Intestinal obstruction

An intestinal obstruction means blockage of the small or large intestine and the blockage might be partial or total, thus it prevents the passage of fluids as well as digested food particles.

Classification of intestinal obstruction

1. Dynamic:- Here peristalsis happens against of mechanical obstruction and might occur in an acute or chronic way.
2. Adynamic:- There is absent or inadequate peristalsis and no mechanical obstruction for example paralytic Iles or pseudo-obstruction.

Clinical classification

1. Small bowel obstruction – high or low2. Large bowel obstruction.
Classification on the basis of nature 
1. Complete 2. Incomplete, partial or subacute.
Other classification
1. Simple 2. Strangulating/ strangulated 

Causes of intestinal obstruction

A. In dynamic type it’s can be intraluminal, intramural, and extraluminal.
• Intraluminal:- Such as Faecal impaction, foreign bodies, bezoars, gallstones.
• Intramural:- Such as strictures, malignancy,intussusception, volvulus.
• Extramural :- Such as bands or adhesions, hernia.
B. In adynamic type causes can be 

• Paralytiu ileus •Psedo- obstruction

Causes of strangulation

A. Direct pressure on the bowel wall 

• Hernial orifices  • Adhesions or bands 

B. Interrupted Mesenteric blood flow

• Volvulus • Intussuscepion

C. Increased intraluminal pressure

• Closed – loop obstruction

Clinical features of Intestinal obstruction

• In case of dynamic intestinal obstruction their present pain, distension , vomiting, and absolute constipation.
• In case of high small bowel obstruction, early vomiting, perfused and patient get quickly dehydrated.On radiological findings minimal distension with little evidence of dilated small bowel loops.
• In low bowel obstruction, pain significant with central distension and delayed vomiting. On radiological findings there present multiple dilated small bowel loops.

• In case of large bowel obstruction, early distension marked, less pain vomiting, and dehydration are late features. On abdominal radiological findings, the colon proximal to the obstruction is distended.
• In case of complete small bowel obstruction following cardinal fractures present such as :- abdominal pain , distension abdomen, vomiting, and absolute constipation.
• Clinical presentation varies according to location , duration, underlying pathology as well as the presence or absence of intestinal ischemia.

• Late manifestations include dehydration, oliguria, hypovolemia, shock, pyrexia, septicemia, respiratory problems and peritonism.
• Pain initial symptom and occurs suddenly and usually severe. It’s colicy type. In the case of small bowel obstruction pain usually centered on the umbilicus and lower abdominal pain in case of large bowel.
• Other clinical features such as Hypokalemia, pyrexia, abdominal tenderness, bowel, dehydration ( mostly small bowel obstruction because of repeated vomiting and fluid sequestration and it results in dry tongue and skin, poor venous filling and sunken eyes with oliguria and result rise in blood urea level and hematocrit increase, result a secondary polycythemia).

• Intestinal obstruction due to strangulation there present constant and severe pain , generalized abdominal tenderness with rigidity and peritonism, and shock may also occurs.

Investigation of Intestinal obstruction

• Clinical evaluations, family history any medical as well diseased conditions are required.
• Abdominal X-ray.
• CT
•  Abdominal USG 
• Air or barium enema
• Blood tests for blood counts, LFT, and RFT and levels of electrolytes need to evaluate.
• Colonoscopy used to evaluate for the large intestine.

Complications of Intestinal obstruction

• Dehydration. • Perforation of the bowel that leads to infection. • Dearranged electrolyte levels. • Renal failure . • Peritonitis. • Multiple organ failures. • septic shock. • Death