incomplete intestinal obstruction
Introduction
Introduction to incomplete intestinal obstruction Incomplete intestinal obstruction means that the contents of the intestine can partially pass through the obstruction point. Therefore, a small amount of gas accumulation and effusion can be displayed in the intestinal lumen below the obstruction point on the abdominal X-ray. The intestinal curvature above the obstruction point is mild, colon There are more gases inside. Incomplete intestinal obstruction can be caused by a variety of causes, such as abdominal surgery, abnormal eating, digestive tract tumors. Paroxysmal abdominal cramps, stop exhaustion, vomiting, bloating, bowel and bowel sounds or bloody stools should be promptly treated in the hospital. Early simple colonic obstruction may consider non-surgical treatment, but it should be closely observed. Once conservative treatment is ineffective or the condition is aggravated, laparotomy should be performed in time. In the operation, the surgical methods should be determined according to different obstructive causes and pathological changes. The vital tube should be preserved as much as possible, but the inactivated intestines should not be left behind. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific people Mode of infection: non-infectious Complications: abdominal pain, nausea and vomiting, bloating
Cause
Causes of incomplete intestinal obstruction
Neurological disorders (30%):
Injury or disorder of autonomic nerves, causing intestinal motor nerve spasm; mesenteric vascular embolization or thrombosis, causing intestinal blood supply disorders, which in turn cause intestinal paralysis and the intestinal contents cannot pass. Causes paralytic ileus.
Chemical stimulation (25%):
Due to nerve reflex or chemical stimulation, the smooth muscle atrophy and fibrosis of the intestinal wall, and the degenerative changes of the intestinal wall or longitudinal muscles become intestinal muscle dysfunction, loss of intestinal peristalsis or intestinal fistula, but no organic The intestinal lumen is narrow. Lead to dynamic intestinal obstruction.
Disease factors (28%):
The intestinal lumen is narrowed by the tumor, and the intestinal contents pass through the obstacle. Causes mechanical intestinal obstruction.
Prevention
Incomplete intestinal obstruction prevention
Paroxysmal abdominal cramps, stop exhaustion, vomiting and bloating, bowel and bowel sounds or bloody stools should be promptly treated in the hospital, in addition to the necessary medical history and physical examination, should be chest and abdomen and abdomen Plain film examination, early symptoms and signs are not clear, should be short-term close observation of the condition, do not easily let the patient away, to prevent delay in diagnosis and treatment, leading to intestinal narrowing intestinal necrosis and severe dehydration hypovolemic and systemic toxic shock death .
Complication
Incomplete intestinal obstruction complications Complications abdominal pain nausea and vomiting bloating
It can produce a series of symptoms such as abdominal distension, abdominal pain, nausea and vomiting and defecation disorder. In severe cases, blood supply to the intestinal wall can be caused, followed by intestinal necrosis. If not treated actively, it can lead to death.
Symptom
Incomplete intestinal obstruction symptoms common symptoms abdominal distension reflex vomiting paroxysmal colic abdominal pain
1. Abdominal pain, paroxysmal cramps.
2. Vomiting, early is reflective. Late stage can be frequent vomiting, high obstruction and vomiting early, and low vomiting.
3. Bloating, generally high is not obvious. Low or paralyzed is significant and wide.
4. The anus stops defecation and exhaust, and there is still venting in the early stage of high position or obstruction.
5. Visible intestinal type and peristaltic wave, bowel sounds are accompanied by gas and water, peritonitis, tenderness and rebound tenderness are manifestations of intestinal strangulation.
Examine
Examination of incomplete intestinal obstruction
1. The general condition examination is a general observation of the general health of the examinee and is the first step in the physical examination. Including gender, age, body temperature, breathing, pulse, blood pressure, development, nutrition, state of consciousness, facial expression, posture, posture, gait, etc. At the same time, attention should be paid to the patient's appearance, personal hygiene, breathing or body odor, as well as the mental state of the inspected person and the response to people and things in the surrounding environment and the comprehensive assessment of systemic and organ function.
2, abdominal X-ray examination: is one of the reliable methods to determine intestinal obstruction, small intestine inflation or a stepped gas-liquid plane; colonic height expansion.
Diagnosis
Diagnosis and diagnosis of incomplete intestinal obstruction
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1, pseudo-intestinal obstruction: 1. Intestinal obstruction begins in children or adolescence, abdominal distension in the intermittent period of intestinal obstruction can not completely disappear. 2. There are similar patients in the family. 3. Have difficulty swallowing or urinating. 4. Cachexia. 5. Have a disease that can cause pseudo-intestinal obstruction or take a drug that may cause pseudo-intestinal obstruction. 6. Jejunal diverticulosis. 7. There are signs of Raynaud or scleroderma. 8. Abdominal X-ray images do not show intestinal flatulence and gas-liquid surface in the presence of mechanical intestinal obstruction; digestive tract pressure measurement shows esophageal and gastrointestinal dysfunction; small intestinal histological examination of Smith silver staining is positive, and the diagnosis can be confirmed.
2, adhesive intestinal obstruction: imaging examination is very important for the qualitative and localization diagnosis of adhesive intestinal obstruction. Abdominal X plain film examination can be seen in the liquid level of different lengths of the step; in the position examination, the distribution of flatulence and intestinal fistula can be seen, the small intestine is in the center, the colon occupies the periphery of the abdomen; when the high jejunum obstruction occurs, there is a large amount in the stomach. Gas and liquid; low intestinal obstruction, more liquid level; complete obstruction, no gas or only a small amount of gas in the colon; strangulated intestinal obstruction, there are circular or lobulated soft tissue mass images in the abdomen, also It can be seen that individual inflated fixed intestinal fistulas have a "C" shape expansion or "coffee bean sign". Abdominal CT and MRI can help doctors to determine the cause, location, extent of intestinal obstruction and the presence or absence of intestinal stricture, especially enhanced CT and MRI with angiography, which can be used to identify the presence or absence of volvulus or intestinal blood. Provide obstacles, avoid misdiagnosis and delay treatment.
