Causes and treatment of adhesive intestinal obstruction. What is adhesive intestinal obstruction - diagnosis, treatment and rehabilitation? Can adhesive intestinal obstruction cause fainting?

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Intestinal adhesions with obstruction (K56.5)

Gastroenterology

general information

Short description

Intestinal adhesions with obstruction represent a complete cessation or serious disruption of the passage of intestinal contents through the digestive tube due to the formation of fibrous adhesions between organs and tissues in the abdominal cavity.

Note 1. The disease is one of the forms of adhesive disease (“Peritoneal adhesions” - K66.0), but is allocated to a separate subheading due to the need to differentiate acute intestinal obstruction syndrome from other causes and, accordingly, select the correct management tactics.

Note 2

Excluded from this subcategory:
- peritoneal adhesions without obstruction (K66.0);
- (K31.5);
- postoperative intestinal obstruction (K91.3);
- obstruction associated with hernia (K40-K46);
- congenital strictures or intestinal stenosis (Q41-Q42);
- postoperative adhesions in the pelvis (N99.4).

Classification

The classification of intestinal adhesions with obstruction remains controversial. The classification of acute adhesive obstruction presented below seems to be the most complete (although not without its shortcomings) (Plechev V.V., Pashkov S.A., 2000).

Classification of acute adhesive obstruction

View:
1. Dynamic (partial).
2. Mechanical (full).

Variety:
1. Early adhesive obstruction.
2. Acute adhesive intestinal obstruction in the abdominal cavity.
3. Acute adhesive intestinal obstruction in the hernial sac.

Form:
1. Obstructive.
2. Strangulation.

Level:
1. Small intestine.
2. Colon.

Stages:
1. Enteral hypertension (ischemic).
2. Enteral insufficiency (water and electrolyte disorders).
3. Peritonitis (endotoxicosis).
4. Multiple organ failure.

Etiology and pathogenesis

The main cause of adhesive intestinal obstruction is the so-called “adhesive disease” (“Peritoneal adhesions” K66.0). In this regard, other diseases in etiology are given as the main causes of adhesive disease.

The most common causes of adhesions:
- operations on the abdominal cavity, during which mechanical trauma and drying of the peritoneum occurs (primarily for acute appendicitis, acute intestinal obstruction, genital diseases);
- hemorrhages in the abdominal cavity;
- inflammatory processes in the abdominal cavity (appendicular infiltrate, inflammation of the uterine appendages, peritonitis);
- postoperative intestinal paresis;
- presence of foreign bodies in the abdominal cavity;
- chronic inflammatory diseases of the abdominal organs;
- local tissue ischemia.
Congenital forms of adhesive intestinal obstruction (congenital adhesions, Jackson membranes) are also known Jackson's membrane is a thin, abundantly vascular membrane between the inner edge of the ascending colon and the parietal peritoneum; may cause intestinal obstruction
).

Types of abdominal adhesions:
- planar - fusions along the plane;

Membranous - connective tissue membranes, usually located in the transverse direction;

Cord-like - thin cords between organs;

Traction - funnel-shaped retraction of the intestine at the site of attachment of the commissure;

Omental adhesions are formed by traction adhesions.

In most cases, adhesions are located between intestinal loops, intestinal loops and the postoperative scar. More rarely, adhesions fix segments of intestines to the parietal peritoneum or other abdominal organs.

Forms of adhesive intestinal obstruction:
1. Obturation Obturation is the closure of the lumen of a hollow organ, including a blood or lymphatic vessel, causing a violation of its patency.
intestines. Adhesions, squeezing the intestine, do not cause disruption of its blood supply and innervation.

2. Strangulation Strangulation - pinching, blocking by squeezing any opening, for example, the respiratory tract, blood vessel or part of the gastrointestinal tract
intestines. Compression of the intestinal mesentery occurs, which is often complicated by intestinal necrosis.

3. Dynamic intestinal obstruction. An extensive adhesive process in the abdominal cavity leads to a slowdown in the motor-evacuation function of the intestine.

Epidemiology

Sign of prevalence: Common

Sex ratio(m/f): 0.9

Morbidity. Adhesive intestinal obstruction accounts for 4.5% of all surgical diseases of the abdominal organs and ranges from 40% to 94.5% of all types of mechanical obstruction of non-tumor origin.

Relationship with pathology. Studies have shown that the risk of acute intestinal obstruction in people with adhesive disease ranges from 10% to 22%.

Age. About 30% of hospitalizations for adhesive intestinal obstruction are recorded in the age range of 45-64 years, 53% in the age range of 65 years and older, which is apparently due to the increasing number of surgical interventions on the intestine.
There are no data on incidence and prevalence in children. The most common cause of adhesive obstruction in children is intussusception. Invagination - invagination of a layer of cells during any formative process
intestines, appendicitis.

