Intestinal Obstruction
Intestinal obstruction is a complete cessation of the passage of materials and gases in a segment of the intestine. The occlusion may have a mechanical cause ( obstruction , strangulation ), functional or mixed.
We distinguish occlusion of the small intestine and occlusions of the colon.
These are common conditions under which many cases the diagnosis is made primarily by the clinic , and increasingly by radiograph "abdomen without preparation" and computed tomography.
Summary |
Mechanisms
Mechanical occlusion
Three possible causes:
- Obstructed by an obstacle that can be:
- intraluminal eg a calculation or a food
- as an intramural tumor benign or malignant
- extra-luminal: The most common is the bridle tight in peritoneal scar the abdomen.
- Strangulation by:
In strangulation, the blood supply is compromised, which can cause necrosis and perforation of the bowel wall.
- Intussusception: a segment of intestine invaginates into a segment further downstream mostly at the junction of small intestine / colon. It is because the bladder obstruction of the lumen mouth invagination and a degree of strangulation because the vessels are compressed. This is where the most rare in adults. (See article on intussusception )
Functional occlusion
There are two possible mechanisms:
- Inflammatory occlusion, which occurs during inflammatory effusions in the peritoneal cavity ( pus or blood ) as peritonitis. The paralysis of the intestine responds to the Stokes law (any muscle behind a serous inflamed is paralyzed).
- Occlusion reflex whose cause may be:
- retroperitoneal in irritations of the retro- peritoneum : hematoma retroperitoneal, trauma of the spine.
- iron overload in such a hypokalemia.
- causes neurological, respiratory, drug ...
Clinical
Signs functional
- Pain : major sign, headquartered varies with the level of occlusion but is periumbilical and most often does not irradiated. Its installation is progressive and evolves to the aggravation. It is kind of paroxysmal, causing painful waves and described as a twist.
But sometimes it may not be evocative, just felt like a stomach upset rather vague.
- Vomiting , which vary according to age:
- Food
- bile
- fcalodes
They are even more precocious than the occlusion is high. They temporarily relieve the subject but may completely miss.
- Judgement of transit , the more specific signs of occlusion and most difficult to explain. There is even earlier than the bite is low. It can sometimes be preceded by diarrhea , misleading.
- Bloat
Note the presence of extra-gastrointestinal: urinary (retention, urinary tract infection), respiratory, cardiac, spinal, neurological, gynecological, infectious ... Make a list of medications taken by the patient.
Clinical signs
- Pulse, voltage, temperature, looking for signs of shock.
- search for a defense abdominal pain peritoneal signing.
- Assessment of abdominal bloating, intestinal peristalsis seeking visible under the skin.
- auscultation in search of air-fluid noises.
- Research abdominal scars.
- Verification hernial.
- DRE in search of a fecal impaction.
- pulmonary examination, urinary ... according to the signs associated functional.
Radiology
As standard, will be performed three radiographs, which will determine the site and type of occlusion:
- Abdomen without preparation of face standing, looking for air fluid levels
- Abdomen without preparation of face Coated
- Abdomen without preparation focuses on diaphragmatic in search of a pneumoperitoneum
A scan is performed abdominal emergency: it determines the site and type of occlusion in the most accurate.
Biology
The following tests are performed to identify possible causes:
- Blood Counts
- for leukocytosis, signs of strangulation or digestive distress.
- for microcytic anemia, pointing to a tumor associated.
- Serum electrolytes, urea and creatinine, serum calcium, research
- for signs of dehydration related to occlusion, correct before proceeding.
- for disorders of the ionic charge occlusive syndrome.
- for possible intervention.
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