Intestinal Obstruction: Pathophysiology, Causes, Symptoms, Treatment

Intestinal Obstruction is a sort of a block, which prevents food or liquids to pass from the small intestine to the large intestine. The main cause for intestinal obstruction is abdominal adhesions, which are usually formed after any type of surgery to the stomach. It can also be caused due to a medical condition called diverticulitis or hernias as well as tumors. If appropriate treatment is not given for this condition, then the blocked part of the intestine may get destroyed causing potentially serious complications, although with adequate treatment and care this condition can be successfully treated.

In intestinal obstruction, there is an obstruction in the intestine which results in blockage of the passage through which stool content passes to the rectum from the intestine. This obstruction causes distension of proximal intestine due to solids, fluids and gases causing pain, increased abdominal girth, and increased tension in intestinal wall. This increased tension in the intestinal wall along with reduced blood supply to the intestine due to the obstruction and/or twisting and external pressure causes tissue death or perforation of bowel. Intestinal obstruction with resultant impairment of blood supply to the affected region also results in activation of systemic inflammatory responses along with translocation of bacteria through walls of the intestines.

Some of the causes of Intestinal Obstruction are:

• Abdominal adhesions
• Hernias
• Tumors of the intestine
• Inflammatory bowel diseases
• Intestinal twisting called as volvulus
• Intussusception.

If Intestinal Obstruction is left untreated, it can cause potentially serious and life-threatening complications, some of which are illustrated below:

Tissue Death: As stated above, Intestinal Obstruction can cause impairment of blood supply to the obstructed part of the intestine resulting in complete necrosis of the tissues in that region. This death of tissue due to lack of blood supply can cause tear of the intestinal wall predisposing the body to infections

Infection: The most common infection caused by Intestinal Obstruction is called as Peritonitis. This infection is extremely serious and life-threatening which requires emergent medical attention and even at times surgery.

Some of the medical conditions that can cause Intestinal Obstruction are:

• Surgical procedures to the abdomen or the pelvis which often at times causes adhesions which is a common form of intestinal obstruction
• Crohn’s Disease can cause thickening of the intestinal walls thus stenosing the passage through which the stools pass to the rectum
• Abdominal cancer is also a cause for Intestinal Obstruction, especially if an individual undergoes surgery for removal of the tumor or radiation treatments.

Symptoms of Intestinal Obstruction Include:

• Cramping pain in the abdomen which waxes and wanes
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Having trouble passing stool
• Abdominal distention.

In order to diagnose Intestinal Obstruction the treating physician will do the following:

Physical Examination: The physician will take a detailed history and ask in detail about the symptoms experienced. A detailed physical examination will also be performed. Intestinal Obstruction will be suspected if the physician observes abdominal distention or there is presence of abdominal tenderness. The physician will also listen to bowel sounds to make sure that they are normoactive

Imaging Studies: If Intestinal Obstruction is suspected, the treating physician may order imaging studies to confirm the diagnosis, which may include an x-ray or a CT scan of the abdomen, which will given a confirmatory diagnosis of an obstruction and also will reveal the source of the obstruction.

Treatment for Intestinal Obstruction is usually done in an inpatient setting and depends on the cause of the obstruction.

To begin with, an IV line will be placed to give fluids in the body. The next step in care is to place an NG tube to remove air from the stomach and aid in relief of swelling of the abdomen.

Partial Intestinal Obstruction: If an individual has a partial obstruction of the intestine, then no particular treatment will be required apart from stabilization explained above. A low fiber diet may be recommended so that the food can pass through the partially obstructed intestine. Surgery may be required in case this partial intestinal obstruction does not clear on its own.

Surgery For Complete Intestinal Obstruction: If there is complete obstruction of the intestine, a surgical procedure will be required to clear the obstruction. The type of procedure performed is dependent on the cause of the obstruction. The surgical procedure will remove the obstruction along with any diseased or damaged structure along with it.

As an alternative, the physician may recommend treating the obstruction using a self expanding stent. The stent is inserted in the colon. This stent forces the colon to open thus clearing the obstruction. This method of treatment is usually done in individuals who have colon cancer or people who need immediate relief prior to surgery but ultimately surgery is required to clear the Intestinal Obstruction.

If Intestinal Obstruction is left untreated, it can cause necrosis of the affected region of the intestine due to lack of blood supply which may cause tear of the intestinal walls, infection and shock.

The overall prognosis of Intestinal Obstruction is dependent on the cause of it. Although majority of the cases of Intestinal Obstruction are perfectly treatable, obstructions caused by cancer more often than not need long term monitoring and treatment.

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