Floor. Women predominate slightly. This is probably due to obstetric, gynecological operations, and the prevalence of diseases of the reproductive system.

Risk factors and groups

- trauma and inflammation of the abdominal organs;
- endometriosis Endometriosis is the appearance in various organs of tissue areas similar in structure to the uterine mucosa and subject to cyclic changes in accordance with the menstrual cycle
;
- hemorrhages into the abdominal cavity.

Clinical picture

Clinical diagnostic criteria

Abdominal pain; nausea; vomit; retention of stool and gases; bloating; abdominal asymmetry

Symptoms, course

Adhesive obstruction combines elements of dynamic and mechanical intestinal obstruction.
The dynamic element is caused by overload of the overlying segment of the intestine in the absence of complete occlusion of the intestinal lumen and intestinal ischemia.
The mechanical element is caused by complete occlusion of the intestinal lumen and ischemia of its wall.

The disease is characterized classic triad of symptoms:
- abdominal pain (possibly in the area of ​​previous surgery or injury);
- nausea and vomiting;
- retention of stool and gases with bloating.

Given that obstruction can be complete or incomplete, and manifest acutely or subacutely, the sensitivity and specificity of symptoms can vary significantly.

Other possible symptoms:
- bleeding from the gastrointestinal tract;
- fever (febrility indicates gangrene and perforation);
- signs of dehydration (oliguria Oligouria is a decrease in the amount of urine excreted by the kidneys. It can be physiological (with limited drinking regime, loss of fluid in hot weather through sweat) and pathological (with prolonged vomiting and diarrhea, high fever, bleeding, acute glomerulonephritis, edema formation, during pregnancy)
, arterial hypotension Arterial hypotension - a decrease in blood pressure by more than 20% from the initial/usual values ​​or in absolute numbers - below 90 mm Hg. Art. systolic pressure or 60 mm Hg. mean arterial pressure
);
- signs of intoxication (tachycardia Tachycardia - increased heart rate (more than 100 per minute)
, mental status disorders)
- signs of peritoneal irritation (with perforation Perforation is the occurrence of a through defect in the wall of a hollow organ.
);
- asymmetry of the abdomen;
- “splashing noise” on auscultation Auscultation is a method of physical diagnosis in medicine, which consists of listening to sounds produced during the functioning of organs.
intestines and other physical signs of obstruction.

Flow options

1. Acute strangulation adhesive obstruction is caused by constriction or entrapment of the intestine by adhesions together with the mesentery The mesentery is a fold of the peritoneum through which the intraperitoneal organs are attached to the walls of the abdominal cavity.
. Characterized by a rapid clinical course with the development of all subjective and objective signs of acute intestinal obstruction. The medical history indicates a previous operation; a postoperative scar is visible on the skin of the anterior abdominal wall.

2. Acute obstructive adhesive obstruction occurs due to kinking of the intestinal loop or compression of it by adhesions without involving the mesentery in the process. Characteristic slower development compared to strangulation obstruction. The clinical picture depends on the level of obstruction.

3. The intermittent form of adhesive obstruction is characterized by recurrent attacks of intestinal obstruction. Attacks are accompanied by cramping pain, vomiting, bloating, retention of stool and gas. History: a number of attacks, stopped by conservative treatment or surgery, as a result, the presence of multiple scars on the skin of the abdomen.

Diagnostics

Diagnosis of adhesive intestinal obstruction is based on:
- a history of adhesive disease or diseases that can lead to its development;
- clinical diagnostics;
- visualization of intestinal obstruction.

1. X-ray examination

A plain radiograph of the abdominal cavity reveals:
1.1 In persons with low adhesive intestinal obstruction:
- intensive Kloiber bowls;
- small intestinal arcades, which, unlike other types of intestinal obstruction, are fixed;
- thickening of Kerkring folds Circular folds (syn. Kerkring folds) - linings of the mucous membrane of the small intestine, arranged circularly, increasing the working surface and helping with the absorption and movement of chyme
;
- stretching of intestinal loops above an obstacle (local meteorite).
1.2 With high overlap of the intestinal lumen:
- Kloiber bowls Kloiber's symptom (syn. Kloiber's cups) - the presence on an x-ray of the abdomen (with the patient in an upright position) of shadows resembling cups of liquid; a sign of accumulation of fluid and gas in the intestines due to obstruction
;
- the arcades are single, but darkening is detected in the lower abdomen.

