Complications of intestinal obstruction
- Volume depletion: Each ileus deprives the patient of fluid, because the secretions (gastric juice, bile, pancreatic and small intestine secretions) that are released into the intestinal lumen are no longer reabsorbed. There are also the losses due to vomiting. The result is a lack of volume (dehydration) that can lead to blood thickening, decreased urine production and shock.
- Secondary intestinal paralysis: In the case of mechanical ileus there is initially more than normal peristalsis. With increasing fatigue of the intestinal musculature, the initially increased peristalsis decreases in intensity, to completely fail after hours or days.
- Transient peritonitis: Prolongation of the ileus leads to bacterial decomposition (autolysis) of the blocked intestinal contents, which makes the intestinal wall permeable to toxins and bacteria. It comes to poisoning the circulation and peritoneal inflammation, which drastically worsens the prognosis.
Treatment of intestinal obstruction
Sudden dull or spasmodic violent abdominal pain, altered stool behavior, nausea and vomiting may indicate a bowel obstruction, so the general practitioner or the emergency medical service should be notified. Also abdominal pain, which occur after food intake, should be clarified, since it can hide, especially in the elderly, a reduced blood flow to the abdominal arteries.
If the home or emergency doctor is called and diagnosed an ileus, he will perform the following emergency measures: With a nasogastric tube, secreted secretions from the stomach and small intestine can be aspirated with a large-volume syringe. Thus, the massive pressure that has built up through the closure, somewhat reduced. Conclusions Small intestinal contents can be recognized by its dirty brown color and the offensive odor. As soon as possible, an infusion will be created. Home or emergency doctor will arrange an immediate hospitalization.
Fast therapy needed
In most cases, the intestinal obstruction must be treated surgically as soon as possible, otherwise the condition will lead to death. Mechanical ileus is an absolute indication for immediate surgery! The operative procedure depends on the cause of the ileus:
- In the best case, only adhesions are dissolved (adhesiolysis or Bridenlösung).
- When Strangulationsileus usually a Darmteilentfernung is required.
- If the constriction can not be surgically removed, for example because a non-operative tumor is the cause of the occlusion, a bypass operation (bypass surgery, the bottleneck is bypassed by another section of the intestine) or the discharge of the intestine as an artificial bowel (stoma) comes into question,
During surgery, an antibiotic is given to prevent the intestinal bacteria from spreading to the abdomen. If there is a preliminary stage of a paralytic bowel obstruction, an attempt can be made to start the intestinal movement with medication.
If a peritonitis is responsible for debilitating intestinal obstruction, the underlying condition must be treated. For example, in case of a perforated gastric or small intestinal ulcer, the fracture site must be sutured or surgically excised if possible.