Pregnancy with intestinal obstruction
Introduction
Introduction to pregnancy with intestinal obstruction Intestinal obstruction during pregnancy is a serious complication for the mother and child. Intestinal obstruction can not only cause changes in the anatomy and function of the intestine itself, but also lead to systemic physiological disorders. Due to the increase of uterus during pregnancy, intestinal obstruction during pregnancy Differential diagnosis is difficult. Coupled with the radiation examination, anesthesia, and surgery concerns of both doctors and patients, diagnosis and surgery delays often lead to an increase in maternal and perinatal mortality. According to the intestinal wall, there is no blood supply disorder. The intestinal obstruction is divided into two types: simple and strangulated. According to the lesion, the degree of obstruction and the progression of the disease can be divided into high and low, complete and incomplete, acute and chronic intestine. obstruction. basic knowledge The proportion of illness: the incidence rate is about 0.008%-0.01% Susceptible population: pregnant women Mode of infection: non-infectious Complications: toxic shock syndrome
Cause
Pregnancy with intestinal obstruction
(1) Causes of the disease
Mechanical intestinal obstruction accounts for more than 90%, more than half of which is caused by adhesion, followed by intestinal torsion, intussusception, congenital malformation, inflammatory stenosis, incarcerated hernia and abdominal mass.
(two) pathogenesis
The enlarged uterus during pregnancy pushes the intestinal fistula, and the previous adhesion causes the intestinal tube to be compressed or twisted to form an obstruction. The mesentery is too long or relatively short. The push of the pregnant uterus can cause the small intestine to twist clockwise to cause intestinal obstruction. The occurrence of obstruction often occurs when the uterus rises from the pelvic cavity into the abdominal cavity from April to May, or when the fetal head drops into the basin before labor and the uterus shrinks and the intestinal fistula shifts sharply during the puerperium, causing intestinal torsion. Zhang Yifang, Zhu Guolan, etc. (1996) Reported 8 cases of intestinal obstruction during pregnancy, 7 cases occurred in the third trimester of pregnancy, puerperium period, increased uterine surface area during pregnancy, absorption of toxins after intestinal obstruction, so that the disease develops rapidly, combined with nausea during pregnancy, vomiting, bloating constipation It is not easy for a clinician to consider the disease for surgical reasons and delay the diagnosis or diagnosis of the early onset of the disease, resulting in serious illness after the onset of the disease.
According to the intestinal wall, there is no blood supply disorder. The intestinal obstruction is divided into two types: simple and strangulated. According to the lesion, the degree of obstruction and the progression of the disease can be divided into high and low, complete and incomplete, acute and chronic intestine. obstruction.
Simple intestinal obstruction, intestine peristalsis above the obstruction, to overcome the intestinal content through the obstacle, the intestinal cavity due to gas and liquid volume expansion and expansion, intestinal dilatation, intestinal wall edema, and finally lead to intestinal peristalsis, while the fluid leaked to the abdominal cavity, obstruction The following intestinal tube collapsed, emptiness or only a small amount of feces, strangulated intestinal obstruction due to blood supply interruption, first venous return obstruction, intestinal wall congestion, edema, thickening dark red, with the progression of the disease followed by arterial blood supply disorders, thrombosis Formation, intestinal tube becomes purple-black, thin, ischemia leads to necrosis, perforation, mortality can be as high as 20% to 30%, is the most serious complication, fluid loss after intestinal obstruction, intestinal expansion, toxin absorption and infection, Shock, if not promptly diagnosed and treated, eventually causes respiratory, circulatory, and urinary system vital organs to die and die.
Prevention
Pregnancy with intestinal obstruction prevention
Although pregnancy itself does not cause intestinal obstruction, after pregnancy, due to increased progesterone levels, the smooth muscle tension of the intestine is reduced, intestinal peristalsis is slowed down; and constipation is prone to occur after pregnancy, causing fecal mass to accumulate in the colon and rectum; The compression of the large uterus on the intestinal tract may be an auxiliary factor for intestinal obstruction. Specific to digestion, originally affected by pregnancy physiology, gastrointestinal motility has slowed down, and she eats a large number of high-protein foods at one time, making food difficult to digest and absorb, and accumulated in the intestines, plus the usual lack of exercise, the intestines The peristalsis is slower, resulting in food ileus. When pregnant with intestinal obstruction, most patients will have persistent or paroxysmal abdominal pain with vomiting, and the anus stops defecation and deflation. Due to the large surface area of the uterus of pregnant women, the absorption of toxins is more. Once the disease occurs, the development of the disease may be faster and more serious (domestic reports indicate that when the disease occurs, the maternal mortality rate is as high as 16.6% and the fetal mortality rate is 44.40/o). In view of this, if pregnant women have abdominal pain, bloating, and anus to stop defecation and venting, they should be highly alert to intestinal obstruction and immediately go to the hospital for examination and treatment.
