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Digestive System Surgery: Small Intestinal Obstruction

Gut tract contents grow stagnant.

Small intestinal obstruction (so called as Ileus) is a disease where part of small intestine becomes narrower or motion of small intestine becomes weakened, then gut tract contents grow stagnant.

Small intestinal obstruction is grouped, by the cause, into mechanical and functional. Mechanical bowel atresia is then grouped, by existence of blood flow disorder, closed type (simple intestinal obstruction) and strangulated type (complex intestinal obstruction). Majority of the cause is autogenous healing of post-operation, and it takes 50 to 80%.

Classification and cause of Intestinal obstruction.

Intestinal obstruction is grouped, by its cause, as below.

Mechanical Intestinal Obstruction
  1. Closed Intestinal Obstruction (Simple Intestinal Obstruction) Obstruction by tumor, arctation by inflammation or scar, congenital anomaly, compression from region, twisted gut tract, autogenous healing of post-operation, obstruction by foreign objects or foods, gut tract which is simply growing stagnant by worm obstruction.
  2. Strangulating intestinal obstruction (complex intestinal obstruction) Most likely in chronic stage, where inflation intussusception or hernia incarcerated as the result of offending gut blood flow and gut tract become necrotic by tightened intestine by cord (like band), twisted intestine, or tied up intestine.
Functional Intestinal Obstruction
  1. Paralytic Bowel Obstruction of the EnteritisGut tract movement becomes worse by the effect of paralytic intestinal obstruction bowel inflammation, inflammation of peritoneum, medical agent or post-operation.
  2. Paralytic Bowel Obstruction SpasmGut contents does not flow out due to the part of paralytic intestinal obstruction gut tract shrunk in paralytic.

Bulging of bowel or vomiting may appear.

Because of the flow of the gut tract get stacked up, contents get stacked up in the gut tract, then gut tract is expanded and gradually stacked towards the mouth, pain on entire bowel like blowing up, bowel bulging, nausea, or vomiting, these symptoms appeared. In case of mechanical type, there is no bowel motion or no gas discharge. In case of functional type, it may accompany with fever or diarrhea.

It may advance in few days if these symptoms are left untreated, or it may be shocked by dehydration. And, in case of strangulating type, blood flow disorder is developed in gut tract, leading to necrosis, develops blood poisoning or perforation of the digestive tract, and surgical treatment is urgently requested to save life.

Diagnose by X-Ray and CT exam.

There is no special exam, and it can be diagnosed by the following general test.

Roentgen/X-Ray Test
Recognized gas image in the expanded small intestine.
CT (Computer Laminographic)
It is helpful in differentiating between the cause of intestinal obstruction, such as expansion of gut tract, gut tract contents, with or without ascites fluid, with or without blood flow disorder, position of obstruction. It is also useful for judging the necessity of surgical operation.

Treatment to the cause of intestinal obstruction.

Treatment differs upon the causes. Basically, they are abstinence from food, supply of water by drip infusion, aspirate, by Ileus tube, the retained contents in stomach and intestine, and depressurize them. Depend on the cause, treatment methods are; surgery, antibiotic agent therapy, reset, or endoscope. Below is the summary of the treatment.

Functional Intestinal Obstruction
  1. Closed Intestinal Obstruction(Simple Intestinal Obstruction) Tumor, congenital anomaly, arctation, twisted gut tract are subject to surgery, inflammation is subject to antibiotic agent therapy, post-operational autogenous healing, obstruction by foreign objects or foods, worm obstruction are subject to conservative management. In case these treatment does not improve, it may turn to surgical operation.
  2. Strangulating intestinal obstruction (complex intestinal obstruction):As strangulating intestinal obstruction is accompanying bowel ischemia, it should be removed by surgical operation. In case gut tract becomes necrotic, cut off gut tract. In case it is not yet necrotic stage, treatment to the cause of obstruction (for Hernia, apply radical operation, for autogenous healing, apply synecology).
Functional Intestinal Obstruction
  1. Paralytic Bowel Obstruction of the EnteritisAntibiotic agent or surgical operation is applied to cure for the cause of inflammation for paralytic intestinal obstruction bowel inflammation and inflammation of peritoneum. Drug-induced treatment enhances bowel motion by administration of a medicine.
  2. Paralytic Bowel Obstruction Spasm
    Administration of antispasmodic agents is used to cure paralytic intestinal obstruction. In conservative management, when obstruction is released, dietary style is gradually increasing from drink water, diet fluid, 50% rice gruel to full rice gruel. Hospitalized period will be one to two weeks. For other, few days to few weeks hospitalization is necessary depend upon disorder.

Person who have surgical history should care for daily eating habit.

The majority causes are post-operational adhesive intestinal obstruction. Few percent of the person who has abdominal surgical history has a risk of intestinal obstruction. To prevent from recurrence or for aborting purpose, eat a meal with biting well and slowly, take enough water, not to eat much and drink much, avoid taking food that is difficult to digest, or food contains much fibers like mushrooms, burdock root or sweet potato. Let’s practice good dietary treatment. Kampo medicines named Daiken Chuto is told it is effective and told it’s good for aborting purpose if it is continued to take, but it is not assured, so that it is recommended to have medical check as soon as any symptom appeared.  

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