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Intestinal Obstruction

Overview

Digested food particles must travel through 25 feet or more of intestines as part of normal digestion. These digested wastes are constantly in motion. However, intestinal obstruction can put a stop to this. An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food.

If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage. If enough pressure builds up, your intestine can rupture, leaking harmful intestinal contents and bacteria into your abdominal cavity. This is a life-threatening complication.

There are many potential causes of intestinal obstruction. Often, this condition can’t be prevented. Early diagnosis and treatment are crucial. An untreated intestinal obstruction can be fatal.

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Symptoms

Symptoms of intestinal obstruction

Intestinal obstruction causes a wide range of uncomfortable symptoms, including:

  • severe bloating
  • abdominal pain
  • decreased appetite
  • nausea
  • vomiting
  • inability to pass gas or stool
  • constipation
  • diarrhea
  • severe abdominal cramps
  • abdominal swelling

Some of the symptoms may depend on the location and length of time of the obstruction. For example, vomiting is an early sign of small intestine obstruction. This may also occur with an obstruction of your large intestine, if it’s ongoing. A partial obstruction can result in diarrhea, while a complete obstruction can result in an inability to pass gas or stool.

Intestinal obstruction may also cause serious infection and inflammation of your abdominal cavity, known as peritonitis. This occurs when a portion of your intestine has ruptured. It leads to fever and increasing abdominal pain. This condition is a life-threatening emergency requiring surgery.

Causes

Causes of intestinal obstruction

An obstruction can be partial, which may resolve without surgery. A complete blockage is more likely to need intestinal surgery.

Mechanical obstructions

Mechanical obstructions are when something physically blocks your intestine. In the small intestine, this can be due to:

  • adhesions, which consist of fibrous tissue that can develop after any abdominal or pelvic surgery or after severe inflammation
  • volvulus, or twisting of the intestines
  • intussusception, a “telescoping,” or pushing, of one segment of intestine into the next section
  • malformations of the intestine, often in newborns, but can also occur in children and teens
  • tumors within your small intestine
  • gallstones, although they rarely cause obstructions
  • swallowed objects, especially in children
  • hernias, which involve a portion of your intestine protruding outside of your body or into another part of your body
  • inflammatory bowel disease, such as Crohn’s disease

Although less common, mechanical obstructions can also block your colon, or large intestine. This can be due to:

  • impacted stool
  • adhesions from pelvic infections or surgeries
  • ovarian cancer
  • colon cancer
  • meconium plug in newborns (meconium being the stool babies first pass)
  • volvulus and intussusception
  • diverticulitis, the inflammation or infection of bulging pouches of intestine
  • stricture, a narrowing in the colon caused by scarring or inflammation

Nonmechanical obstruction

Your small and large intestines normally work in a coordinated system of movement. If something interrupts these coordinated contractions, it can cause a functional intestinal obstruction. This is generally known as a nonmechanical obstruction. If it’s a temporary condition, it’s referred to as an ileus. It’s called a pseudo-obstruction if it becomes chronic, or long term.

Causes for ileus include:

  • abdominal or pelvic surgery
  • infections, such as gastroenteritis or appendicitis
  • some medications, including opioid pain medications
  • electrolyte imbalances

Intestinal pseudo-obstruction can be caused by:

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In infants

Intestinal obstruction in infants

Intestinal obstruction in infants typically arises from infections, organ diseases, and decreased blood flow to the intestines (strangulation). Some children experience the condition after having a stomach flu. This can cause inflammation in their intestines.

Intussusception is most common in children 2 years old and younger. This occurs when one part of their bowel collapses or slides into another part. As a result, their intestine becomes blocked.

Any type of intestinal obstruction is difficult to diagnose in infants because they can’t describe their symptoms. Instead, parents must observe their children for changes and symptoms that could indicate a blockage. Examples include:

  • abdominal swelling
  • drawing knees up to their chest
  • appearing excessively drowsy
  • having a fever
  • grunting in pain
  • passing stools that appear to have blood in them, known as a currant jelly stool
  • very loud crying
  • vomiting, particularly bile-like vomiting that is yellow-green
  • displaying signs of weakness

If you notice these symptoms or other changes in your child, seek immediate medical attention.

See a doctor

When to see a doctor

Seek medical care if you have symptoms of an intestinal obstruction, especially if you’ve recently undergone abdominal surgery. If you experience abdominal bloating, severe constipation, and a loss of appetite, seek immediate medical attention.

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Diagnosis

How intestinal obstruction is diagnosed

First, a doctor may push on your abdomen to examine it. They then listen with a stethoscope to any sounds being made. The presence of a hard lump or particular kinds of sounds, especially in a child, may help determine whether an obstruction exists.

Other tests include:

  • blood tests for blood counts, liver and kidney function, and levels of electrolytes
  • X-rays
  • CT scan
  • colonoscopy, a flexible lighted tube that your doctor uses to look at your large intestine
  • enema with contrast
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Complications

Potential complications

Treatment is essential to reduce complications such as:

  • dehydration
  • electrolyte imbalances
  • perforation, or a hole that forms in your intestines, which leads to infections
  • kidney failure

If the obstruction is preventing blood from getting to a segment of intestine, this can lead to:

  • infection
  • tissue death
  • intestinal perforation
  • sepsis, a life-threatening blood infection
  • multiple organ failure
  • death

For some people with a chronic obstruction due to a stricture or narrowing of their intestine, a doctor may place a metal stent that expands inside the intestine using a long tube called an endoscope. The stent, a wire mesh, holds open the intestine. The procedure may not require cutting into the abdomen, and it’s usually used if a person isn’t a candidate for traditional surgery.

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Treatment

Treating intestinal obstruction

Treatment depends on the location and severity of the obstruction. Don’t attempt to treat the problem at home. The appropriate treatment depends on the type of intestinal obstruction.

For partial obstructions or an ileus, it may be possible to treat by simply resting the bowels and giving intravenous (IV) fluids. Bowel rest means you’ll be given nothing to eat, or clear liquids only, during that time. If the cause of the obstruction is known, your doctor treats that as well.

Treating dehydration is important. A doctor may give you IV fluids to correct electrolyte imbalance. A catheter may be inserted into your bladder to drain urine.

A tube may need to be passed through your nose and down into your throat, stomach, and intestines to relieve:

  • pressure
  • swelling
  • vomiting

If your problem is due to the use of narcotic pain medications, your doctor can prescribe medication that reduces the effect of the narcotics on your bowels.

Surgery will be required if these measures fail or if your symptoms become worse. Treatment in this case typically requires a hospital stay. You’ll be given IV fluids, because in addition to relieving dehydration, they help prevent shock during surgery.

A severe complication of a bowel obstruction can be permanent damage to your intestine. If this occurs, a surgeon will perform an operation to remove the section of dead tissue and rejoin the two healthy ends of your intestine.

While prescription medications can’t treat the obstruction itself, they can help reduce your nausea until further interventions are performed. Examples of medications your doctor may prescribe include:

  • antibiotics to reduce infection
  • antinausea medicines to keep you from vomiting
  • pain relievers

You shouldn’t ignore the symptoms of an intestinal obstruction or attempt to treat an intestinal obstruction at home.

Outlook

Outlook for intestinal obstruction

When left untreated, intestinal obstruction can cause the tissue in the affected part of your intestine to die. It can also lead to a hole, or perforation, in the wall of your intestine, severe infection, and shock.

Overall, the outlook of your condition depends on its cause. Most cases of intestinal obstruction are treatable. However, other causes, such as cancer, require long-term treatment and monitoring.

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