intestinal obstruction
Introduction
Introduction to intestinal obstruction Intestinalobstruction (ileus) refers to the intestinal contents being blocked in the intestine. For common acute abdomen, it can be caused by a variety of factors. At the beginning of the disease, the intestinal segment of the obstruction has anatomical and functional changes first, followed by the loss of body fluids and electrolytes, intestinal wall circulatory disorders, necrosis and secondary infections. Toxicemia, shock, death. Of course, if diagnosed in time, active treatment can mostly reverse the development of the disease, resulting in cure. basic knowledge Sickness ratio: 0.0004% Susceptible people: no specific people Mode of infection: non-infectious Complications: ischemic colic
Cause
Cause of intestinal obstruction
Mechanical intestinal obstruction (30%):
1. Intestinal foreign bodies: intestinal stones, parasites, large gallstones and fecal blocks are blocked or incarcerated.
2, intestinal polyps, new organisms, benign or malignant tumors or lymphoma blockage.
3, intussusception.
4, intestinal congenital anomalies: including congenital intestinal atresia, intestinal congenital fibrous curtain or hernia formation, Merkel diverticulum stenosis, etc., intestinal congenital abnormalities are generally less common.
5, intestinal or peritoneal inflammatory lesions: such as intestinal tuberculosis, Crohn's disease, tuberculous peritonitis, radiation enteritis and NSAIDs and other drugs caused by intestinal inflammatory ulcers caused by stenosis.
6, intestinal adhesions: often due to abdominal or pelvic surgery, or intra-abdominal chronic inflammatory lesions (such as tuberculous peritonitis, Crohn's disease, etc.), intestinal adhesions after surgery to the small intestinal adhesions.
7, sputum: such as inguinal hernia, intra-abdominal hernia, including retinal sac sputum, femoral hernia and other incarceration.
8, intestinal torsion: reversal is more common in mesenteric tumor or its basal stenosis and other reasons.
9, extra-intestinal tumors and other compression: such as intra-abdominal, omental, mesenteric giant tumor, retroperitoneal giant tumor, pancreatic pseudocyst, etc. can cause intestinal tube compression, severe intestinal obstruction, in recent years caused by intestinal compression The intestinal obstruction has an increasing trend.
Dysfunctional ileus (20%):
Dysfunctional ileus is caused by disorder of muscle activity in the intestinal wall, which leads to the inability of the intestinal contents to operate. Instead of mechanical factors causing intestinal obstruction inside and outside the intestinal cavity, it is also called pseudo-intestinal obstruction. The causes are:
1, paralytic ileus after surgery: common after surgery.
2, non-surgical paralytic ileus: common in:
(1) Electrolyte disorders (especially blood potassium, sodium, magnesium are more common).
(2) a variety of systemic or intra-abdominal inflammation, such as sepsis, intra-abdominal abscess, severe pancreatitis and pyelonephritis, pneumonia.
(3) Heavy metal poisoning.
(4) uremia.
(5) myelitis.
(6) hypothyroidism.
3, due to intestinal smooth muscle disease or intermuscular nerve plexus and other diseases caused by intestinal muscle dysfunction caused by intestinal obstruction, often referred to as chronic pseudo-intestinal obstruction, more common in the following lesions:
(1) intestinal smooth muscle lesions: such as progressive systemic sclerosis, connective tissue disease, amyloidosis, radiation damage and mitochondrial myopathy, etc., patients with primary familial visceral muscle disease are often accompanied by chronic pseudo-intestine obstruction.
(2) intestinal myenteric plexus lesions: can be seen in: a. neurogenic intestinal dysplasia, isolated intestinal dysplasia with neurofibromatosis, or with multiple endocrine neoplasia and myotonic dystrophy; b. Multiple recessive and dominant hereditary diseases; c. sporadic visceral neuropathy (including non-inflammatory degenerative diseases and degenerative inflammatory diseases such as American trypanosomiasis, cytomegalovirus infection, etc.); d. enteric nerves Or dysplasia dysplasia, such as myenteric plexus maturation disorders (often accompanied by central nervous system dysplasia and neuronal abnormalities), total colonic ganglion cell deficiency.
