Adhesive intestinal obstruction
Introduction
Introduction to adhesive intestinal obstruction Adhesive Intestinal Obstruction refers to the intra-abdominal intestinal adhesion caused by various reasons, which causes the intestinal contents to not pass and run smoothly in the intestine. When the contents of the intestines are blocked, a series of symptoms such as bloating, abdominal pain, nausea and vomiting, and defecation disorders may occur. It belongs to the category of mechanical intestinal obstruction. According to the onset of illness, it can be divided into acute intestinal obstruction and chronic intestinal obstruction; according to the degree of obstruction, it can be divided into complete intestinal obstruction and incomplete intestinal obstruction; according to the obstruction site, it can be divided into high intestinal obstruction. Low intestinal obstruction and colonic obstruction; according to the blood supply of the intestine, it is divided into simple intestinal obstruction and strangulated intestinal obstruction. Some of the disease can be resolved by non-surgical treatment, but most recurrent or conservative treatments are ineffective and still require surgery. basic knowledge Sickness ratio: 0.1% Susceptible people: no specific population. Mode of infection: non-infectious Complications: abdominal pain
Cause
Causes of adhesive intestinal obstruction
Intestinal obstruction is prone to occur under the following conditions:
External factors (30%):
1. After the overeating, the contents of the proximal intestine suddenly increased, and it could not pass through the narrow intestinal lumen, forming a relative obstruction.
2, inflammation or adhesion edema in the adhesion site, as well as food debris, foreign body blockage, can lead to intestinal stenosis.
Internal factors (30%):
A group of intestinal fistulas are closely adhered to each other. And fixed under the abdominal wall incision scar, because the intestinal lumen is small, intestinal peristalsis is affected, the intestine can not expand, prone to obstruction. A segment of intestinal fistula adheres and is fixed at its own folded position, so that the intestinal lumen at the tortuous portion is narrow and prone to obstruction.
A section of intestinal fistula adheres to a point farther away, and due to pulling the intestinal fistula to make the adhesion point an acute angle, obstruction is easy to occur. The other end of the abdominal cord-like adhesion is fixed to the posterior wall of the abdomen, and the intestinal tube is compressed to cause obstruction.
Strangulated intestinal obstruction (10%):
The intestinal wall adheres to the abdomen wall, and other parts of the intestinal tract do not adhere. Due to strong intestinal peristalsis or sudden changes in body posture, the intestinal fistula may be twisted with the adhesion as a fulcrum, causing strangulated intestinal obstruction.
Prevention
Adhesive intestinal obstruction prevention
Timely and correct treatment of abdominal inflammation is important to prevent adhesions. Special attention should be paid to: hematoma caused by incomplete hemostasis in abdominal surgery, excessive exposure of the intestine to the abdominal cavity, or long-term coverage of the gauze dressing, contact with the damaged serosa, and foreign matter such as unwashed talcum powder on the glove is brought into the abdominal cavity, peritoneum Tearing, defect, ligation of large pieces of tissue, placement of abdominal drainage, etc., are all iatrogenic factors that contribute to adhesion and should be prevented. In addition:
1. Activating blood circulation to remove blood stasis
It has been confirmed by long-term research; Chinese herbal medicines such as angelica, red medicine, safflower, paeonol, peach kernel, yuanhu, Wulingzhi, rhubarb, Chuanxiong, crustacean, and black medicinal herbs all have the effect of preventing intestinal adhesion.
2. Research and application of intraperitoneal perfusion
(1) Intra-abdominal perfusion of safflower and Zelan liquid, it was observed that safflower had strong anti-hemagglutination effect, and Zeeland had obvious effect of enhancing fibrinolysis.
(2) Lard oil, body fat (large omentum, breast, etc.) preparation for intraperitoneal perfusion. Our department used lard and body fat to prevent and treat intestinal adhesions and achieved good results.
(3) intraperitoneal perfusion of dimethyl silicone oil.
3, laser treatment of intra-abdominal adhesions
The application of laser acupoint irradiation is one of the promising methods.
4, magnetic therapy to prevent intestinal adhesions
Magnetic therapy has a good effect on preventing intestinal adhesion.
Most of the intra-abdominal adhesions do not lead to intestinal obstruction. The occurrence of obstruction often has some incentives, and patients must be reminded to pay attention to:
(1) The diet should be regular, avoid overeating, and prevent a large amount of food from entering the proximal intestinal tube that has been affected by adhesion;
(2) Pay attention to food hygiene, prevent gastrointestinal inflammation, and avoid abnormal peristalsis of the intestine;
(3) It is not advisable to do vigorous physical activity after a meal, especially the sudden change of body position. The above matters are especially important for patients who have had intestinal obstruction.