Signs of adhesive intestinal obstruction when studying the passage of an aqueous suspension of barium sulfate through the intestines:
- the appearance of horizontal levels of liquid in the absence of arches (symptom of “horizontal levels”), which give “volubility” to the image (symptom of “stretched spring”);
- retention of barium suspension in individual small intestinal loops;
- a symptom of “sagging” intestinal loops, manifested by the lowering of the terminal loops of the ileum into the lower abdominal cavity and even into the pelvic cavity.

The symptom of “horizontal levels” is formed by different contrasting media, but not as usual - air (arch) - liquid, but only liquid. The lower level of liquid consists of a heavier barium suspension, the upper level consists of liquid resulting from exudation. The level of liquid without gas appears 2-4 hours earlier, indicating microcirculatory disorders that have already occurred.

The main symptom of adhesive intestinal obstruction with X-ray contrast examination - retention of aqueous suspension of barium sulfate in the small intestine for more than 4-5 hours.
When a barium suspension is introduced into the duodenum through a probe, a delay of contrast in the intestine for more than 1.5-2 hours is considered pathological.
In adhesive disease, retention of aqueous suspension of barium sulfate for more than 9-12 hours is observed only in individual intestinal loops (symptom of “local depot”) when it enters the cecum in a timely manner.

2. Computed tomography- is considered the “gold standard” of diagnosis.

3. Laparoscopy Laparoscopy (peritoneoscopy) is the study of the abdominal organs by examining them using medical endoscopes inserted into the peritoneal cavity through a puncture of the abdominal wall.
- used in doubtful cases.

4. Ultrasound The abdominal cavity reveals not only the presence of fluid, but also the diameter of the small intestine, the thickness of its wall, the pendulum-like nature of peristalsis or the absence of peristaltic movements.

Laboratory diagnostics

There are no specific laboratory tests for diagnosing adhesive intestinal obstruction, as well as for distinguishing nosological types of intestinal obstruction from each other. However, a comprehensive laboratory study is necessary (especially in elderly patients and children) to calculate conservative therapy and assess the risks of anesthesia and surgery.

1. General blood analysis.
Moderate changes: leukocytosis, increased ESR, increased hematocrit Hematocrit - determination of the hematocrit number (the ratio of the volume of blood cells to the volume of plasma).
(dehydration due to vomiting).
Pronounced changes: leukocytosis Leukocytosis is an increased content of leukocytes in the peripheral blood.
more than 18x10 9 indicates gangrene Gangrene is a type of necrosis in which dead tissue either mummifies (dries out) or undergoes putrefactive decay
and/or peritonitis.

2. Biochemistry. Normal liver and pancreas test results. Possible hypoproteinemia Hypoproteinemia is a low protein content in the blood serum, observed when there is insufficient intake into the body or significant losses
associated with eating disorders; hypokalemia Reduced potassium content in the blood serum.
, hypochloremia Reduced chloride content in blood serum.
associated with the loss of electrolytes during vomiting and the deposition of fluid in the third space.

3. Feces. There may be traces of blood (usually with damage to the large intestine).

Differential diagnosis

Adhesive intestinal obstruction should be differentiated from the following diseases:
- other types of intestinal obstruction;
- appendicitis;
- acute cholecystitis;
- acute pancreatitis;
- intestinal ischemia;
- diverticulitis;
- hernias with symptoms of obstruction;
- tumors of the gastrointestinal tract;
- acute myocardial infarction;
- pneumonia and/or pleurisy.

The main methods of differential diagnosis are imaging methods.

Complications

- perforation Perforation is the occurrence of a through defect in the wall of a hollow organ.
intestines with the development of peritonitis Peritonitis is inflammation of the peritoneum.
;
- sepsis;
- dehydration with the development of hypovolemic shock Hypovolemic shock is a condition caused by a decrease in circulating blood volume. Characterized by a mismatch in tissue oxygen demand, metabolic acidosis (increased acidity)
and/or toxic shock;
- bleeding from the gastrointestinal tract.

Medical tourism

Intestinal obstruction is a pathological condition of the body in which the passage of food debris and gastric juices towards the patient’s colon occurs. If you ignore the clinical picture of the disease, untimely detection or self-medication, the disease can acquire more impressive dimensions, causing significant harm to the human body.

What are adhesions and how they occur?

Adhesions are cords formed from parts of connective tissue, resulting in fusion and displacement of the patient’s internal organs. The main reason for the appearance of adhesions in the body is a damaging factor. Due to accidental mechanical trauma, an infectious disease, the presence of a large number of accumulated blood clots or foreign bodies, as well as due to exposure to a variety of chemicals, the connective tissue begins to grow, leading to the formation of small processes. In most patients (5-20%), adhesions occur as a result of previous operations. In this case, the disease may appear either immediately after surgery or several years after it. There is also a separate category of patients who have a predisposition to the occurrence of adhesions in the form of an excess of certain enzymes. Such enzymes make themselves felt in cases of even the smallest and most insignificant injuries.

