‘Bowel obstruction,’ also known as ‘intestinal obstruction,’ occurs when something blocks the intestines and hampers the normal peristaltic or colicky movement of their 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 – Doctors perform this abdominal X-ray by injecting contrast material through the anal opening. The contrast material then stands out clearly 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- Doctors always perform these. They usually take patients with bowel obstruction for surgery. Blood investigations help determine the basal hemoglobin level and blood group.
Treatment:
1. Once doctors diagnose bowel obstruction, they keep the patient ‘nil orally.’ The patient cannot have any solids or liquids by mouth.
2. A nasogastric tube passed from the nose through the oesophagus and used to decompress the stomach of its contents.
3. Doctors insert an intravenous line into a vein in the arm or leg to start fluids. Multiple vomiting episodes can cause dehydration, so they give fluids to rehydrate the patient. 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. They monitor patients regularly throughout the day and note any aggravation of symptoms.
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:
You can prevent causes of bowel obstruction by maintaining a good diet and a 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.
