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 Intestinal obstruction

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تاريخ التسجيل : 02/04/2008

مُساهمةموضوع: Intestinal obstruction   الجمعة 17 أكتوبر 2008, 21:51





Alternative Names



Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus



Definition





Intestinal obstruction involves a partial or complete blockage of the
bowel that results in the failure of the intestinal contents to pass
through.



Causes




Obstruction of the bowel may be caused by ileus -- in which the bowel
doesn't function correctly but there is no "mechanical" (anatomic)
problem -- or by mechanical causes. Paralytic ileus, also called
pseudo-obstruction, is one of the major causes of obstruction in
infants and children.





Ileus - X-ray of distended bowel and stomach






Ileus - X-ray of bowel distension



The causes of paralytic ileus may include the following:



Medications, especially narcotics


Intraperitoneal infection


Mesenteric ischemia (decreased blood supply to the support structures in the abdomen)


Injury to the abdominal blood supply


Complications of intra-abdominal surgery


Kidney or thoracic disease


Metabolic disturbances (such as decreased potassium levels)


Paralytic ileus may lead to complications causing jaundice and
electrolyte imbalances. In the newborn, paralytic ileus that is
associated with destruction of the bowel wall (necrotizing
enterocolitis) is life-threatening and may lead to infection in the
infant's blood and lungs.



In older children, gastroenteritis may be a cause of paralytic ileus,
which is sometimes associated with peritonitis and a ruptured appendix.



Paralytic ileus is marked by abdominal distention, absent bowel sounds
(no noise heard when listening to abdomen), and abdominal pain.



Mechanical obstruction occurs when movement of material through the
intestines is physically blocked. The mechanical causes of obstruction
are numerous and may include the following:



Hernias


Postoperative adhesions or scar tissue


Impacted feces (stool)


Gallstones


Tumors blocking the intestines


Granulomatous processes (abnormal tissue growth)


Intussusception


Volvulus (twisted intestine)


Foreign bodies (ingested materials that obstruct the intestines)


If the obstruction blocks the blood supply to the intestine, the tissue
may die, causing infection and gangrene. Risk factors for tissue death
include intestinal malignancy, Crohn's disease, hernia, and previous
abdominal surgery.





Intussusception - X-ray






Symptoms




Abdominal fullness, gaseous


Abdominal distention


Abdominal pain and cramping


Vomiting


Failure to pass gas or stool (constipation)


Diarrhea


Breath odor



Exams and Tests




While listening to the abdomen with a stethoscope your health care
provider may hear high-pitched bowel sounds at the onset of mechanical
obstruction. If the obstruction has persisted for too long or the bowel
has been significantly damaged, bowel sounds decrease, eventually
becoming silent.





Small bowel obstruction - X-ray




Early paralytic ileus is marked by decreased or absent bowel sound.



Tests that show obstruction include:




Barium enema


Abdominal CT scan


Upper GI and small bowel series


Abdominal film



Treatment




The objective of treatment is to decompress the intestine with suction,
using a nasogastric (NG) tube inserted into the stomach or intestine.
This will relieve abdominal distention and vomiting.



Surgery to relieve the obstruction may be necessary if decompression by
NG tube does not relieve the symptoms, or if tissue death is suspected.



Outlook (Prognosis)




The outcome varies with the cause of the obstruction.



Possible Complications




Infection


Gangrene of the bowel


Perforation (hole) in the intestine


When to Contact a Medical Professional Return to top



Call your health care provider if persistent abdominal distention
develops and you are unable to pass stool or gas, or if other symptoms
of intestinal obstruction develop.



Prevention




Prevention depends on the cause. Treatment of conditions (such as
tumors and hernias) that are related to obstruction may reduce the risk.



Some causes of obstruction are not preventable

_________________




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