Adhesive intestinal obstruction

　　What are the causes of adhesive intestinal obstruction

　　What complications can adhesive intestinal obstruction easily lead to

　　The prognosis of adhesive intestinal obstruction depends on the cause and type of obstruction and is closely related to the timing of diagnosis and treatment. Generally, simple intestinal obstruction without severe systemic toxic symptoms has a good surgical prognosis. If there is intestinal necrosis, it depends on the length and extent of the necrotic intestinal tract. Generally, timely rescue has a good effect. If too much intestinal resection is performed, it is difficult to maintain normal intestinal function, leading to malabsorption of nutrition and a poor prognosis.

　　One, Abdominal tenderness, rebound tenderness, and muscular rigidity. Abdominal distension and hyperactive bowel sounds are not obvious.

　　Two, Sudden deterioration of the general condition, with obvious sepsis and shock may occur.

　　Three, X-ray film examination shows that the upper intestinal segments above the obstruction are dilated and filled with fluid, resembling a tumor or in the shape of a 'C', known as the 'coffee bean sign'. Abdominal fluid is often visible between the dilated intestinal segments.

　　Adhesive intestinal obstruction belongs to mechanical obstruction, and it manifests as abdominal pain, vomiting, abdominal distension, and constipation due to the obstruction of intestinal content movement. The clinical manifestations can vary due to the site, severity, onset, and presence of blood supply obstruction in an individual patient.

　　One, Stopping defecation and flatus at the anus

　　Incomplete intestinal obstruction may have intermittent small amounts of stool, which should be distinguished from the initial small stool in high-position intestinal obstruction to avoid misdiagnosis. If there is bloody mucus, it suggests the possibility of intestinal strangulation.

　　Two, Abdominal pain

　　It is manifested by intermittent abdominal pain accompanied by hyperactive bowel sounds, visible intestinal shape and peristaltic waves. The site of abdominal pain is often at the site of adhesion and obstruction. Postoperative adhesive intestinal obstruction usually causes pain near the incision and palpable pain mass.

　　In the early stage, hyperactive bowel sounds and water-like sounds can be heard. If there is a blood supply obstruction in the intestinal tract, the interval between abdominal pain may shorten, presenting as persistent severe colicky pain or signs of peritonitis.

　　Three, Abdominal distension

　　It generally appears later and its severity is related to the site of obstruction. In cases of high-position obstruction, due to frequent vomiting, abdominal distension is not obvious, but sometimes the gastric shape can be seen. In low-position intestinal obstruction, abdominal distension is marked, affecting the entire abdomen, and percussion sounds like a drum. In incomplete intestinal obstruction, abdominal distension may not be obvious.

　　Four, Vomiting

　　In the early stage of obstruction, vomiting is reflexive. The vomit consists of gastric juice and duodenal juice. Low-position intestinal obstruction is characterized by delayed and less vomiting, with vomit resembling feces. When there is a blood supply obstruction in the intestinal tract, the vomit may be brownish or bloody, which is also a symptom that may appear in adhesive intestinal obstruction.

　　Adhesions within the abdominal cavity usually do not cause intestinal obstruction. The occurrence of obstruction is often due to certain triggering factors, and it is necessary to remind patients to be aware of this:

　　One, meals should be regular, avoid overeating, and prevent a large amount of food from entering the proximal intestinal tract affected by adhesion.

　　Two, pay attention to food hygiene, prevent gastrointestinal inflammation, and avoid abnormal peristalsis of the intestinal tract.

　　Three, it is not advisable to engage in strenuous physical activities after meals, especially sudden changes in body position, which is particularly important for patients who have already had intestinal obstruction.

　　The examinations that adhesive intestinal obstruction patients need to do include:

　　One, laboratory examination

　　Hemoglobin, hematocrit can increase due to dehydration and blood concentration, and the changes in whole blood carbon dioxide binding power and serum sodium, potassium, and chloride ions can understand the situation of electrolyte acid-base imbalance. If the vomit or stool is bloody, and the white blood cell count and neutrophils are significantly increased, attention should be paid to the possibility of strangulated intestinal obstruction.

　　Two, imaging examination

　　X-ray examination, generally after 4 to 6 hours of obstruction, abdominal X-ray fluoroscopy or plain film shows gas in the intestinal lumen and stepped gas-liquid levels.

　　Ultrasound examination shows that the small intestine is significantly thickened, there is a liquid shadow in the intestinal tract, and sometimes gas reflection can be seen in the expanded intestinal tract.

　　Preventing adhesion is the key to solving adhesive intestinal obstruction. For diseases that cause peritonitis, such as tuberculous peritonitis, peritonitis after gastrointestinal perforation, etc., active prevention and thorough treatment of abdominal inflammation should be carried out.

　　One, meals should be regular, avoid overeating, and prevent a large amount of food from entering the proximal intestinal tract affected by adhesion.

　　Two, pay attention to food hygiene, prevent gastrointestinal inflammation, and avoid abnormal peristalsis of the intestinal tract.

　　Three, it is not advisable to engage in strenuous physical activities after meals, especially sudden changes in body position.

　　The incidence rate of adhesive intestinal obstruction accounts for 47% of all types of intestinal obstructions. Clinically, most of them are caused by surgery, accounting for about 80%, among which 30% occur after appendectomy and 22% after intestinal surgery. Due to intestinal adhesion caused by surgery itself, it is generally not easy to perform surgery again. In the following situations, surgical treatment should be considered:

　　1. It is indeed a non-strangulated intestinal obstruction suspected to be caused by widespread adhesion, that is, diagnosed as痞结type or瘀结type in traditional Chinese medicine.

　　2. The primary disease is tuberculosis, and there has been relief with anti-tuberculosis drugs.

　　For patients with severe illness, showing signs of shock, or with obvious peritonitis, diagnosed as carbuncle-type; or those whose condition worsens after treatment with traditional Chinese and Western medicine, still require surgical treatment.