An intestinal obstruction can manifest itself suddenly and dramatically (for example, if a piece of intestine is trapped in a rupture sac) or form creeping and discrete (eg in a slowly growing, constricting tumor) - medical terms are "acute abdomen" and "subileus".
Symptoms of intestinal obstruction
- The intestinal contents accumulate in the stomach, which leads to the vomiting of faeces (the term for this is Miserere).
- Pain is caused by spasmodic bowel contractions (markedly increased intestinal peristalsis with mechanical ileus) or a simultaneous peritonitis.
- Stool and wind behavior occurs especially in paralytic ileus.
- As a result of the intestinal enlargement, the abdomen is distended (meteorism).
Often, however, an ileus develops painless and for weeks to months. In the case of a mechanical intestinal obstruction, a normal defecation can be discontinued if there is a high degree of occlusion in the area of the small intestine, since in this section of the intestine the defecation is still fluid and the fluid can easily pass through the narrowed intestinal section. If a mesenteric infarction is the cause of an ileus, abdominal pain, which occurs again and again after eating, indicates a reduced perfusion of the mesenteric arteries.
Intestinal obstruction: diagnosis
If the condition of the patient permits, a comprehensive survey of the history of the patient (anamnesis) takes place. Indications of repeated gastric ulcers, spasmodic pain that occurs immediately after eating (evidence of mesenteric infarction) or pain in the right lower abdomen (eg, appendicitis) may be helpful in narrowing down the various causes and initiating the necessary examinations.
The question of the type of pain provides information about which organ could be affected. Sudden, severe and stabbing pains in the right upper abdomen are more likely to indicate gallbladder inflammation or a duodenal ulcer. If this pain radiates to the right back, then it may be gallbladder inflammation. Therefore, the exact description of the pain is as important as the description of the nature of the pain.
Examination by the doctor
After the medical history follows the physical examination. Often a person affected by a bowel obstruction is restless, his legs may be angled to reduce tension in the abdomen and allow relief. The examination reveals a defense tension of the abdomen. This occurs either at a certain point or is distributed over the entire belly. The abdomen is often painful to the touch.
With the stethoscope, the bowel sounds can be judged. Metallic-sounding bowel sounds indicate mechanical ileus. Missing bowel sounds (absolute silence in the stomach), however, indicate a debilitating intestinal obstruction (paralytic ileus). Rectal examination (palpation of the rectum with the finger) can be painful, especially if appendicitis has irritated the peritoneum.
To assess the abdomen, X-rays are taken standing or in left lateral position. When a bowel obstruction crescent-shaped air and fluid collections can be seen. Depending on the involvement, they are referred to as small or large intestine. Free air under the diaphragm is a sign of a "leak" in the gastrointestinal tract, often the air passes through an inflamed and leaky mucosal area.
The ultrasound examination (sonography) can be used to narrow down the cause of the intestinal obstruction. Pendulum peristalsis (intestinal content is no longer transported) speaks for a mechanical intestinal obstruction and lack of peristalsis for a crippling intestinal obstruction. Computed tomography is performed as a supplementary examination to assess the internal organs.
Depending on the cause of the intestinal obstruction, many blood levels may be abnormally altered. The blood count allows the determination of white (leucocytes) and red (erythrocyte) blood cells, the red blood pigment (hemoglobin) and the platelets (thrombocytes). Blood loss leads to a reduction of the red blood pigment (hemoglobin). In contrast, inflammation causes a marked increase in white blood cells. The erythrocyte sedimentation rate, the C-reactive protein and the lactate dehydrogenase (LDH) are increased.
In addition, liver values and pancreatic levels may increase morbidly. As the disease progresses, coagulation levels also deteriorate.