(3) Neuronal diseases: can be seen in Parkinson's disease, selective acetylcholine dysfunction and brain stem tumor after EB virus infection.
(4) Metabolic endocrine diseases: seen in mucinous edema, pheochromocytoma, hypoparathyroidism, acute intermittent porphyria.
(5) small bowel diverticulosis: seen in small intestine diverticulosis with similar progressive systemic sclerosis, with visceral neuronal disease and neuronal inclusions in the nerve cell.
(6) Drug factors: found in the application of phenothiazines, tricyclic antidepressants, clonidine, opiates, vincristine and narcotic bowel syndrome.
4, other: secondary to sclerosing mesenteric inflammation, steatorrhea and lipidosis.
Acute ischemic intestinal obstruction (20%):
1. The blood supply to the intestine is caused by obstacles, which often causes the muscle activity of the intestinal wall to disappear. If the blood supply to the intestine can not be restored, the intestinal tube is prone to necrosis, especially the intestinal tube that supplies blood through the terminal branch, and the blood supply to the intestine is impeded. It is more common in mesenteric arterial thrombosis or embolism caused by various reasons, as well as mesenteric venous thrombosis.
2, according to the blood supply of the intestine can be divided into 2 categories
(1) Simple intestinal obstruction: only the intestinal contents are difficult to pass, and there is no intestinal blood supply disorder, but simple intestinal obstruction can evolve into strangulated intestinal obstruction.
(2) strangulated intestinal obstruction: manifested as obstruction of intestinal contents, accompanied by intestinal blood vessel disorders.
3, according to the degree of obstruction can be divided into 2 categories
(1) Complete intestinal obstruction: the contents of the intestines could not pass at all.
(2) Incomplete intestinal obstruction: part of the intestinal contents can still pass through the obstruction, and incomplete intestinal obstruction can evolve into complete intestinal obstruction.
4, according to the obstruction can also be divided into 3 categories
(1) high intestinal obstruction: generally refers to obstruction occurring in the duodenum and jejunum.
(2) low-grade small bowel obstruction: generally refers to obstruction occurring in the distal ileum.
(3) Colonic obstruction: generally occurs in the left colon, especially in the sigmoid colon or sigmoid colon and rectal junction.
5, according to the onset of illness can be divided into 2 categories
(1) acute intestinal obstruction: strangulated intestinal obstruction is generally acute intestinal obstruction, but also complete.
(2) chronic intestinal obstruction: chronic intestinal obstruction is generally incomplete, incomplete intestinal obstruction is generally simple intestinal obstruction, chronic intestinal obstruction can also evolve into acute.
Pathogenesis
From simple intestinal obstruction to intestinal wall strangulation, necrosis, perforation, etc., a series of pathophysiological changes occur, which can be divided into the following three aspects:
1. Intestinal dilatation and body fluid loss obstruction above the obstruction site is filled with gas and liquid in the proximal intestine, which makes the intestine dilate, and the intestinal wall becomes thinner in acute intestinal obstruction; chronic obstruction is often due to hyperactivity of the intestines, and the muscle layer of the intestinal wall is gradually thickened, the intestine Thickening, there are three sources of gas in the intestine:
(1) Gas from ingestion (68%): Experimental intestinal obstruction in animals. If the esophagus is blocked, there is little gas accumulation in the intestine above the obstruction. It is clinically attracted by the stomach tube to keep the stomach empty. Then the intestines have little gas.
(2) Gas from the decomposition of food by bacteria during digestion.
(3) Gases from the blood that diffuse into the intestinal lumen, especially nitrogen, which account for 32% of all gases.
Hibbard reported in 1976 that the dog's experimental intestinal obstruction contained gas components in the intestinal lumen.