Causes of adhesive intestinal obstruction

Adhesions are a protracted and quite serious disease. Ignoring their existence by the patient can lead to the formation of an acute form of adhesive intestinal obstruction. In this case, the patient experiences a violation of the passage of the contents of the gastrointestinal tract, microcirculation and inflammation of the abdominal cavity develop.

Adhesive intestinal obstruction is usually divided into two main groups: and mechanical. The main cause of dynamic obstruction in patients of different age categories is the resulting spasm (paralysis) of the intestine. Such a spasm can be triggered by anything: poisoning with chemical or toxic substances, previous severe infectious diseases, etc. Mechanical adhesive intestinal obstruction is a disease that occurs in more than 80% of patients. In addition to the presence of a large number of adhesions in the body, the disease can be caused by strangulation of some part of the intestine due to a hernia, as well as volvulus, the presence of worms or gallstones.

Symptoms of the disease

The first and main symptom that can be used to diagnose adhesive obstruction in the intestine is pain. Depending on the severity and extent of the disease, the pain can be either sharp and intense or moderately weak and regularly recurring. The patient's attacks of pain may subside and return again. In addition, the patient experiences unpleasant bloating, strong and weak urination. In the early stages of the disease, vomiting with an unpleasant yellow-green mixture may occur. The nature and amount of vomit depends on the stage of the disease. With progressive intestinal obstruction, the patient begins to experience breath holding, cardiovascular spasms, the temperature rises and tachycardia begins.

Diagnostics

A qualified specialist can diagnose intestinal obstruction both during palpation and through a thorough examination and questioning of the patient. When detecting adhesions in the body, any information about the nature of the pain plays an important role. The patient donates blood for laboratory analysis, and also undergoes radiography of all abdominal organs. A more detailed examination includes ultrasound and computed tomography, which makes it possible to more accurately identify the root cause of the disease, make a diagnosis, and prescribe correct and effective treatment.

Treatment of adhesive intestinal obstruction

In the presence of an early stage of the disease, therapeutic procedures begin with complex conservative treatment. The most difficult task for a doctor is to determine the timing of conservative treatment and (if they are ineffective) to choose the most rational method of surgical intervention. The preoperative period includes feeding the patient orally with special nutritional mixtures, as well as a set of measures that have an enhanced effect on colon peristalsis and reduce dehydration. If there is a late stage of obstruction, urgent preoperative preparation is carried out. Doctors prescribe gastric lavage, enema and bilateral renal blockade with novocaine to the patient.

Surgical intervention consists of resection of the intestinal region, separation of adhesions and bypass anastomosis of both the afferent and efferent loops of the intestines. Also very popular recently is the Noble operation, during which specialists carry out complete or partial separation of the loops, eliminate existing adhesions and place parts of the small intestine next to each other, stitching and firmly fixing them in this position. After the operation, the patient continues to be given intravenous blood substitutes and saline solutions, given antibacterial and anti-inflammatory therapy, and also stimulates the motor function of the intestines in all available ways. In the first few days, the patient is prescribed bed rest and a gentle diet. He can eat and drink only with the permission of a doctor. During the first month, the patient remains under clinical observation and undergoes a variety of rehabilitation and physiotherapeutic procedures.

Proper nutrition when sick

Of particular importance in the treatment of adhesive intestinal obstruction is correct prepared diet. The main recommendations for maintaining a gentle diet come down to the minimum amount of food consumed. The patient should not overeat and overload his body. Food should be fractional, it should be taken in small portions every 2-3 hours. The maximum volume of liquid is 1.5 liters per day.

The basis of the diet is to take low-fat meat or vegetable broths, warm decoctions and dishes that have a ground or pureed appearance. It is allowed to eat porridge with water, various egg and curd soufflés, compotes and decoctions. It is necessary to exclude carbonated water, milk, kefir, as well as products with a dense consistency from the menu.

The most common form of intestinal obstruction is adhesive intestinal obstruction. There are different types of this disease that require special treatment. What signs indicate that the patient is developing adhesions in the intestines, what treatment is indicated and what preventive measures should be followed to get rid of such a disease?

What kind of disease is this?

Adhesive intestinal obstruction is a disease in which bridges form in the intestines, as a result of which the movement of food through the organ is disrupted. This disease manifests itself as a complication from a previous surgical procedure. Adhesions interfere with the normal digestion process and cause discomfort and pain in the abdomen.

If a small child has previously had an operation on the abdominal cavity, for example, removal of appendicitis, and after this there is severe pain in the intestinal area, you should immediately consult a doctor, since acute adhesive obstruction most often forms. The disease can manifest itself at an early age if the child has congenital intestinal adhesions. In this case, conservative surgical intervention to eliminate scars will help.