More bedtime and less activity will increase the chance of food-induced intestinal obstruction. Therefore, pregnant women must pay attention to proper exercise during pregnancy (such as walking). Eat more digestible, cellulose-rich plant foods, such as fruits, vegetables, etc.; eat less animal foods, especially do not eat too much food containing high protein and not easy to digest and absorb, meat can be cooked until cooked Eat later. For some foods that are not easy to chew and are easy to form clumps, such as glutinous rice, grapes, mushrooms, bamboo shoots, animal fascia, tendons, etc., try to eat as little as possible. Especially those who are often constipated, usually should be more active, drink more water, eat more fruits and vegetables, eat less spicy, if necessary, take some medicine under the guidance of a doctor. In addition, active prevention and treatment of various complications during pregnancy is also one of the important measures to prevent food-induced intestinal obstruction.
Complication
Pregnancy with complications of intestinal obstruction Complications toxic shock syndrome
Strangulated intestinal obstruction can lead to necrosis and perforation of the intestinal wall, as well as severe abdominal infection and toxic shock.
Symptom
Pregnancy with intestinal obstruction symptoms Common symptoms Nausea paroxysmal colic, abdominal distension, abdominal pain, acute abdomen, bowel discharge, dysfunction, reversible vomiting, peritoneal irritation, suffocation
Intestinal obstruction during pregnancy is basically similar to non-pregnancy intestinal obstruction, but the enlarged uterus in the third trimester occupies the abdominal cavity, the intestinal fistula moves to the back or both sides of the uterus, or the postpartum abdominal wall is loose, which can make the signs insignificant, not typical.
Symptom
(1) Abdominal pain: Abdominal pain is the main symptom of intestinal obstruction, usually persistent or paroxysmal colic. The pain site is mostly located in the umbilical cord, but it can also be on the side of the obstruction. The reason is that the intestinal contents pass through the obstruction and obstruction. In the above part, the intestinal peristalsis is enhanced, and the smooth muscle of the intestinal wall is strongly contracted and paralyzed, causing paroxysmal severe cramps.
(2) vomiting and bloating: early vomiting is mostly reflex vomiting caused by intestinal dilatation. After that, vomiting and bloating vary with the location of obstruction. When high intestinal obstruction occurs, vomiting occurs early and frequently, and vomit is stomach and fingers. The contents of the intestines are accompanied by a large amount of gastrointestinal fluid, pancreatic juice and bile, and the abdominal distension is not obvious. When the intestinal obstruction is low, the vomiting is late and the number of times is small. In the late stage, the intestinal contents with feces can be spit out, and the abdominal distension is generally heavier. Diffuse.
(3) defecation, dysfunction: incomplete intestinal obstruction and high intestinal obstruction in the early stage may have venting and a small amount of defecation, patients with complete intestinal obstruction no longer exhaust defecation.
2. Signs
Abdominal and intestinal peristaltic waves can be seen in the abdomen. The palpation can sometimes touch the mass. The obstruction site has tenderness and peritoneal irritation. The abdomen is drum sounded, the auscultation of bowel sounds is hyperthyroidism, there is gas over water, and some strangulated intestinal obstruction The bowel sounds can disappear.
Examine
Examination of pregnancy with intestinal obstruction
There is no obvious change in early laboratory examination of simple intestinal obstruction, and late dehydration, blood concentration, electrolyte imbalance, etc., and the corresponding laboratory examination changes may occur. For example, when the total number of white blood cells and neutrophils are significantly increased, the twisting should be eliminated. Narrow intestinal obstruction.
1. Abdominal X-ray and flat tablets can show the gas and liquid planes of the intestines with excessive flatulence and varying amounts.
2. B-ultrasound can be seen in the intestinal cavity to expand the accumulation of gas to form a significant gas-liquid level, the first examination is not clear can be reviewed after 6h, the general small bowel obstruction can be determined after 12h to determine the diagnosis, mobile voiced positive, such as B-ultrasound found ascites Is an important evidence of strangulated intestinal obstruction.
Diagnosis
Diagnosis and diagnosis of pregnancy complicated with intestinal obstruction
Due to changes in the anatomical position of the pregnancy, as with other surgical acute abdomen during pregnancy, the clinical manifestations of intestinal obstruction may be atypical. Therefore, pregnant women may have abdominal pain, nausea, vomiting, acute abdomen, medical history, physical signs, disease progression and various It is very important to carry out comprehensive and comprehensive analysis of auxiliary examinations and to conduct continuous and close observation. X-ray examination should be performed once the suspected intestinal obstruction is possible. Most patients can be diagnosed by X-ray examination. The nature of obstruction must be clearly defined after the diagnosis is established. The location and extent of obstruction to establish a treatment plan.
Pregnancy with intestinal obstruction should be differentiated from pregnancy with ovarian cyst torsion, premature delivery, recessive placental abruption, acute polyhydramnios and other endoscopic diseases such as acute appendicitis, cholecystitis, cholelithiasis and other diseases.
