Spastic bowel obstruction
Introduction
Introduction to spastic intestinal obstruction Due to the spasmodic contraction of the intestinal wall muscle, the intestinal contents are not well-runn, called sputum intestinal obstruction. Murphy (1896) first described the disease, which is extremely rare in clinical practice, but it does exist. This disease is more common in neuroticism. Women are mostly middle-aged. basic knowledge The proportion of illness: the probability of illness in middle-aged people is 0.05% Susceptible people: middle-aged people Mode of infection: non-infectious Complications: intestinal obstruction shock
Cause
Causes of spastic intestinal obstruction
(1) Causes of the disease
The occurrence of spastic intestinal obstruction is mainly related to the following factors:
Intestinal cavity factor
Such as foreign bodies in the intestine, parasites, inflammation, irritating foods, intestinal wall ulcers and blood circulation disorders, etc., can sometimes cause intestinal wall spasm.
2. Reflective factors
Trauma or surgery of the abdomen, lesions of the intestines or other organs in the abdomen, such as intussusception, can cause intestinal obstruction through the reflex of the celiac plexus and the inferior mesenteric plexus.
3. Factors caused by the central nervous system
Such as brain tumors, abscesses, rickets, uremia and various abdominal cramps, etc., through the role of the central nervous system, and occasionally can also cause intestinal cramps.
4. Other
Food poisoning and other unexplained causes.
It is worth noting that although there are many reasons for intestinal fistula, it is rare to actually cause obstruction, and most of them are an auxiliary factor for other intestinal obstruction factors, such as aphid, gallstone or foreign body intestinal obstruction. The obstruction factor is sometimes not enough to block the entire intestinal lumen to form an obstruction. At this time, the intestinal wall muscle is stimulated by the obstruction factor to contract and form an intestinal occlusion.
(two) pathogenesis
Intestinal spastic lesions may involve any part of the small intestine and large intestine. The extent of involvement of the intestine can be limited to a certain point, resulting in a narrowing of the intestine; occasionally it can also involve multiple parts of the intestine at the same time, forming multiple segmental stenosis; Can affect the entire large intestine, making it a hard cord, the most commonly affected is the descending colon and sigmoid colon of the large intestine, the distal ileum of the small intestine, the intestinal tract of the sputum is often pale, anemia, and the intestine is small and hard, with There is a clear dividing line between the upper and lower normal intestines. If the time of sputum is longer, the proximal intestinal lumen can cause secondary enlargement, the hypertrophy of the hypertrophy, the distal intestinal lumen becomes smaller, and the intestinal wall becomes thinner.
Prevention
Sputum intestinal obstruction prevention
Intestinal obstruction is a multi-pathogenic disease, so prevention must start from many aspects.
1 Early postoperative activities: Most of the adhesive intestinal obstruction is related to abdominal surgery. In order to reduce intestinal adhesion, the patient will get out of bed early after the doctor's guidance.
2 reduce the occurrence of gastrointestinal dysfunction: intestinal obstruction obstruction and gastrointestinal function state have a certain relationship. Most gastrointestinal disorders are caused by eating disorders, so don't overeating.
3 taboos after the meal for strenuous exercise.
4 pay attention to the treatment of intestinal mites and diet; sputum intestinal obstruction is caused by intestinal mites, in addition to pay attention to hygiene, pay attention to deworming treatment.
Complication
Sputum intestinal obstruction complications Complications, intestinal obstruction, shock
The disease can cause loss of body fluids and electrolytes as well as complications such as infection and toxemia. Toxemia refers to bacterial toxins that enter the blood circulation from locally infected lesions, resulting in systemic persistent high fever accompanied by excessive sweating, weak pulse or shock. Bacterial toxins enter the blood circulation from locally infected lesions, producing systemic persistent hyperthermia with a large amount of sweating, weak pulse and shock. Since blood toxins directly damage blood cells in the blood, anemia often occurs. Bacteria can not be found in blood culture. It is worth noting that severe lesions, vascular embolism, intestinal obstruction and other diseases, although no bacterial infection, but the destruction of large areas of toxins can also cause toxemia.
Symptom
Symptoms of spastic intestinal obstruction Common symptoms Abdominal pain Abdominal distension Constipation Abdominal pain with nausea, vomiting, bowel, intestinal fistula, persistent colic, peritoneal irritation, fecal vomit, visceral obstruction
The clinical manifestations of this disease are very similar to mechanical intestinal obstruction. Patients have obvious abdominal cramps. Patients with small bowel obstruction have nausea, vomiting, colon obstruction have constipation, and even stop defecation and venting; those with longer obstruction are often seen in the abdomen. Intestinal type can be sputum and hard cord; often has bowel sounds hyperthyroidism, even gas over water sound; there may also be progressive abdominal distension, therefore, clinically often misdiagnosed as mechanical intestinal obstruction.
Examine
Examination of spastic intestinal obstruction
X-ray examination can help the diagnosis of this disease. Intestinal can be found in the inflated, dilated and liquid level of the intestine; the colonic fistula can be examined by barium enema. It can be seen that the intestinal lumen is obviously narrow or even unable to pass. For colon cancer, but the colonic mucosa has no change, and there is no filling defect or other mechanical obstruction lesions like colon cancer. Small bowel fistula can be used for systemic barium meal examination, and it may be found that the barium agent passes through the typical performance of obstruction. After the drug treatment, the intestinal tract disappeared and the X-ray inflated image disappeared.
Diagnosis
Diagnosis and diagnosis of spastic intestinal obstruction
Diagnostic criteria
In the diagnosis of this disease, you should inquire about the past medical history in detail. If you have had a history of similar attacks in the past and can relieve yourself, you should be suspected of having the disease; or acute intestinal obstruction occurs after abdominal trauma, or at the same time as renal colic. The suspected intestinal fistula may be combined with clinical manifestations and X-ray findings to make a preliminary diagnosis. In addition, B-ultrasound, CT, and MRI have little significance for the diagnosis of this disease, but can help to eliminate the intestinal tract or Mechanical obstruction caused by organic lesions in other organs of the abdominal cavity.
Nevertheless, it is still very difficult to make a clear identification of this disease and acute mechanical intestinal obstruction. In most cases, it must be confirmed by exploratory laparotomy.
Differential diagnosis
The disease should be differentiated from paralytic ileus and mechanical intestinal obstruction.
Paralytic ileus
More secondary to abdominal surgery, abdominal inflammatory lesions, chest and abdomen or spinal trauma such as stimulation, clinical persistent abdominal pain as the main symptoms, no colic attacks, bowel sounds weakened or disappeared, full abdominal distension, intestinal type is not Obviously, X-ray examination showed that the gastrointestinal tract was generally flatulent, the small intestine was inflated, and the intestinal fistula was relatively uniform in size.
2. Mechanical intestinal obstruction
Mostly caused by small intestinal obstruction, small bowel malformation and extraintestinal compression, the clinical manifestations are sudden, severe abdominal pain, abdominal distension, vomiting is mainly gastric matter, X-ray examination shows that the inflated and inflated intestine is limited to obstruction Above the small intestine, the size of the inflatable bowel is different.
The X-ray examination of the disease is not obvious, and the disappearance of the inflated image of the intestine after the application of the antispasmodic drug is an important feature.