Types of disease

Depending on the nature of the origin of adhesions, different types are distinguished in the intestine. By origin, acute adhesive intestinal disease is congenital, when a person is born with a pathology and at a certain stage of life characteristic symptoms appear that indicate the presence of the disease. Adhesions can be acquired, which appear as a result of mechanical damage or as a complication after surgery.

The disease is also characterized by the way in which the vessels that supply nutrition to the organ are compressed. If the vessels of the mesentery are compressed, then the adhesive disease is called strangulation. When a mechanical obstruction appears in the intestine, obstructive adhesive disease develops. The combination of both syndromes at the same time is called combined adhesions.

Causes of the disease

Adhesions in the intestines are formed due to mechanical traumatic damage when blood is released into the abdominal cavity during intestinal failure. The disease can develop against the background of a foreign object entering the intestine, which disrupts the patency of the organ, resulting in inflammation. Toxins and poisonous substances also cause adhesions. Scars appear as a complication after a previous operation on the abdominal organs, as a result of a disease of the genitourinary system.

Scars in the intestines are formed as a result of a disorder in the organ's ability to resolve inflammatory scars, as a result of which specific intestinal tissues are replaced by ordinary connective epithelium. When intestinal injury occurs, a special substance is formed at the site of the wound - exudate, which promotes rapid healing of the injury site by releasing a special substance that envelops the wound. A scar forms at this site, which under normal circumstances resolves as the wound heals. But it happens that this does not happen, resulting in adhesions.

Characteristic signs

If a person develops adhesions in the intestines, the first symptom is the manifestation of a feeling of pain in the place where the scar is localized. If treatment is not started in time, then the painful sensation spreads throughout the lower abdomen, interfering with full functioning. In some cases, scars do not cause severe pain; the patient feels discomfort in the abdomen, which intensifies and then subsides. Over time, the number of attacks increases, the patient feels unwell, loses weight, and other disturbances in the functioning of the body develop along the way: problems with the respiratory and cardiovascular systems appear. Due to intestinal obstruction, a process of intoxication begins in the body, when decay products are not eliminated fully and naturally. The patient becomes ill, has attacks of angina pectoris and suffocation, dizziness, and loss of consciousness. The patient is plagued by the following symptoms of acute adhesive obstruction:

• nausea and frequent bouts of vomiting;
• constant constipation, due to which a large amount of gas is formed in the intestines;
• heaviness in the stomach due to the fact that food is not fully digested and stagnates in the organs of the gastrointestinal tract.

If you have such symptoms and have regular pain attacks in the abdominal area, you should immediately seek medical help, since delay and untimely treatment causes serious complications that can only be eliminated through surgery. To make a final diagnosis and begin adequate treatment, the doctor refers the patient to diagnostic studies and tests.

Diagnosis of adhesive intestinal obstruction

Intestinal obstruction is a dangerous disease, so in order to identify it, the patient needs to undergo a thorough diagnostic examination. For this disease, the doctor most often prescribes an MRI, CT, ultrasound or X-ray examination using contrast. Thanks to these research methods, it will be possible to establish an accurate diagnosis without causing discomfort or pain to the patient. Before undergoing any type of research, you need to prepare, since the accuracy and information content of the result will depend on this. When the diagnosis of adhesive obstruction of the organ is confirmed, the doctor selects an appropriate treatment regimen.

Treatment of the disease

Treatment of the disease depends on the nature and symptoms of its manifestation. If the disease is detected at an early stage, then the doctor prescribes intravenous injections to speed up the process of resorption of adhesions. In addition, a therapeutic diet is prescribed that will help the organs of the gastrointestinal tract recover. Therapeutic exercise and daily routine are also mandatory elements in curing the disease.

If the disease is identified late and it is advanced, then in this case only conservative surgical intervention will help. It is important to have surgery on time, since inflammatory processes in the intestines provoke tissue necrosis. The day before the operation, the patient undergoes intestinal lavage. If the patient is admitted to the hospital in serious condition, he is urgently taken to the intensive care unit and provided with the necessary medical care. The operation is done in the following ways:

1. when a large incision is made in the abdominal cavity, in other words - laparotomy;
2. when a small incision is made and the operation occurs with video assistance;
3. During the operation, a small puncture is made, without cutting the walls of the organ. This type of operation is the safest, the person is exposed to minimal danger, the recovery period is short, and the postoperative scar is practically invisible.

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The functioning of the digestive system plays an important role in the life of every person. Various types of disturbances occurring in this area cause discomfort to people and significantly worsen the quality of life. The most common digestive tract disorder is diarrhea. A much more dangerous and quite rare disease is adhesive intestinal obstruction. Every person who is concerned about their own health needs to have an idea of ​​how pathology manifests itself and is diagnosed.

