Intestinal obstruction

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Overview

A bowel obstruction can either be a mechanical or functional obstruction of the small or large intestines. The obstruction occurs when the lumen of the bowel becomes either partially or completely blocked. Obstruction frequently causes abdominal pain, nausea, vomiting, constipation-to-obstipation, and distention. This, in turn, prevents the normal movement of digested products. Small bowel obstructions (SBOs) are more common than large bowel obstructions (LBOs) and are the most frequent indication for surgery on the small intestines. Bowel obstructions are classified as a partial, complete, or closed loop. A closed-loop obstruction refers to a type of obstruction in the small or large bowel in which there is complete obstruction distally and proximally in the given segment of the intestine.

Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of contents through the intestine due to pathology that causes blockage of the bowel. Symptoms include cramping pain, vomiting, obstipation, and lack of flatus. Diagnosis is clinical and confirmed by abdominal x-rays.

Symptoms

Crampy abdominal pain that comes and goes.

Loss of appetite.

Constipation.

Vomiting.

Inability to have a bowel movement or pass gas.

Swelling of the abdomen.

Causes

An obstruction can be partial, which may get better without surgery. A complete blockage is more likely to need intestinal surgery.


Mechanical obstructions

Mechanical obstructions are when something physically blocks your intestine. In the small intestine, this can be due to:


adhesions, which are made of fibrous tissue that can develop after any abdominal or pelvic surgery or after severe inflammation

volvulus, or twisting of the intestines

intussusception, a “telescoping,” or pushing, of one segment of intestine into the next section

malformations of the intestine, often in newborns, but can also occur in children and teens

tumors within your small intestine

gallstones, although they rarely cause obstructions

swallowed objects, especially in children

hernias, which involve a portion of your intestine pushing outside the muscle or tissue in your body or into another part of your body

inflammatory bowel disease, such as Crohn’s disease

Although less common, mechanical obstructions can also block your colon, or large intestine. This can be due to:


stool stuck in your colon or rectum (impacted stool)

adhesions from pelvic infections or surgeries

ovarian cancer

colon cancer

meconium plug in newborns (meconium is the stool babies first pass)

volvulus and intussusception

diverticulitis, the inflammation or infection of bulging pouches of intestine

stricture, a narrowing in the colon caused by scarring or inflammation

Nonmechanical obstruction

Your small and large intestines normally work in a coordinated system of movement. If something interrupts these coordinated contractions, it can cause a functional intestinal obstruction.


This is generally known as a nonmechanical obstruction. If it’s a temporary condition, it’s referred to as an ileus. It’s called a pseudo-obstruction if it becomes chronic, or long-term.


Causes for an ileus include:


abdominal or pelvic surgery

infections, such as gastroenteritis or appendicitis

some medications, including opioid pain medications

electrolyte imbalances

Intestinal pseudo-obstruction can be caused by:


Parkinson’s disease, multiple sclerosis, and other nerve and muscle disorders

Hirschsprung’s disease, a disorder in which there’s a lack of nerves in sections of the large intestine

disorders that cause nerve injury, such as diabetes mellitus

hypothyroidism, or an underactive thyroid gland


Risk factors

Abdominal or pelvic surgery, which often causes adhesions — a common intestinal obstruction.

Crohn's disease, which can cause the intestine's walls to thicken, narrowing the passageway.

Cancer in your abdomen.

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Complications

Treatment is essential to reduce complications such as:


dehydration

electrolyte imbalances

perforation, or a hole that forms in your intestines, which leads to infections

kidney failure

If the obstruction is preventing blood from getting to a segment of intestine, this can lead to:


infection

tissue death

intestinal perforation

sepsis, a life threatening blood infection

multiple organ failure

death


Prevention

Try to chew each bite about 20 times or until it is liquid. Avoid high-fibre foods and raw vegetables and fruits with skins, husks, strings, or seeds. These can form a ball of undigested material that can cause a blockage if a part of your bowel is scarred or narrowed.