‘Bowel obstruction’ which is also known as ‘intestinal obstruction’ is obstruction of the intestines which hamper the normal peristalsis / colicky movement of the intestinal contents. The obstruction can be mechanical (something physically preventing the forward flow of intestinal contents) or functional (inert defect in muscles of intestines which causes stasis of contents).
It can also be classified either by obstruction in the small intestine or in the large intestine. Bowel obstruction is a surgical emergency and 1 in 1000 patients are affected/diagnosed every year. It is very essential to know the prominent causes and symptoms of bowel obstruction in order to begin the treatment at an early stage.
Causes:
1. Adhesions –
These are small tags of fibrous tissues usually formed after previous abdominal surgery. Adhesion formation is the most common cause of bowel, especially small bowel obstruction.
2. A hernia-
Increase in intra-abdominal pressure causes part of the intestinal wall to protrude through small muscular weak points in the abdominal wall.
3. Volvulus, Intussusception –
wherein a part of the bowel gets twisted.
4. Inflammatory diseases of the gut
5. Worm infestation –
Especially in cases of small infants.
Symptoms of bowel obstruction:
The classical symptoms of bowel obstruction are:
1. Vomiting
2. Pain in abdomen (usually colicky pain which comes and goes off)
3. Absolute constipation (Not able to pass stools or gas)
Additionally, patients can present with:
4. Distension of abdomen
5. Loss of appetite
Symptoms are also specific to the site of obstruction- whether there is a blockage in the small intestine or in the large intestine.Small bowel obstruction usually has pain in upper abdomen, vomiting is more prominent.
Large bowel obstruction presents with the relatively earlier onset of constipation and less prominent vomiting. The pain is also restricted to mid or lower part of the abdomen. In case a person experiences any of the above-mentioned symptoms, we recommend you to consult a health care doctor for diagnosis and treatment.
Diagnosis:
The doctor is alerted to intestinal obstruction by the typical history which the patient gives. He will further examine the abdomen and absence of bowel sounds will further corroborate the diagnosis.
The clinical hunch of bowel obstruction is confirmed by investigations:
1. Standing and Lying down X-ray of the abdomen – shows multiple air-fluid levels and distended intestines.
2. Contrast enema – This is an X-ray of the abdomen in which a contrast material is injected from the anal opening and the contrast material stands out in the X-ray. This is useful in determining the level of obstruction.
3. CT scan of the abdomen also confirms all the above findings.
4. Findings can also be confirmed by colonoscopy wherein an endoscopy scope is passed from the anus. This provides visual confirmation of site of obstruction and the physical cause of obstruction.
5. Blood tests- these are always done. Patients having bowel obstruction are usually taken up for surgery and blood investigations to determine the basal hemoglobin level and blood group is necessary.
Treatment:
1. Once a diagnosis of bowel obstruction is made, the patient is kept ‘nil orally’ – not allowed to have any solids or liquid orally.
2. A nasogastric tube passed from the nose through the oesophagus and used to decompress the stomach of its contents.
3. An intravenous line is taken in the veins in arm/leg to start fluids. With multiple vomiting episodes, the patient is usually dehydrated and fluid administration is necessary. This also helps in correcting electrolyte imbalance caused due to vomiting.
4. Broad spectrum antibiotic injection is given.
Most cases of small bowel obstruction respond to conservative management. Usually, the adhesions loosen up and bowel open up. Patients are monitored regularly throughout the day and any aggravation of symptoms noted.
5. In case of nonresponse to conservative management or large mechanical obstruction, patients undergo surgery to physically remove the cause of obstruction and maintain gut continuity.
Prevention:
Causes leading to bowel obstruction can be prevented by maintaining a good diet and healthy lifestyle. Have plenty of fruits and fresh vegetables in the diet. Also, the fiber content in the diet should be adequate. These measures are a primary preventive measure for colorectal cancer. People must avoid lifting heavyweights in order to prevent hernia formation.