Complication
Adhesive intestinal obstruction complications Complications, abdominal pain
The prognosis depends on the cause and type of obstruction, and is closely related to the diagnosis and treatment of the morning and evening. General simple intestinal obstruction, no symptoms of severe systemic poisoning, the prognosis is good, such as intestinal necrosis, depending on the length of the necrotic bowel , the scope, the general rescue timely effect is better, such as excessive intestinal resection, it is difficult to maintain the normal function of the intestine, nutritional absorption disorders, poor prognosis.
Symptom
Adhesive intestinal obstruction symptoms common symptoms aphid intestinal obstruction abdominal muscle tension low fever peritonitis abdominal pain peritoneal irritation fecal vomit bowel
In addition to children, mechanical intestinal obstruction should consider the possibility of adhesive intestinal obstruction after exclusion of abdominal hernia and colonic obstruction, especially when the patient has a history of previous abdominal surgery, trauma or peritonitis, or the patient has been Repeated episodes of secondary obstruction, or more likely to be found in abdominal surgery scars during physical examination, but the final diagnosis can only be made during laparotomy.
Special mention is needed for early postoperative adhesive intestinal obstruction, which is common in lower abdominal surgery such as appendectomy, often 4 to 5 days after surgery, intestinal peristalsis has recovered and has been vented and began to eat, suddenly bursting Abdominal pain, bowel sounds hyperthyroidism, may be accompanied by low fever, but generally no strangulation phenomenon, as mentioned above, this adhesion is fibrinous, the vast majority can absorb and heal, can be given symptomatic treatment, generally no surgery.
Examine
Examination of adhesive intestinal obstruction
Abdominal X-ray and plain film: It can be seen that the small intestine is inflated with tension and liquid level, the colon is not inflated, and the bowel enema is colonic and contracted without gas, so that the complete mechanical small bowel obstruction can be diagnosed.
Abdominal puncture: hemorrhagic ascites is mostly strangulated intestinal obstruction.
Diagnosis
Diagnosis and identification of adhesive intestinal obstruction
diagnosis
Can be diagnosed based on clinical symptoms and laboratory tests.
Differential diagnosis
First, the identification of simple intestinal obstruction and strangulated intestinal obstruction strangulated intestinal obstruction can occur on the basis of simple mechanical intestinal obstruction, simple intestinal obstruction due to poor treatment and converted to strangulated intestinal obstruction accounted for 15 ~ 43%. It is generally believed that the following signs should be suspected of strangulated intestinal obstruction:
1. Sudden onset of severe abdominal pain persists, or changes from paroxysmal colic to persistent abdominal pain. The pain is more fixed. If the abdominal pain involves the back, the mesentery is pulled, which is more likely to be strangulated intestinal obstruction.
2, the abdomen has tenderness, rebound tenderness and abdominal muscle rigidity, abdominal distension and bowel sounds are not obvious.
3, vomit, gastrointestinal decompression drainage, abdominal puncture fluid containing blood, may also have blood in the stool.
4, the general condition deteriorates drastically, the toxemia is obvious, and shock can occur.
5, X-ray film examination shows that the intestinal segment above the obstruction site is dilated and filled with liquid, if the tumor or "C" shaped surface is called "coffee bean sign", ascites is often seen between the dilated bowel.
Second, the identification of small bowel obstruction and colonic obstruction high intestinal obstruction frequent vomiting and abdominal distension is relatively light, low intestinal obstruction is the opposite, the clinical manifestations of colonic obstruction and low intestinal obstruction are similar, but the original abdominal plain film examination can be distinguished. Small bowel obstruction is aflated intestines throughout the abdomen, more liquid level, and the colon does not show, if it is colonic obstruction, the dilated colon and pocket shape can be seen around the abdomen, and the gas in the small intestine is not obvious.
Third, the identification of complete intestinal obstruction and incomplete intestinal obstruction Complete intestinal obstruction is mostly acute and obvious symptoms, incomplete intestinal obstruction is mostly chronic obstruction, symptoms are not obvious, often intermittent episodes, X-ray film Intestinal fistula inflation was evident in patients with complete intestinal obstruction, and incomplete intestinal obstruction was not.