The gas in the intestinal lumen, mainly N2, CO2, O2, can be balanced by the penetration of mucous membranes into the blood. The diffusion of N2 is minimal, so N2 is predominant in the intestinal lumen. Methane (CH4) is produced by bacteria breaking down food. Hydrogen sulfide (H2S) can turn the rubber tube for decompression of the stomach into black. Some people think that H2S is a substance that causes poisoning due to intestinal obstruction, but Hibbard observed in 1936 that 600-800 ml of H2S saturated solution was injected into the closed jaw of the animal. No symptoms of poisoning occurred.
Part of the liquid in the intestine comes from ingested water, but most of it is accumulated digestive juice. Normal human digestive tract secretes 8 to 10 L of digestive juice within 24 hours. Except 100 to 200 ml is excreted from the human body, most of which is absorbed into the blood to maintain the dynamic balance of body fluids. The electrolyte component of the digestive juice in the intestine is similar to the electrolyte component in plasma (Fig. 1), so the loss of intestinal fluid is equal to the loss of plasma.
When there is low obstruction, there is less vomiting. Due to the dilatation of the intestine, the absorption function of the intestinal mucosa is reduced. Although some electrolytes are absorbed, the actual loss of water and electrolyte is still obvious. In the case of high obstruction, due to frequent vomiting, gastric juice, bile, pancreatic juice and jejunal fluid are the main factors. The loss of sodium ions is more than that of chloride ions, so there are more opportunities for acidosis. In addition, gastric juice and intestinal fluid contain twice as much potassium ions as plasma, so they are often accompanied by the loss of potassium ions. Among the 400 cases of the First Hospital of Beijing Medical University, 27.2% were low sodium, 18.5% were low chlorine, 9.8% were low potassium, 44.0% were lower than 22mmol/L, and 1.6% higher than 29mmol/L.
Haden and Orr described in 1923-1924 that the input brine seemed to buffer the toxins absorbed by the intestines. It is now known that saline can replenish lost electrolytes, thereby prolonging the lives of patients.
When the obstruction develops to a narrowing, blood loss can occur. When most of the intestines are strangulated, there is no initial interruption of complete blood circulation in the affected intestine. When the small intestine is twisted, it first affects its venous return, resulting in congestion and congestion of the intestine. Following the small arterial spasm, intestinal peristalsis increases, further causing small blood vessel rupture, blood flow into the submucosa and muscle layer, resulting in hemorrhagic infarction. At this time, the blood penetrates into the intestinal cavity and the peritoneal cavity, so bloody ascites can be produced. Until the narrowed intestinal pressure is equal to the arterial pressure, the blood circulation is completely interrupted, causing coagulation in the small blood vessels. The amount of blood loss is proportional to the length of the narrowed intestine.
2. An important change in the reproduction of bacteria and the absorption and obstruction of toxins is the excessive reproduction of bacteria in the intestines above the obstruction, mainly Escherichia coli and anaerobic bacteria. Bacterial reproduction can increase the chance of infection in surgery, especially in large bowel obstruction. In addition, the toxin produced by bacteria is absorbed into the body through the blood circulation and lymph, and can also be absorbed into the abdominal cavity through the intestinal wall and absorbed by the peritoneum. The absorption of the toxin in the abdominal cavity occurs in the late stage of intestinal obstruction. There are a large number of aerobic and anaerobic bacteria in the intestines of normal people. The growth of anaerobic bacteria is accelerated after intestinal obstruction, and the number and distribution of bacteria in the intestinal tract are simultaneously changed. For example, bacteroides in the intestinal tract of normal animals are usually located. In the large intestine, once obstruction occurs. A large number of bacilli can also be found in the small intestine. In the case of strangulated intestinal obstruction, the bleeding of the intestine is beneficial to the reproduction of bacteria, and the large number of bacteria in the narrowed intestine and the production of a large amount of toxins are often the cause of death. In animal experiments, Barnett injected the peritoneal exudate of strangulated intestinal obstruction into the abdominal cavity of other animals to kill the animal. If the twisted intestinal fistula is placed in an impermeable plastic bag, the mortality rate of the animal can be lowered. Yull also found the same toxic substances in the peritoneal effusion of human strangulated intestinal obstruction in 1962. At the beginning of the strangulation, the intestinal wall transit has not changed, and the bacteria have not penetrated into the abdominal cavity, and the patient's symptoms of poisoning are not obvious. When necrosis occurs in the narrowed intestine, especially when the narrowed intestine is long, the reproduction of Escherichia coli and streptococcus in the intestinal lumen reaches a peak, and the symptoms of poisoning are severe. Once the intestine ruptures, the infection and shock are more serious, endangering the patient's life.
