A Basic Guide To Understanding Intestinal Obstruction

Intestinal obstruction, likewise known as bowel obstruction, is a blockage in the small or large intestine that prevents the proper excretion of waste products. 

Intestinal obstruction can be partial or total, and the nature of obstruction will determine the amount of content that will be excreted. 

Bowel obstruction prevents the passing out of digested materials through the bowels and eventually through the anus. In the absence of bowel evacuation, content such as air, fluids, food, gastric acids, and bacteria accumulate in the abdomen and cause discomfort.

What are the symptoms of Intestinal obstruction?

Common signs and symptoms of Intestinal Obstruction include:

  • Abdominal pain: is a very common manifestation. It can manifest: Suddenly and severe, as cramps and intermittently, Spastic in nature, pain that can last for a couple of minutes or longer, and location of pain are usually mid-abdomen to lower abdominal region. 
  • Nausea
  • Vomiting (expulsion of stomach content through the mouth without fecal material)
  • Constipation
  • Abdominal distension (Bloating) 
  • Inability to pass gas
  • Dehydration

Intestinal obstruction is a common disorder that affected about 3.2 million people in 2015 worldwide and 254,000 deaths, according to Wikipedia. There are more than 100 thousand incidents per year in Nigeria. Intestinal obstruction is caused by so many structural and functional factors. 

What causes intestinal obstruction?

  1. Adhesions: are a fibrous band that forms post-surgically. It is the most common cause of bowel obstruction, and it is the cause of bowel obstruction in about 65-75% of cases. 
  2. Crohn’s disease: is inflammation of the bowels (mainly the small intestine).
  3. Diverticulitis: inflammation of abnormal intestinal pouches. 
  4. Obstructed inguinal hernia
  5. Colon cancer
  6. Volvulus: a twisted loop of intestine. 
  7. Appendicitis
  8. Intussusception: is the folding of the intestine into another section of the intestine 
  9. Tuberculosis 
  10. Intestinal atresia: narrowing/stenosis of the intestine. 
  11. Superior mesenteric artery syndrome: is a compression of the duodenum by the superior mesenteric artery and the abdominal aorta. 
  12. Ischemic colitis: is inflammation of the large intestine caused by the inadequate blood supply to the colon. 
  13. Foreign bodies: such as gallstones 
  14. Endometriosis
  15. Hirschsprung’s disease 
  16. Fecal impaction 
  17. Postpartum bowel obstruction 
  18. Sclerosing peritonitis 
  19. Radiation enteritis 
  20. Fecaloma

Complications of Intestinal Obstruction can include:

  • Dehydration
  • Electrolyte imbalance
  • Difficulty in breathing due to pressure on the diaphragm by the bloated abdomen 
  • Fecal vomiting is the expulsion of fecal material through the mouth. It is characterized by the odor of feces on the breath. Fecal vomiting is known to be the cause of death in severe cases of bowel obstruction. 
  • Bowel perforation.
  • Bowel necrosis due to ischemia
  • Sepsis

How is an intestinal obstruction diagnosed?

  • Abdominal CT scan
  • X-rays of the abdomen: will detect gas bubbles, multiple gas-fluid levels on standing and lying position 
  • Barium enema
  • Abdominal Ultrasound
  • Colonoscopy (visualize the colon)
  • Endoscopy (visualize the upper GI tract and content of obstruction can be taken for biopsy). 

What is the treatment for Intestinal Obstruction?

The treatment options for Intestinal Obstruction may include one or more of the following:

  1. Nasogastric tube: is used to decompress abdominal distention and 
  2. Correction of dehydration and electrolyte abnormalities. 
  3. Pain medications. 
  4. Anti-emetics: Domperidone, Haloperidol, Metoclopramide, Chlorpromazine, Dolasetron and Granisetron. 
  5. Surgery to unblock the intestines: bowel resection
  6. Treatment of cause: for example, an inguinal hernia can be managed with herniorrhaphy, herniotomy, and hernioplasty