A little theory

From the name of the disease “adhesive intestinal obstruction,” it can be assumed that this deviation is the formation of adhesions in the abdominal cavity, which cause difficulty in passing feces. In scientific terms, the pathology is a violation of passage through the intestines. Obstruction can be mechanical or dynamic:

1. Mechanical intestinal obstruction is diagnosed in 80% of patients. It is caused by tissue damage (surgery, trauma, peritonitis, cesarean section).
2. Dynamic obstruction is detected less frequently. This type of pathology occurs as a result of a sharp spasm of the digestive tract, which may be caused by poisoning, poor diet, consumption of poisons, or an inflammatory process. The mucous membranes secrete a substance that glues tissues together, forming durable films.

The adhesions that appear in the intestines are so-called cords. They can glue loops together (horizontally or vertically), and also attach the digestive tract to the abdominal wall. Much less often, adhesions tighten the intestines with other organs located nearby.

Classification

Adhesive intestinal obstruction can be divided into types. Each of them has distinctive features.

1. Complete obstruction (is the most dangerous option for the development of pathology). When the intestines are completely blocked, a person’s life is threatened.
2. Partial obstruction (diagnosed in more than 50% of all cases). The danger of this disease depends on which part of the intestine is damaged and by how much.

According to the nature of the disease, it is divided into chronic and acute. In the latter case, more pronounced symptoms are present, and the disease is easier to diagnose. Also, adhesions formed in loops can have the following forms:

• obstructive - adhesions compress the loops, but do not disrupt blood circulation and other important functions of the digestive tract;
• strangulation - invisible films compress the intestinal mesentery, which, in the absence of proper treatment, often leads to its gradual death (necrosis);
• dynamic - the extensive process of formation of adhesions slows down the passage of intestinal contents.

It is important to know about the symptoms of the disease. Often people have no idea about the existing pathology and self-medicate. Such a negligent attitude towards one’s own health is fraught with all sorts of troubles.

How does the disease manifest?

Depending on the type and stage of the disease, as well as associated factors and the general well-being of the patient, different symptoms may appear. Absolutely all types of intestinal obstruction are accompanied by painful sensations. Women who have had the opportunity to give birth to children compare this condition with contractions. During a spasm of smooth muscles, the pain increases, and when relaxed, it decreases. The patient can talk about unpleasant sensations and indicate where they occur (locally). But much more often the pain spreads throughout the entire peritoneum. In addition, the disease is manifested by the following symptoms:

Timely correct diagnosis and assistance provided are the key to a favorable outcome.

Diagnosis at home and at the doctor

Despite all the recommendations, many patients try to independently determine the cause of abdominal pain. They are guided by different reasons: some don’t have enough time, others are afraid. How to determine at home that adhesive obstruction has occurred? Pay attention to the following indicators.

• the stomach hurts crampingly, the patient wants to take the fetal position, tuck his legs;
• during the last 24 hours there has been no stool or gas;
• attempts to go to the toilet are unsuccessful;
• the amount of urine and the frequency of the urge to urinate decreases;
• there is no appetite, there is vomiting or nausea, unpleasant belching.

Doctors use different methods to make a diagnosis: palpation, ultrasound, x-rays, use of a contrast medium, laparoscopy. Anamnesis must be taken into account and a survey is carried out, since one of the common causes of the formation of adhesions is previous surgical intervention.

What can't you do?

Treatment of intestinal obstruction at home very often begins with the wrong actions. It is important to remember what you should not do if the signs are described:

Before using any other medication, be sure to read the instructions. If intestinal obstruction is indicated in the contraindications column, then taking medications is not only useless, but also dangerous.

Treatment at home

Gastrointestinal colic caused by the formation of adhesions can sometimes be treated at home. It is important to remember the basic rule: if it hasn’t gotten better for several hours, and the pain only gets worse, then you need to call an ambulance or go to the nearest hospital as an emergency.

Herbs

In case of incomplete or partial intestinal obstruction, it is permissible to use plant decoctions. Anti-inflammatory drugs that soothe and indirectly reduce pain are ideal. You can brew:

• chamomile;
• sage;
• lemon balm.

To do this, pour a glass of boiling water over a spoonful of dry herbs and leave until it cools. The decoction is taken warm during the day. If there is increased gas formation in the intestines, you can use a decoction of fennel or dill seeds (the method of preparation is the same).

How can I help myself?

In order for gases to leave the intestines faster, you need to take a knee-elbow position. The head should be placed as low as possible. The back should form an angle with the surface on which the patient is located. The bigger it is, the better. Being in this position provokes the rise of gases and their unhindered exit.

Important: this method only works for incomplete intestinal obstruction.

