Intestinal Obstruction – Diagnosis and Treatment
Many people experience abdominal pain at some point in their lives. This pain can result from various conditions.
Tumors, cancer, diverticulitis, and Crohn’s disease are serious illnesses that can cause these symptoms. Complications from abdominal or pelvic surgery, constipation, diarrhea, or dehydration can also lead to abdominal pain.
Symptoms like vomiting, nausea, bloating, and changes in bowel movements may occur. Severe or long-lasting pain may signal conditions that need quick medical care.
Diagnosis
Doctors follow several steps to identify a bowel or intestinal blockage. These steps help them locate the blockage and find its cause.
Physical Exam
The doctor asks about past health problems and current symptoms. They gently press on the belly to check for swelling, pain, or any noticeable masses.
The doctor listens for unusual bowel sounds with a stethoscope to detect changes from the obstruction.
Imaging Tests
| Test Name | What It Shows | Who It Helps Most |
|---|---|---|
| Abdominal X-ray | Offers a quick look for air, fluid, or signs of blockage. | Useful in adults |
| CT Scan | Shows detailed images to pinpoint the exact location and cause. | Most common for adults |
| Ultrasound | Detects classic signs like a “bull’s-eye” in kids with intussusception. | Best for young children |
| Air/Barium Enema | Highlights the colon, can reveal causes like twisting or intussusception. | Mostly in children |
Special Situations
Doctors order extra tests like a barium enema for colonic obstruction or suspected twisting of the intestine. Helical CT scans help identify adhesive small bowel obstruction and complex cases.
Treatment
When a patient arrives at the hospital with an intestinal blockage, medical staff act quickly to keep the person stable. They give IV fluids to prevent dehydration and maintain the body’s balance.
Staff insert a nasogastric (NG) tube through the nose into the stomach to remove air and fluid. This step reduces swelling and pain in the belly.
A urinary catheter may be used to drain and monitor urine. These steps prepare the patient for further treatment and help watch for problems like shock or worsening symptoms.
Approaches to Managing Intussusception
Intussusception is a type of bowel blockage often seen in young children. Doctors use a barium or air enema as both a test and a treatment.
The enema can sometimes fix the blockage, so surgery is not needed. If the enema does not work or in adults, doctors may perform surgery to remove or repair the affected intestine.
Handling Partial Blockages
With a partial intestinal blockage, some food and liquid can still move through. After stabilizing the patient, doctors usually recommend a low-fiber diet to reduce stress on the intestine.
Doctors often try conservative management first, so surgery can sometimes be avoided. They monitor the patient with fluids and diet changes.
If the blockage does not improve, doctors may perform surgery to remove the cause, such as adhesions from old surgeries, scar tissue, or hernias. If surgery is needed, they may remove the blockage or create a small opening in the bowel, called a colostomy or ileostomy.
Choosing Treatment for a Total Blockage
Complete blockages prevent anything from passing through the intestine. In these cases, doctors usually perform surgery right away.
They remove the source of the blockage, which could be a hernia, volvulus (twisting of the bowel), or tumor. Sometimes, doctors also cut out sections of the intestinal wall that have died from lack of blood flow.
For some patients at high risk for surgery or those with bowel cancer, doctors may place a self-expanding metal stent. They insert this wire tube through an endoscope to keep the bowel open and help waste pass. This can be a temporary fix or a step before surgery.
Types of Surgical Procedures
| Obstruction Cause | Type of Surgery | Possible Additions |
|---|---|---|
| Adhesions | Adhesiolysis | Bowel resection if tissue is dead |
| Hernia | Hernia repair | Bowel resection if ischemic |
| Volvulus | Untwisting and possible resection | Temporary stoma |
| Tumor/Cancer | Tumor removal or stent placement | Colostomy or ileostomy if required |
Addressing Pseudo-Obstruction and Ileus
Pseudo-obstruction or paralytic ileus looks like a blockage but happens when the bowel stops moving. Doctors closely monitor the patient in the hospital.
They may give nutrition by IV or NG tube to prevent malnutrition. Medications might be used to stimulate bowel contractions.
If a medication or illness caused the problem, stopping the source can help. If the bowel is very swollen, doctors may perform colon decompression with a colonoscope or surgery.
Surgery for pseudo-obstruction is rare and only happens if other treatments do not work.
Getting Ready for Your Visit
If you face a possible intestinal blockage or fecal impaction, preparation is important, even with little time. This problem is usually a medical emergency, so quick action matters.
If you have time, make a detailed list of every symptom, especially new or unusual ones. Note when symptoms began and how they have changed to help the healthcare provider understand your situation.
Gather personal medical information, such as recent surgeries, injuries, or long-term conditions. Make a list of any medicines or supplements you use, as these can affect diagnosis and treatment.
Write down questions you want to discuss.
Key Tips for Preparation:
- List main symptoms (pain, nausea, vomiting, constipation, fever, blood in stool).
- Record when symptoms started and how they changed.
- Bring information about recent medical treatments or hospital stays.
- Have a list of all current medications.
- Bring someone for support, if possible.
A table can help organize important information:
| Details to Note | Why It Matters |
|---|---|
| When symptoms started | Helps track how fast it worsens |
| Type/location of pain | Guides the exam |
| Past surgery or radiation | May lead to blockages |
| Recent bowel habits | Shows changes in digestion |
Questions Your Provider May Ask
Doctors quickly try to find what is causing your symptoms. They may ask:
- When did the stomach pain or other symptoms begin?
- Did the discomfort start suddenly, or have you experienced this before?
- Do you feel the pain all the time or off and on?
- Have you had nausea, vomiting, fever, diarrhea, or trouble passing stool?
- Is there any blood visible in your stool?
- Have you ever had surgery or medical treatment on your stomach or abdominal area?
Being ready to answer these questions makes your visit more effective and helps the healthcare provider act quickly. Responding clearly can prevent delays in treatment.
