Intestinal Obstruction: Symptoms and Diagnosis

Intestinal Obstruction: Symptoms and Diagnosis

In the case of an intestinal obstruction (ileus), the intestine – as the name suggests – is closed so that leftover food can hardly or not at all be excreted. A blocked bowel can manifest itself suddenly and dramatically, for example, when a piece of bowel becomes trapped in a hernial sac or develops gradually and discreetly, for example, in the case of a slowly growing, constricting tumour. But no matter what clinical picture occurs, an intestinal obstruction is always a life-threatening emergency and must be treated immediately in the hospital.

Symptoms of mechanical bowel obstruction

 An obstacle (tumour, ball of faeces) that blocks the intestine is usually responsible for a mechanical intestinal obstruction. It can also happen that the intestine is constricted from the outside, such as in the case of adhesions or an injury.

The symptoms of a blocked bowel can vary depending on the cause and severity. However, the following signs are noticeable:

  • Intestinal contents back into the stomach, causing belchingnausea, and vomiting. In extreme cases, the patient has to vomit faeces (miserere).
  • Pain is caused by violent, spasmodic and relapsing intestinal contractions or simultaneous peritonitis.
  • As a result of the intestinal expansion, the abdomen is bloated (meteorism)

Caution: In the case of strangulation ileus, the affected section of the intestine is no longer supplied with blood. The pain then persists, the blood pressure drops, the pulse accelerates, and the patient vomits profusely (including stool).

Often, however, an ileus develops painlessly and over weeks to months. In the case of mechanical intestinal obstruction, if the obstruction is localized in the area of ​​the small intestine, regular bowel movements can be passed since the bowel movement is still liquid in this section of the intestine, and the liquid can easily pass through the narrowed section of the intestine.

If the food passage is not entirely interrupted but only restricted, one speaks of a “subileus”.

 

Symptoms of paralytic intestinal obstruction

Paralytic intestinal obstruction is caused by paralysis of the muscles in the intestinal wall. As a result, the intestinal contents can no longer be transported further.

The symptoms of the paralytic type are not as pronounced as those of the mechanical type and appear with a delay. Nausea and vomiting also occur, but since the bowel is paralyzed, no bowel sounds can be heard. In medicine, one then speaks of “grave or dead silence”.

The pain is constant and diffuse, so the patient cannot clearly say where the pain is coming from. A particularly characteristic feature of a paralytic intestinal obstruction is the bloated abdomen, which, in the event of additional peritonitis, can become a so-called rigid and tense “drum belly”. As the disease progresses, the patient may have to vomit liquid intestinal contents.

Intestinal obstruction: Diagnosis

A detailed medical history (anamnesis) is carried out if the patient’s condition permits. Evidence of repeated stomach ulcers, cramp-like pain immediately after eating (indication of a mesenteric infarction), or pain in the right lower abdomen (for example, due to appendicitis ) can help narrow down the various causes and initiate the necessary investigations.

Asking about the type of pain provides information about which organ could be affected. Sudden, severe and stabbing pain in the right upper abdomen is more likely to indicate gallbladder inflammation or a duodenal ulcer. If this pain radiates to the right back, it could be gallbladder inflammation. Therefore, the precise description of the extent of the pain is just as important as the description of the type of pain.

 

Further examinations by the doctor

The physical examination findings follow the medical history. A person affected by an intestinal obstruction often appears restless; their legs may be bent to reduce the tension in the stomach and allow for relief. The examination reveals defensive tension in the abdomen. This occurs at a specific point or is distributed over the entire abdomen. The abdomen is often generally tender.

The intestinal sounds can be assessed using the stethoscope. Metallic-sounding intestinal noises indicate mechanical ileus. On the other hand, a lack of intestinal sounds indicates a paralyzing intestinal obstruction.

The rectal examination (palpation of the rectum with a finger) can be painful, mainly if appendicitis has irritated the peritoneum.

Imaging studies

To assess the abdomen, x-rays are taken while standing or lying on the left side. In the event of an intestinal obstruction, crescent-shaped accumulations of air and fluid can be seen. Depending on the involvement, they are called minor or large intestines. Free air under the diaphragm is a sign of a “leak” in the gastrointestinal tract; the air often escapes through an inflamed and leaky mucous membrane area.

Ultrasound examination  (sonography) can be used to narrow down the cause of the intestinal obstruction. Pendulum peristalsis (intestinal contents are no longer transported) indicates a mechanical intestinal obstruction, and a lack of peristalsis indicates a paralyzing intestinal obstruction.

Computed tomography is a supplementary examination to assess the internal organs.

Information through values ​​in the blood

Depending on the cause of the intestinal obstruction, many blood values  ​​can be pathologically altered. The blood count enables the determination of white ( leukocytes ) and red ( erythrocytes ) blood cells, the red blood pigment haemoglobin and blood platelets ( thrombocytes ).

Blood loss leads to a reduction in haemoglobin. Inflammation, on the other hand, causes a significant increase in white blood cells. ESR, C-reactive protein and lactate dehydrogenase (LDH) are increased.

In addition, liver ​​and pancreatic values ​​can increase abnormally. As the disease progresses, the coagulation values ​​also deteriorate.

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