Intestinal Obstruction
Contents:
Intestinal obstruction is a serious condition caused by a violation of the movement of intestinal contents through the digestive tube due to a mechanical obstacle, which is a tumor in the intestine itself or in the abdominal cavity.
Clinical syndrome is especially characteristic of patients with intestinal cancer, 15–20% learn about the disease for the first time after an emergency operation for acute obstruction.
Intestinal Obstruction Cause
The main cause of intestinal obstruction is the overlapping of the intestinal lumen with a cancer tumor or compression of the intestinal tube from the outside by tumor nodes in the abdominal cavity, which often happens in ovarian cancer.
In cancer patients, the overwhelming majority of them are obstructed by cancer of the colon, since malignant neoplasms of the small intestine are very rare.
At first, intensively contracting, the blocked gut tries to push through hard fecal masses to no avail, strongly stretches above the site of the block and falls into nervous paralysis. Through the paralyzed sluggish intestinal wall, toxic products are absorbed into the blood, leading to severe intoxication and oxygen starvation of tissues — polyorgan failure.
The onset of the disease is rather slow, but up to a certain limit, when an enormous amount of microelements, proteins and fluids are lost with emetic masses, poisoning with decomposition products — endotoxicosis — is clinically manifested.
Together with toxins from the lumen of the necrotic bowel bacteria enter the blood, and peritonitis begins in the abdominal cavity with the formation of inflammatory infiltrates and abscesses — abscesses.
In the abdominal cavity, the pressure rises sharply, which is called «compartment syndrome», which additionally disrupts the blood supply to the starving internal organs.
Intestinal Obstruction Diagnostics
Obstruction may be partial, when not the entire lumen of the intestine overlaps, evacuation of liquid contents is possible with a passage width of just one centimeter. In the lower parts of the colon, when all the liquid has sucked from the contents, such a small lumen leads to catastrophic consequences more quickly.
You can suspect the disease by the symptoms and appearance of the patient. Diagnosis of obstruction consists in abdominal radiography revealing typical symptoms, the most characteristic of which is the «Kloyber bowl». On the survey radiograph in the lumen of the intestine will be visible inverted cup with liquid and a gas bubble above it. The small intestine swollen like an arch, transfusion of liquid contents in intestinal loops in the absence of gases in them can be determined.
In doubtful cases, a CT scan or MRI scan of the abdominal cavity must be done to make a diagnosis. Endoscopy — colonoscopy determines the level of the lesion and the diameter of the narrowing, which is important for developing tactics of surgical intervention, and also take a biopsy when performing unloading stenting at the first stage.
Timely diagnosis of severe, but not uncommon, complications of colorectal cancer allows for optimal treatment while maintaining the integrity of the intestinal tube, which will make life long and qualitatively different.
Intestinal Obstruction Symptoms
Symptoms of the disease increase gradually over several days or even weeks, manifested by constipation and lack of appetite, flatulence and increasing weakness.
At the stage of compensation of the process, active conservative therapy can significantly improve the condition in order to calmly and efficiently prepare the patient for a planned surgical intervention.
Further development of the disease leads to aggravation of all clinical signs, led by constipation, for up to three days with marked bloating, but with intestinal gases that are difficult to escape or not flow at all. This is not a compensated, but a subcompensated state, but the insufficiency of organs and systems is not yet manifested, although it is radiologically possible to reveal specific signs of an impaired patency of the intestinal tube.
The progression of obturation leads to a significant deterioration of the state up to fatal decompensation, during this period the most typical:
- Severe abdominal pain occurs suddenly, with periods of increased intensity every quarter of an hour — during peristaltic contractions. Sighing pain after two days does not indicate improvement, on the contrary — these are signs of organ death.
- In the abdomen a «dead silence» with a distant heartbeat is heard with a stethoscope.
- Asymmetrical abdominal distention, against which one can see contractions of the intestines.
- Lack of stool, with swelling of the right parts at first, there may be abundant stools due to reflex emptying below the underlying intestine.
- Intestinal gases do not leave.
- Vomiting first occasionally; with the progression of the disease it becomes almost constant with appearance and smell similar to feces.
- The anal opening widens; blood and mucus may be released during the disintegration of the cancer node.
Intoxication increases — the temperature rises, the heartbeat increases, the skin is dry, the tongue is dry and rough, severe weakness.
The condition is so severe that without taking emergency measures, life begins to yield to the arrival of a painful death. Hospitalization is compulsory and emergency, the patient is entrusted to resuscitation and oncologists who have coloproctological experience.
Intestinal Obstruction Treatment
At the initial stage and with incomplete overlap of the tube lumen — during periods of compensation and subcompensation of the disease, emergency surgery can be avoided and the patient is prepared for a planned surgical intervention in Moscow with a lower probability of complications. The planned preparation for surgery is given no more than 10 days, all this time the patient is in the hospital.
A very serious treatment is being carried out with the intravenous administration of large quantities of different solutions and antibiotics, suction of the contents of the gastrointestinal tract, enemas, and all in conditions of an intensive ward or intensive care unit. If the condition against the background of 6–12 hours of active conservative therapy does not improve, then the question is raised about emergency surgical treatment.
In the final stage of the disease, after a very brief preparation for vital reasons, an urgent surgery is performed. The probability of postoperative complications is very high, even in modern conditions, every fourth person does not tolerate the consequences of the ensuing multiorgan failure and is unable to cope with fecal peritonitis.
The surgery scope is determined by the patient’s condition and complications of intestinal obstruction:
- in severe cases, but without purulent complications in the abdominal cavity and bleeding from tumor vessels, they are limited to stoma placement — the intestine is removed to the abdominal wall above the affected area; the cancer tumor removal is delayed for several weeks or months;
- in case of bleeding, the cancer affected part of the intestine is removed — resected, but not stitched, and the upper sections are brought out on the stomach with the formation of a stoma, while the condition improves, the second operation is performed — resection with the formation of the anastomosis — stitching the intestine into a single tube;
- with the development of peritonitis and extremely severe condition of the patient, it is sometimes possible only to remove the purulent exudate from the abdomen — drain, when it is possible to improve the condition and relieve inflammation, resection of the intestine is performed;
- The best option — removal of the affected areas with the restoration of the intestinal tube is performed at one time only in the absence of complications, in most cases two operations are performed with an interval of several weeks or months — after the completion of chemotherapy courses;
- in the absence of bleeding and peritonitis, preservation of the intestinal wall, cancer recurrence in the area of primary surgery or compression of the intestine from the outside, good results are achieved with stenting, setting the wall inside the intestinal tube allows the patient to be prepared for a planned operation.
Intestinal obstruction may be the first sign of colorectal cancer, which the patient does not even suspect, but it is always a
Most surgeons know how to deal with obstruction, but they are not able to perform optimal surgery for advanced cancer. Specialists of our clinic will ideally perform a radical operation and provide the fastest recovery to continue the comprehensive treatment.