Intestinal stone obstruction

　　1. Etiology

　　Primary intestinal bile acid stones may be due to excessive gastric acid secretion, which lowers the pH of the proximal jejunum, or due to excessive bacterial proliferation in the intestinal loop, causing the jejunum pH to drop, while decomposing bile salts into bile acids. Bile acids are not soluble in water in the jejunum with a lower pH, forming bile acid crystals. Bile acid crystals can serve as the core of stones, and together with certain insoluble or indigestible inorganic salts, food, or foreign bodies, they form special coagulants or hard lumps in the gastrointestinal tract, becoming intestinal stones. The enlargement of stones can block the small intestine, leading to intestinal obstruction caused by intestinal stones.

　　Second, pathogenesis

　　According to the mixed components of intestinal stones, the intestinal stones causing obstruction can be divided into 3 types:

　　1, True intestinal stones:Generally, it is composed of a core consisting of intestinal mucosal epithelium, small fecal stones, fruit kernels, and other foreign bodies, which forms a stone after the deposition of inorganic salts.

　　2, Drug-induced intestinal stones:It is an insoluble hard mass formed in the intestine after long-term oral intake of drugs containing calcium, phosphorus, and magnesium.

　　3, Mixed intestinal stones (plant hair-like stones):Formed by eating certain fruits, vegetables, or swallowing hair, especially eating unripe fruits is more likely to form.

　　Among the stones that cause intestinal obstruction, plant hair-like stones are more common. Among them, the plant stones formed by persimmons are the most common. Unripe persimmon juice and ripe persimmon skin contain tannic acid, which, when in contact with gastric acid, forms a gelatinous polymer and precipitates, and then continuously adsorbs plant fibers to form lumps. After the inorganic salts such as calcium, phosphorus, and magnesium are deposited, they form intestinal stones. The more persimmons eaten, the easier it is to form stones. Hair-like stones are often seen in people with mental disorders who have eaten their own or others' hair, leaf fibers, woolen clothing, etc. A large amount of hair can be tangled with gastrointestinal peristalsis to form a ball, thus forming a solid and isolated mass. There are also reports that a part of the gastrointestinal anastomosis line has fallen off and formed a core for the formation of stones leading to intestinal obstruction. People with a history of gastric surgery, such as subtotal gastric resection with Billroth II anastomosis, vagotomy, pyloroplasty, etc., are more prone to form stones. Michael reported that among 113 cases of gastrointestinal stones, 106 had undergone gastric surgery. The reason is that after gastric surgery, the gastric peristalsis is slow, and the emptying is delayed, which makes the contact time between the gastric contents and gastric acid longer, and it is easy to form gastric stones, especially after eating persimmons. After gastric surgery, especially after Billroth II anastomosis, due to the larger anastomotic mouth, the gastric stones formed in the stomach are more likely to enter the small intestine and cause obstruction. It is also easy to form intestinal stones at the site of intestinal diverticula and the proximal part of intestinal stricture.

　　Intestinal torsion, intestinal wall necrosis, and perforation are common complications of this disease. Abdominal distension, abdominal pain, and constipation are the main clinical symptoms, while nausea and vomiting are secondary symptoms. Physical examination shows abdominal distension, the lower abdomen is still soft when pressed, there is no obvious tenderness, rebound pain, and occasionally a mass can be palpated. Mechanical intestinal obstruction often has intermittent abdominal colic due to increased peristalsis. When abdominal pain occurs, patients often feel gas running in the abdomen and other symptoms.

　　The clinical manifestations of intestinal stone ileus are similar to those of biliary stone ileus, which often starts as a partial obstruction. When the intestinal stone moves downward with peristalsis to the terminal ileum, which has a smaller lumen, it can cause complete intestinal obstruction. Therefore, the site of obstruction is often seen in the terminal ileum, and a few cases may be seen in the duodenum, colon, rectum, and other parts. When the intestinal stone abrades or compresses the intestinal mucosa and causes necrosis, gastrointestinal bleeding may occur, and it can also cause intestinal torsion, intestinal wall necrosis, perforation, and form a diffuse peritonitis. Sometimes, brownish-red fruit skin or hair and other substances can be seen in vomit or feces.

　　There is currently no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of the disease.

　　Total parenteral nutrition, that is, injecting the necessary nutrients for the body through the venous route. Total parenteral nutrition during intestinal obstruction can serve as preoperative preparation, as well as supportive treatment for non-surgical treatment or late postoperative feeding. If the disease is resolved and intestinal function is restored, it is best to start oral intake as soon as possible. Patients who cannot eat normal food can consume elemental diet, and actively prevent the occurrence of the disease.

　　1. X-ray abdominal film shows signs of partial or complete intestinal obstruction, and barium meal or barium enema shows intestinal loop dilatation and intestinal lumen filling defect.

　　2. Gastroscopy examination of the stomach and duodenum is of great help in diagnosing gastric stones and duodenal obstruction.

　　3. Ultrasound examination can show strong chyme reflux and arc-shaped heterogeneous strong echo bands in the intestinal lumen, with successive attenuation of acoustic shadows behind the echo bands.

　　1. What foods are good for the body with intestinal stone obstruction

　　Suitable for light, nutritious, and liquid foods. Rice porridge, vegetable soup, lotus root starch, egg flower soup, noodles, etc.

　　2. What foods should be avoided for intestinal stone obstruction

　　Avoid indigestible,刺激性 food, long fiber food, bloating, greasy, fishy and smelly food.

　　Lamb, beef, scallion, chili, chicken soup, beef bone soup, milk, soybeans, broad beans, sweet potatoes, potatoes, celery, spinach, chives, Chinese cabbage, coriander, bamboo shoots, etc.

　　Some patients can relieve symptoms with non-surgical treatments such as fasting, gastrointestinal decompression, antispasmodic analgesics, and oral liquid paraffin. Most still require surgical treatment. In the selection of surgical methods, most experts advocate first trying to crush intestinal stones with hand pressure to push them into the large intestine, and if this fails, to perform enterotomy to remove stones. If there is intestinal necrosis, a partial intestinal resection should be performed.