3, the increase of intestinal pressure on the intestinal tract affects the intestinal pressure, pressure on the intestinal wall, in addition to the expansion of the intestinal tract also affects the absorption of intestinal mucosa, but also the intestinal wall of the blood circulation disorders, causing intestinal wall necrosis. The normal intestinal pressure is 0.267 to 0.533 kPa (2 to 4 mmHg), and the intestinal pressure above the obstruction can be raised to 1.33 kPa (10 mmHg) or more.
Simple low intestinal obstruction, due to the longer intestinal tube above the obstruction, the intestinal pressure is lower, the small intestinal obstruction lasts 48 ~ 96h, the intestinal pressure is generally 0.53 ~ 1.87kPa (4 ~ 14mmHg). In the case of peristalsis orgasm, the pressure can reach 2.67 ~ 4kPa (20 ~ 30mmHg). When the distal end of the colon is obstructed, the intracolonic pressure is higher. Because 60% of patients, the ileocecal valve function is good, the colon becomes a closed, so the internal pressure can be as high as 2.45kPa (25cmH2O). Also because the intestinal wall of the cecum is thin, and it is the concentration point of stress reaction. Therefore, in this case, perforation is likely to occur in the cecum.
The increase in intestinal pressure causes the intestine to swell, and also increases bowel movements and intestinal colic. Long-lasting increase in intestinal pressure can cause paralysis of the intestinal muscles, weakened bowel movements, and weakened bowel sounds.
An increase in intestinal pressure will cause a slowing of venous return. After intestinal obstruction for 48-96 hours, it can be observed that water, glucose, strychnine (strychnine) which can be penetrated at normal time has obvious absorption and decline. In contrast, lymphatic absorption is enhanced. Experiments have shown that in the intestinal tube of the obstruction, a dye can be seen in the lymph nodes of the mesentery; when injected into the non-obstructed intestine, no dye appears in the same time. This may be due to the stagnation of intestinal contents, which increases the venous pressure and accelerates the lymphatic circulation, which promotes the absorption of this dye.
In addition, above the obstruction, intestinal venous return is blocked, intestinal edema, secretion of water, sodium, potassium increased. A small intestine of 15 cm can secrete 500 ml of liquid.
If the intestinal hypertension rises for too long, a change in intestinal permeability is produced. In 1935, Sperling and Wangensten used dogs to perform ileal closed bowel obstruction experiments. It was found that when the intestinal pressure reached the intracapillary capillary pressure for 10 hours (pressure 2.0 kPa, or 15 mmHg), the vitality and permeability of the intestinal wall did not change significantly. After 28 hours, the vitality was lost and the permeability was enhanced. Recently, Deitch experiment found that the simple intestinal obstruction 6h, bacteria can reach the mesenteric lymph nodes, 24h up to the liver, spleen and blood flow. The authors believe that this is due to bacterial growth and barriers to the intestinal mucosal barrier. When the intestinal canal pressure continues to rise and the intestinal wall pressure is equal to or greater than the intestinal wall internal arterial perfusion pressure, the intestinal wall produces ischemia. If the obstruction is not relieved at this time, necrosis and perforation of the intestinal wall can be produced. Bacterial toxins in the intestinal lumen enter the abdominal cavity, causing severe infection poisoning as described above, entering the most dangerous state of intestinal obstruction pathology, often taking away the patient's life.
