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Intestinal Obstruction & Ileus

Surgery > General surgery

Background Knowledge 🧠

Definition

  • Intestinal Obstruction: Blockage preventing the normal flow of intestinal contents through the digestive tract.
  • Ileus: A type of bowel obstruction caused by a lack of peristalsis or motility, without any physical blockage.

Types

  • Mechanical Obstruction: Physical barrier such as tumours, hernias, or strictures.
  • Functional Obstruction (ileus): Resulting from neuromuscular dysfunction, e.g., post-operative ileus, medications, or spinal injuries.

Clinical Features 🌡️

Clinical Presentation

  • Colicky abdominal pain.
  • Vomiting: Feculent in lower obstruction.
  • Constipation and absence of flatus.
  • Distended abdomen.
  • Audible bowel sounds, or “tinkling” in mechanical obstruction; absent bowel sounds in ileus.

Differential Diagnoses

  • Gastroenteritis.
  • Pancreatitis.
  • Mesenteric ischaemia.

Investigations 🧪

Investigations

  • Plain abdominal X-ray: Dilated bowel loops, air-fluid levels in obstruction.
  • CT scan: Detailed view, especially in suspected strangulation.
  • Abdominal ultrasound: Particularly in suspected intussusception in children.
  • Blood tests: Electrolytes, kidney function, lactate (if strangulation suspected).

Management 🥼

Management

  • Nil by mouth (NBM) and nasogastric tube insertion for decompression.
  • Fluid resuscitation and correction of electrolyte imbalances.
  • Surgery: In cases of mechanical obstruction, especially if strangulation or necrosis is suspected.
  • For ileus, treat the underlying cause, e.g., discontinuing causative medications.

Complications

  • Strangulation leading to bowel ischaemia.
  • Dehydration and electrolyte imbalances.
  • Peritonitis if bowel perforates.
  • Bowel necrosis.

Key Points

  • Bowel obstruction can be caused by mechanical (tumour) or functional (ileus) factors.
  • Early diagnosis and management is required to reduce complications, such as bowel strangulation.
  • Often presents with colicky abdominal pain, abdominal distension, constipation and vomiting.
  • Diagnosis is based on characteristic signs on abdominal X-ray (dilated bowel loops).
  • Management includes making patient NBM and nasogastric tube insertion, with fluid resuscitation and surgery (mechanical obstruction) or treating underlying cause (ileus).

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General surgery