Nutrition

When there is an intestinal blockage, meals should be minimal and fractional. It is not recommended to eat hard and solid foods. Bran, which is so beneficial for the human body, is strictly prohibited. Any food that is not digested can cause serious harm.

Preference should be given to soft foods: broths, pureed soups, pureed masses. Vegetables and fruits must undergo heat treatment before consumption. Fermented milk products, fatty meats, smoked foods, alcohol and carbonated drinks are prohibited.. You need to eat in small doses every 2-3 hours.

Intestinal obstruction in children

In newborn babies and children under the age of one year (usually 4-7 months), a pathology called “intussusception” may occur. This condition is characterized by the fact that one loop can seem to penetrate into another. As a result, the intestines become blocked. The signs of this condition are as follows:

• restless behavior, poor sleep;
• refusal to eat, vomiting;
• sudden bouts of crying, which are replaced by normal behavior;
• the child kicks his legs, his stomach is swollen;
• There is no stool, no gas either.

This pathology most often occurs in overweight children. If you consult a doctor in time and receive qualified help, the prognosis will be favorable. Treatment for intussusception of intestinal loops involves straightening them. The procedure involves pumping the excretory system with air, but this method is effective only for 12-18 hours after the event. In other situations, surgical intervention is performed.

Let's summarize

Intestinal obstruction is a very serious pathology that can be fatal. Doctors have several treatment tactics. The choice will depend on the clinical picture and type of obstruction, the number of adhesions. Hospitalization is carried out in 95% of cases when this diagnosis is confirmed.

Laparoscopy is widely used in the treatment of pathology. The operation allows you to separate the loops and remove adhesions without unpleasant consequences.

– a disorder in the passage of the contents of the digestive tract as a result of the formation of rough cicatricial adhesions in the abdominal cavity. Pathology is caused by various reasons, but most often it is a consequence of surgical intervention. The disease is characterized by severe pain and asymmetrical bloating, vomiting, inability to pass gas and stool, and a gradual increase in signs of intoxication. Diagnosis consists of conducting a survey radiography of the abdominal organs, ultrasound, CT and MRI. Tactics depend on the form of the pathology and the time of its appearance; As a rule, a repeat operation is performed.

General information

Adhesive intestinal obstruction is a violation of the movement of food masses and digestive juices through the intestines, associated with the formation of adhesions. This is a fairly common pathology, which is a serious problem in surgery and gastroenterology, it occupies approximately 30-40% of all types of intestinal obstruction. It appears equally often in both men and women, regardless of age. The relevance of the disease has recently increased significantly due to the increase in the number and volume of surgical interventions on the abdominal organs. According to many authors, approximately 40% of all operations are accompanied by the appearance of adhesions, while up to 60% of all laparotomies are performed for adhesive intestinal obstruction.

Causes of adhesive intestinal obstruction

The reasons for the formation of adhesions can be traumatic injuries, bleeding into the abdominal cavity, ischemia of the gastrointestinal tract, foreign bodies, negative effects of toxins, purulent processes in the abdominal cavity (peritonitis, appendicular abscess, etc.), surgical interventions during which the peritoneum is dried out ( most often these are appendectomies, operations for pathology of the uterus and appendages), genetic predisposition.

The mechanism of formation of adhesions is explained by a disorder in the processes of resorption of inflammatory elements and their replacement by connective tissue. It is known that the peritoneum, in response to injury and any impact, produces exudate, which has adhesive properties. Connective tissue fibers are formed from its cells, fibrin gradually falls out, which should be absorbed after the healing process is completed. If this does not happen, it grows with collagen and elastic fibers, vessels - this is how adhesions are formed.

Symptoms of adhesive intestinal obstruction

Adhesive intestinal obstruction is divided into three types: obstructive, strangulation and combined (with signs of mechanical and dynamic type: usually develops when adhesions form between the focus of inflammation in the abdominal cavity and intestinal loops). There are also hyperacute, acute and chronic forms of pathology, which differ in the speed of development, severity and severity of symptoms.

The obstructive type of pathology is caused by compression of intestinal loops by adhesions, but they do not disrupt its blood supply and innervation. Painful sensations appear suddenly, they are associated with increased peristalsis and are paroxysmal in nature. The time at which vomiting with bile and greens appears depends on the level of the obstruction: the higher the obstruction, the faster the vomiting develops. The patient experiences uniform bloating, gases are disturbed, and constipation occurs. The doctor can see bowel movements through the abdominal wall and detect increased sounds.