Prevention
Intestinal obstruction prevention
1, mechanical intestinal obstruction: treatment of primary disease (such as: children with congenital intestinal stenosis, intestinal wall tumor, intestinal stone, mites group, abdominal incarceration, etc.), to prevent disease progression, intestinal obstruction.
2, adhesive intestinal obstruction: more secondary to abdominal surgery, peritonitis, injury, bleeding, etc., so it is necessary to get out of bed as soon as possible after surgery.
3, the cause of intestinal obstruction is many, prevention can be done in children with tsutsugamushi should be actively deworming treatment, there should be timely repair, the operation of abdominal surgery is gentle, there are reports of postoperative carboxymethyl in the abdominal cavity Sodium carboxymethyl cellulose and oral vitamin E can reduce the incidence of intestinal adhesions.
Complication
Intestinal obstruction complications Complications ischemic colic
When the contents of the intestines are blocked, a series of symptoms such as abdominal distension, abdominal pain, nausea and vomiting and defecation disorders may occur, and severe cases may cause blood supply disorders in the intestinal wall, followed by intestinal necrosis, which may lead to death if not actively treated.
Symptom
Symptoms of intestinal obstruction Common symptoms Abdominal pain, abdominal distension, abdominal pain, nausea, vomiting, acute abdomen, abdominal muscle tension, exhaust disorder, bowel sounds, constipation, abdominal mass, constipation, severe abdominal pain, gastrointestinal motility
1, symptoms:
There are 4 main symptoms of acute intestinal obstruction:
(1) Abdominal pain: paroxysmal colic, jejunum or upper ileal obstruction, 1 episode every 3 to 5 minutes, ileum end or large intestine obstruction, 1 episode every 6 to 9 minutes, intermittent pain relief, colic During the period accompanied by bowel sounds hyperthyroidism, bowel sounds are high-profile, sometimes can smell the sound of water, paralytic intestinal obstruction can be no abdominal pain, high intestinal obstruction colic can not be serious, middle or low intestinal obstruction is typically severely twisted Pain, located in the umbilical cord or inaccurate positioning, each time the colic can last from a few seconds to a few minutes, if paroxysmal cramps turn into persistent abdominal pain, it should be considered to have developed strangulated intestinal obstruction.
(2) Vomiting: After obstruction, the reverse peristalsis of the intestine causes vomiting in the patient. The vomit begins as the stomach contents, and later is the contents of the intestine. The high intestinal obstruction is not heavy, but the vomiting is frequent, and the middle or distal small intestine is obstructed. Vomiting occurs later, and low-level bowel obstruction vomit is sometimes "fecal-like" (feculent vomitting) due to retention of intestinal contents, excessive bacterial growth, and decomposition of intestinal contents.
(3) bloating: more often in the advanced stage, high intestinal obstruction is not as good as low level, colonic obstruction due to the presence of ileocecal valve, rarely reflux, obstruction is often closed, so abdominal distension is obvious, strangulated intestinal obstruction, The abdomen is asymmetrically swelled and can reach the enlarged intestinal fistula.
(4) Exhaust and defecation stop: patients with intestinal obstruction generally stop anal defecation and deflation, but mesenteric vascular embolization and intussusception can discharge loose stools or bloody mucus, colon tumors, diverticulum or gallstone obstruction patients are also often There are black stools.
2, signs
(1) heart rate: simple intestinal obstruction, when the water is not heavy, the heart rate is normal, the heart rate is accelerated, the performance of low blood volume and severe water loss, strangulated intestinal obstruction, due to the absorption of toxins, the heart rate is more obvious.
