Intestinal obstruction is a blockage that occurs in the intestine, both small intestine and large intestine. This condition can cause problems with the absorption of food or fluids in the digestive tract. If not treated immediately, the blockage of the intestine can die and cause serious complications.
Blockages in the intestines cause a buildup of food, fluids, stomach acid, and gas. This condition will put pressure on the intestines. When the pressure is greater, the intestine can tear, and expel its contents (including bacteria), into the abdominal cavity.
Symptoms of Intestinal Obstruction
Intestinal obstruction can be recognized by the following symptoms:
- Abdominal cramps that come and go.
- Bloated.
- Constipation or diarrhea.
- Swollen belly.
- Nausea and vomiting.
- Lost appetite then
- Difficulty passing gas, because bowel movements are disturbed.
Reason and Risk Factors Intestinal Obstruction
Based on the cause, intestinal obstruction is divided into two types, namely mechanical and non-mechanical. Here is the full explanation.
Mechanical bowel obstruction
Mechanical bowel obstruction occurs when the small intestine becomes blocked. This can be triggered by intestinal adhesions or adhesions, which usually appear after abdominal or pelvic surgery. Other conditions that can trigger a mechanical bowel obstruction are:
A hernia that causes the intestine to protrude into the abdominal wall.
- Inflammation of the intestines, such as Crohn's disease.
- Swallowed foreign body (especially in children).
- Gallstones
- Diverculitis.
- Intussusception or intestine that folds inward.
- Meconium plug (the baby's first stool that doesn't come out).
- Colon or ovarian cancer (ovarian).
- Narrowing of the colon due to inflammation or scar tissue, for example due to intestinal tuberculosis.
- Accumulation of feces.
- Volvulus or twisted bowel condition.
Non-mechanical bowel obstruction
Nonmechanical bowel obstruction occurs when there is a disturbance in the contraction of the large intestine and small intestine. Disturbances may occur temporarily (ileus), and can occur in the long term (pseudo-obstruction).
Nonmechanical bowel obstruction is triggered by a number of conditions, such as:
- Abdominal or pelvic area surgery.
- Gastroenteritis or inflammation of the stomach and intestines.
- Appendicitis or inflammation of the appendix.
- Electrolyte disturbances.
- Hirschsprung's disease.
- Nervous disorders, eg Parkinson's disease or multiple sclerosis.
- Hypothyroidism
- Use of drugs that affect muscles and nerves. For example, tricyclic antidepressants, such as amitriptyline, or pain medication oxycodone.
Intestinal Obstruction Diagnosis
To determine whether the patient is suffering from intestinal obstruction, the doctor will first ask about the symptoms experienced and their medical history. Then, the doctor will perform a physical examination by listening to bowel sounds using a stethoscope. Patients can be suspected of having intestinal obstruction if the abdomen looks swollen, painful, or there is a lump in the abdomen.
Furthermore, supporting examinations will be carried out to strengthen the diagnosis, such as X-ray examination, CT scan, or ultrasound of the abdomen. These imaging tests can help doctors pinpoint the location of the blockage.
Another method used to confirm the diagnosis of intestinal obstruction is X-ray examination with the help of barium enema or air. This procedure is performed by introducing barium liquid or air into the patient's intestine through the anus. The barium liquid or air serves to see the intestines in more detail during X-ray examinations.
Intestinal Obstruction Treatment
Treatment of bowel obstruction depends on the underlying cause. Patients need to be hospitalized for treatment which includes:
- Insertion of a nasogastric tube (feeding tube). The insertion of this feeding tube is not intended to provide food directly to the stomach, but to drain the gastric contents to the outside, thereby reducing complaints of swollen stomach. A nasogastric tube will be inserted through the nose into the stomach.
- Catheter insertion. A catheter is placed to empty the patient's bladder.
- Administration of fluids by infusion. This action is to restore the electrolyte balance in the patient's body.
In addition to the above treatment, surgery can also be recommended in cases of intestinal obstruction. Bowel obstruction surgery should ideally be preceded by fasting. However, because this condition is sometimes classified as an emergency, fasting is often not possible.
Intestinal obstruction surgery is performed by first giving the patient general anesthesia. The method of surgery can be done by open surgery or surgery with minimal incisions (the size of a keyhole) using special tools such as a camera tube (laparoscopy).
The choice of method of action depends on the location and size of the obstruction, as well as the underlying cause. For example, in obstruction caused by adhesions that have spread widely or large tumors, the doctor will perform open surgery. Meanwhile, if the obstruction occurs due to infection or a small tumor, it is sufficient to treat it with laparoscopic surgery.
Types of treatment for bowel obstruction include:
- Colectomy. Colectomy or bowel cutting is surgery to remove all or part of the intestine, both the small intestine and the large intestine. This procedure is performed when the intestinal obstruction is caused by a tumor. Colectomy can be performed by open surgery or by laparoscopy.
- colostomy. A colostomy is a procedure for making a stoma (hole) in the abdominal wall, as a way of removing feces. This procedure is performed when the patient's intestines are damaged or inflamed. A colostomy can be made permanent or temporary.
- Adhesion release surgery (adhesiolysis). Intestinal adhesions or adhesions can be freed by open or laparoscopic surgical methods. Open surgery is performed by making a long incision in the patient's abdomen, so that the doctor can see the condition of the internal organs directly. Meanwhile, laparoscopy uses special tools such as a camera tube to display an image of the internal organs of the abdomen, so it is enough to make several small incisions in the abdomen.
- Installation stent. In this procedure, stent (a tube-shaped net) is placed in the patient's intestine, to keep the intestinal tract open and prevent the blockage from occurring again. This procedure is performed when the obstruction occurs repeatedly, or if the intestine is severely damaged.
- Revascularization. Revascularization is a procedure to restore blood flow to normal. This procedure is performed when the patient has ischemic colitis, which is a condition in which the intestines become inflamed due to reduced blood supply.
Intestinal Obstruction Complications
If not treated immediately, intestinal obstruction can cause life-threatening complications, one of which is the death of intestinal tissue due to cessation of blood supply. This condition can trigger a tear (perforation) in the intestinal wall, resulting in peritonitis or infection in the abdominal cavity. Perforation with peritonitis is an emergency condition that needs to be treated immediately.