Strangulation is characterized by compression of the intestinal mesentery and is complicated by necrosis of the digestive tract. Clinical signs develop acutely and suddenly: severe abdominal pain without clear localization, pale skin, the patient cannot find a comfortable position, and refuses to eat. Intestinal necrosis may cause symptoms to subside, but only for a short time. Vomiting is without impurities, it is of a reflex nature and is caused by trauma to the mesentery. Gradually, there is a delay in the passage of gas and stool. Signs of toxicosis increase rapidly (increased heart rate, changes in blood pressure, weakness, dizziness, dehydration, etc.). At first, the abdomen is soft, but pain causes tension in the abdominal muscles. Peristalsis is invisible to the naked eye.

Adhesive intestinal obstruction, as a rule, is a complication of surgical procedures, and it can develop at different times. In patients with severe peritonitis, pathology is recorded in the first days after surgery. The serious condition of patients and pronounced signs of the underlying pathology mask the symptoms of obstruction. Patients are bothered by periodic cramping pain and vomiting. Asymmetrical bloating gradually develops. Palpation is painful, touching the muscles causes increased pain. There is no chair.

Adhesive obstruction sometimes develops 5-13 days after surgery and improvement in general condition, or 3-4 weeks. In this case, distinct symptoms of the disease are observed: intense periodic pain, frequent vomiting mixed with bile, asymmetrically swollen abdomen, visible peristalsis, increased bowel sounds. Symptoms gradually increase, independent stool disappears and the patient’s condition sharply worsens.

If the disease develops after a long period of time after the surgical procedure, it is called late adhesive intestinal obstruction. The pathology is characterized by the sudden onset of cramping pain, frequent vomiting, severe anxiety and a forced position of the patient. Gases and stools do not pass away on their own. The abdomen is asymmetrically swollen, touching it increases attacks of pain, and peristalsis of the intestinal loops is clearly visible. The patient quickly develops signs of intoxication.

Diagnosis of adhesive intestinal obstruction

Adhesive intestinal obstruction can be suspected based on clinical signs and history of previous surgery on the abdominal organs. The main diagnostic methods are considered to be radiological: survey radiography of the abdominal cavity and after contrasting the intestines with a suspension of barium sulfate. These studies make it possible to determine the distension of intestinal loops, Kloiber's cups (swollen areas of the digestive tract containing liquid and gases), darkening of the lower abdomen, contrast retention in individual loops, etc.

In recent years, laparoscopy, abdominal ultrasound, CT and MRI have been increasingly used as diagnostic methods. They help the gastroenterologist and surgeon identify the cause of the pathology, as well as the severity and type of damage.

Treatment of adhesive intestinal obstruction

Therapeutic procedures depend on the type of pathology and time of its onset, as well as the general condition of the patient and concomitant diseases. Treatment of early adhesive intestinal obstruction must begin with conservative methods that allow you to restore the functions of the digestive system and are often preoperative preparations. It is very important to correctly calculate the permissible period of conservative therapy, and if there are no positive results, immediately perform surgery.

When early signs of the disease are registered, all patients are prescribed parenteral (intravenous) nutrition, as well as measures that improve intestinal motility, prevent the development of intoxication and normalize the general condition. If symptoms of the disease appeared 2-3 days after the surgical procedure against the background of intestinal paresis and peritonitis, then it is necessary to eliminate the paretic component of the obstruction: for this purpose, trimecaine is injected into the epidural space. Along with this, gastric lavage, siphon enemas are prescribed, hypertonic sodium chloride solution and neostigmine are infused intravenously. All of the above procedures are carried out in courses (about 2-3) within 24 hours. In the absence of positive dynamics, laparotomy is performed 5-6 hours after the appointment of therapy.

If early strangulation obstruction is suspected, short-term conservative treatment is indicated, followed by surgery followed by supportive therapy and care. Treatment of late obstruction is always surgical; delay can cause necrotic changes in the intestinal walls. Before the surgical procedure, preparations are carried out: the stomach is washed, a siphon enema is done, proserin is administered. If after 2-3 hours the pain subsides and signs of pathology disappear, then the patient is left in the department under observation and anti-adhesion therapy is prescribed. Otherwise, an operation is immediately performed to separate adhesions, apply a bypass anastomosis, or resection of a section of intestine (the type of intervention is selected individually).

If the patient is taken to the hospital in serious condition, intensive therapy is prescribed to eliminate signs of intoxication, minimal preoperative preparation is given, and the surgical procedure begins immediately.

Prevention and prognosis of adhesive intestinal obstruction

Prevention of adhesive intestinal obstruction consists of careful operation, prevention of drying out of the peritoneum and administration of dry drugs, timely evacuation of blood and foreign objects. After surgery, physical therapy has a good effect: UHF, electrophoresis, as well as physical therapy and diet. The prognosis of adhesive intestinal obstruction with timely diagnosis and rational therapy is favorable, but the likelihood of relapse of the pathology is high.