(2) Body temperature: normal or slightly elevated, elevated body temperature is a sign of intestinal tube narrowing or intestinal necrosis.
(3) Abdominal signs: should pay attention to whether there are surgical scars, obese patients should pay special attention to inguinal hernia and femoral hernia, because the subcutaneous fat is easy to ignore, the inflated intestine has tenderness, colic with intestinal or peristaltic waves, if Local tenderness with abdominal muscle tension and rebound tenderness is a sign of strangulated intestinal obstruction. At the time of auscultation, attention should be paid to the change of bowel sound tone. When the colic is accompanied by the sound of gas over water, the intestinal tube is highly dilated and can be smelled. (tinkling) metal tone (high-profile).
(4) digital rectal examination: pay attention to whether there is a tumor in the rectum, whether the finger sets have blood, blood should be considered intestinal mucosal lesions, intussusception, thrombosis and other diseases.
Examine
Examination of intestinal obstruction
Laboratory inspection
1, hemoglobin and white blood cell count: early intestinal obstruction normal, obstruction time is longer, when dehydration signs occur, blood concentration and leukocyte increase can occur, white blood cells increased with left shift, indicating the presence of intestinal stenosis.
2, serum electrolytes (K, Na, Cl-), carbon dioxide binding, blood gas analysis, urea nitrogen, blood cell pressure measurement are important to determine dehydration and electrolyte imbalance, and to guide the input of liquid.
3, serum inorganic phosphorus, creatine kinase (creatine kinase) and isoenzyme determination of the significance of the diagnosis of strangulated intestinal obstruction, many experiments have shown that intestinal wall ischemia, necrosis, blood inorganic phosphorus and creatine kinase high.
Film degree exam
1. X-ray examination: X-ray examination is very important for the diagnosis of intestinal obstruction. After the jejunum and ileal gas are filled, the X-ray images have their own characteristics: the jejunal mucosal folds are arranged in parallel with the fishbone bone, and the gap rule It is like a spring-like shape; the ileal mucosal folds disappear, and the outline of the intestine is smooth; the flatulence of the colon is located around the abdomen, showing a colon-shaped shape.
X-ray findings of small bowel obstruction: gas accumulation in the intestine above the obstruction, effusion and dilatation of the intestine, the liquid surface appears quickly in the intestinal lumen after obstruction, the longer the obstruction time, the more the liquid surface, the higher the liquid level of the lower obstruction, the liquid surface Generally, after 5 to 6 hours of obstruction, the liquid level of different lengths of the step can be seen in the standing position. The distribution of flatulence and intestinal fistula can be seen in the position examination. The small intestine is in the center, the colon occupies the periphery of the abdomen, and the high jejunum obstruction. A large amount of gas and liquid appear in the stomach, and low intestinal obstruction, the liquid level is more, when there is complete obstruction, there is no gas or only a small amount of gas in the colon.
The performance of strangulated intestinal obstruction: there are circular or lobulated soft tissue mass images in the abdomen, and it can be seen that individual inflated fixed intestinal fistulas have a "C" shape expansion or "coffee bean sign".
The performance of paralytic ileus: the small intestine and the colon are evenly expanded, but the gas in the intestine and the liquid surface are less. If it is caused by peritonitis, there is exudative fluid in the abdominal cavity, and the intestine is floating. The intestinal tube spacing is widened, the edges are blurred, and the jejunal mucosa is thickened.
2, B-mode ultrasound examination: soft abdomen can be formed in the abdomen, the intestinal sound image can be seen in the peristalsis, the liquid can be seen, the intussusception can be seen in the concentric cavity image, the center of the echo is strong, the longitudinal surface can be seen in the multi-layer wall Structure, the use of B-mode ultrasound diagnosis of intestinal obstruction to be further research and improvement.
