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Intestinal obstruction

Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus

 

Intestinal obstruction is a partial or complete blockage of the bowel. The contents of the intestine cannot pass through it.

Causes

 

Obstruction of the bowel may be due to:

  • A mechanical cause, which means something is in the way
  • Ileus, a condition in which the bowel does not work correctly, but there is no structural problem causing it

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:

  • Bacteria or viruses that cause intestinal infections (gastroenteritis)
  • Chemical, electrolyte, or mineral imbalances (such as decreased potassium level)
  • Abdominal surgery
  • Decreased blood supply to the intestines
  • Infections inside the abdomen, such as appendicitis
  • Kidney or lung disease
  • Use of certain medicines, especially narcotics

Mechanical causes of intestinal obstruction may include:

  • Adhesions or scar tissue that forms after surgery
  • Foreign bodies (objects that are swallowed and block the intestines)
  • Gallstones (rare)
  • Hernias
  • Impacted stool
  • Intussusception (telescoping of 1 segment of bowel into another)
  • Tumors blocking the intestines
  • Volvulus (twisted intestine)

 

Symptoms

 

Symptoms may include:

  • Abdominal swelling (distention)
  • Abdominal fullness, gas
  • Abdominal pain and cramping
  • Breath odor
  • Constipation
  • Diarrhea
  • Inability to pass gas
  • Vomiting

 

Exams and Tests

 

During a physical exam, the health care provider may find bloating, tenderness, or hernias in the abdomen.

Tests that show obstruction include:

  • Abdominal CT scan
  • Abdominal x-ray
  • Barium enema
  • Upper GI and small bowel series

 

Treatment

 

Treatment involves placing a tube through the nose into the stomach or intestine. This is to help relieve abdominal swelling (distention) and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum.

Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms. It may also be needed if there are signs of tissue death.

 

Outlook (Prognosis)

 

The outcome depends on the cause of the blockage. Most of the time, the cause is successfully treated.

 

Possible Complications

 

Complications may include or may lead to:

  • Electrolyte (blood chemical and mineral) imbalances
  • Dehydration
  • Hole (perforation) in the intestine
  • Infection
  • Jaundice (yellowing of the skin and eyes)

If the obstruction blocks the blood supply to the intestine, it may cause infection and tissue death (gangrene). Risks for tissue death are related to the cause of the blockage and how long it has been present. Hernias, volvulus, and intussusception carry a higher gangrene risk.

In a newborn, paralytic ileus that destroys the bowel wall (necrotizing enterocolitis) is a life-threatening condition. It may lead to blood and lung infections.

 

When to Contact a Medical Professional

 

Call your provider if you:

  • Cannot pass stool or gas
  • Have a swollen abdomen (distention) that does not go away
  • Keep vomiting

 

Prevention

 

Prevention depends on the cause. Treating conditions, such as tumors and hernias that can lead to a blockage, may reduce your risk.

Some causes of obstruction cannot be prevented.

 

 

References

Fry RD, Mahmoud NN, Maron DJ, Bleier JIS. Colon and rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.

McKenzie S, Evers BM. Small intestine. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 50.

Mizell JS, Turnage RH. Intestinal obstruction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 123.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Ileus - X-ray of distended bowel and stomach

    Ileus - X-ray of distended bowel and stomach - illustration

    This abdominal X-ray shows a stomach filled with fluid and a swollen (distended) small bowel, caused by a blockage (pseudo-obstruction) in the intestines. A solution containing a dye (barium) that is visible on X-rays was swallowed by the patient (upper GI series).

    Ileus - X-ray of distended bowel and stomach

    illustration

  • Ileus - X-ray of bowel distension

    Ileus - X-ray of bowel distension - illustration

    This abdominal x-ray shows thickening of the bowel wall and swelling (distention) caused by a blockage (psudo-obstruction) in the intestines. A solution containing a dye (barium), which is visible on X-ray, was swallowed by the patient (the procedure is known as an upper GI series).

    Ileus - X-ray of bowel distension

    illustration

  • Intussusception - X-ray

    Intussusception - X-ray - illustration

    This abdominal x-ray shows an intestinal condition in which a loop of bowel has slipped into another section of bowel (intussusception), causing swelling, reduced blood flow, obstruction, and tissue damage. Intussusception requires emergency treatment (barium enema or surgery) to prevent intestinal tissue death (necrosis), intestinal perforation, peritonitis, and death.

    Intussusception - X-ray

    illustration

  • Volvulus - X-ray

    Volvulus - X-ray - illustration

    A GI series in a patient with a twisted bowel (volvulus).

    Volvulus - X-ray

    illustration

  • Small bowel obstruction - X-ray

    Small bowel obstruction - X-ray - illustration

    X-rays of the abdomen are important in diagnosing the presence of small bowel obstruction. When obstruction occurs, both fluid and gas collect in the intestine. They produce a characteristic pattern called "air-fluid levels". The air rises above the fluid and there is a flat surface at the "air-fluid" interface.

    Small bowel obstruction - X-ray

    illustration

  • Small intestine anatomy

    Small intestine anatomy

    Presentation

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Ileus - X-ray of distended bowel and stomach

      Ileus - X-ray of distended bowel and stomach - illustration

      This abdominal X-ray shows a stomach filled with fluid and a swollen (distended) small bowel, caused by a blockage (pseudo-obstruction) in the intestines. A solution containing a dye (barium) that is visible on X-rays was swallowed by the patient (upper GI series).

      Ileus - X-ray of distended bowel and stomach

      illustration

    • Ileus - X-ray of bowel distension

      Ileus - X-ray of bowel distension - illustration

      This abdominal x-ray shows thickening of the bowel wall and swelling (distention) caused by a blockage (psudo-obstruction) in the intestines. A solution containing a dye (barium), which is visible on X-ray, was swallowed by the patient (the procedure is known as an upper GI series).

      Ileus - X-ray of bowel distension

      illustration

    • Intussusception - X-ray

      Intussusception - X-ray - illustration

      This abdominal x-ray shows an intestinal condition in which a loop of bowel has slipped into another section of bowel (intussusception), causing swelling, reduced blood flow, obstruction, and tissue damage. Intussusception requires emergency treatment (barium enema or surgery) to prevent intestinal tissue death (necrosis), intestinal perforation, peritonitis, and death.

      Intussusception - X-ray

      illustration

    • Volvulus - X-ray

      Volvulus - X-ray - illustration

      A GI series in a patient with a twisted bowel (volvulus).

      Volvulus - X-ray

      illustration

    • Small bowel obstruction - X-ray

      Small bowel obstruction - X-ray - illustration

      X-rays of the abdomen are important in diagnosing the presence of small bowel obstruction. When obstruction occurs, both fluid and gas collect in the intestine. They produce a characteristic pattern called "air-fluid levels". The air rises above the fluid and there is a flat surface at the "air-fluid" interface.

      Small bowel obstruction - X-ray

      illustration

    • Small intestine anatomy

      Presentation

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Intestinal obstruction

           

             

            Review Date: 5/11/2016

            Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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