regular bowel movements. When the intestines have recovered, ballast diet helps the digestive system keep going. It is also important to ensure adequate hydration - at least 1.5 liters daily, water, tea (unsweetened); if the diet is high in fiber, the amount of fluid should be increased.
You can do that yourself
Bowel obstruction is basically a medical emergency that can be fatal in the worst case scenario. Once it has come to an intestinal obstruction, the person affected needs intensive medical intervention as soon as possible, so that the defecation can work again and it does not come in the worst case to a perforation. In this respect, self-help in everyday life with a bowel obstruction is unfortunately not possible.
If symptoms such as severe abdominal pain, pressure with simultaneous no longer existing digestion or only small amounts of slimy-fermented stool strong, you should not try to cure yourself with home remedies. Waiting or conventional laxatives are useless in case of intestinal obstruction. The intestinal passage is closed and may need to be treated surgically. Topping time or eating fiber-rich foods can make the situation worse.
In this respect, in the field of self-help with regard to intestinal obstruction, care must first be taken to ensure that digestion remains in flux at an early stage. On the other hand, for symptoms that make intestinal obstruction appear possible, seek medical advice immediately. If it comes to symptoms such as vomiting, an emergency doctor must be alerted immediately.