Diagnosis
Diagnosis and differential diagnosis of intestinal obstruction
diagnosis
1, whether the patient has intestinal obstruction, intestinal obstruction, abdominal pain and vomiting, early should be differentiated from some acute abdomen, such as biliary and urinary calculi, ovarian cysts, torsion and other diseases with abdominal cramps, in addition Need to be differentiated from gastroenteritis, food allergies, etc., to determine abdominal pain is colic, in addition to the nature of the pain, it is best to auscultate the abdomen during the onset of pain, if you hear the bowel sounds, it shows that abdominal pain is caused by Intestinal fistula, in addition to X-ray examination can further make a diagnosis, in addition to gas in the stomach and the colon in the normal person, occasionally visible bubbles in the abdomen of the duodenum, no gas in the small intestine, intestinal dilatation of the intestinal obstruction, at the same time Filled with liquid and gas, the ladder-shaped liquid surface can be seen in the standing position, and the liquid surface generally appears in the obstruction for 5 to 6 hours. Therefore, it is possible to confirm the abdominal fluoroscopy for suspicious patients.
2, whether it is strangulated intestinal obstruction: strangulated intestinal obstruction has the following characteristics:
(1) The incidence is relatively rapid, abdominal cramps are more severe, and the pain is persistent or persistent abdominal pain accompanied by paroxysmal aggravation.
(2) If the strangulation of the intestine occurs in the abdominal cavity, but not in the abdominal wall, there are signs of local peritoneal irritation, local tenderness and muscle tension, and the abdomen may sometimes touch the mass.
(3) The body temperature increased and the white blood cells increased significantly (>10×109/L).
(4) The performance of shock, due to the narrowing of the intestines, blood and plasma exudation, if the gills are longer, the blood loss can be serious. In addition, after the intestines are narrowed, the bacteria in the intestines produce toxins, so patients with strangulated intestinal obstruction Early shock occurred.
(5) Dehydration and electrolyte imbalance are more obvious than simple obstruction, and metabolic acid-base disorders are also obvious.
3, the location of intestinal obstruction: the level of small intestine obstruction is closely related to treatment, the cause of death caused by high obstruction is the loss of body fluid, the low intestinal obstruction is the serious consequence of intestinal dilatation, colonic obstruction, such as sigmoid torsion, then Not only the problem of rehydration, the urgent need to solve the relief of colonic obstruction, how to distinguish high position, low intestinal obstruction, mainly depends on the main clinical symptoms, high obstruction, vomiting is a prominent symptom, intestinal colic and abdominal distension are not obvious, low In small bowel obstruction, intestinal colic and abdominal distension are prominent manifestations, the number of vomiting is less, colonic obstruction is highlighted by abdominal distension, no vomiting, colic is not serious, X-ray examination can identify the arrangement of intestinal mucosa and The shape of the colonic bag can be considered in the obstruction site. The X-ray abdominal plain film in the supine position, the delicate study of the dilated small intestine can be seen in the obstruction site, in the standing X-ray examination, if there is a large liquid level in the cecum Time is a feature of large bowel obstruction.
4, the cause of intestinal obstruction: according to the material of the North University of China, intestinal obstruction to adhesion, tumor, inflammation and torsion as a common cause, such as the history of surgery, the cause of obstruction with adhesion is the most likely, if there is repeated bowel The history of obstructive episodes, combined with peritoneal irritation and fever at each episode, is the most likely cause of Crohn's disease. The obstruction of the elderly is mostly caused by colon tumors, sigmoid torsion, and fecal obstruction. Those with a history of cardiovascular disease may be mesenteric vessels. Embolization, children under two years of age are most likely to intussusception.
Differential diagnosis
Strangulated intestinal obstruction is one of the acute abdomen, so it is often necessary to distinguish from peptic ulcer perforation, acute severe pancreatitis, gallbladder perforation, acute appendicitis or perforation of the appendix. In general, according to the clinical manifestations of each of the above diseases , laboratory examination, X-ray examination or CT, MRI and other examinations, differential diagnosis is often no difficulty.
