Paralytic intestinal obstruction

Paralytic intestinal obstruction is caused by infectious-toxic, neuro-reflex, neurotoxic effects, impaired serum electrolyte content or a decrease in blood flow in the intestinal wall. Infectious-toxic causes: peritonitis, pneumonia, uremia, acidosis, diabetes mellitus, porphyrin disease and morphine poisoning. Reflex factors that can lead to paralytic intestinal obstruction: postoperative stress, biliary and renal colic, pancreatitis, ovary torsion, large omentum, trauma of the abdominal cavity and retroperitoneal space, myocardial infarction. Neurogenic causes: spinal cord, syringomyelia, shingles, spinal cord trauma. Myogenic paresis of the intestine is a consequence of avitaminosis, hypoproteinemia, hypokalemia, hypomagnesemia, disturbed blood flow in the intestinal wall with portal hypertension, heart failure, thrombosis and embolism of mesenteric vessels. A special form of unclear genesis, affecting the colon, is called pseudo-obstruction (there are clinical manifestations of obstruction, but even during surgery, no obstacles to passage of intestinal contents are detected).

Symptoms, course. Constant blunt abdominal pain in the abdomen with periodic enhancements in the type of contractions, nausea, vomiting stagnant contents. Bloating. The tongue is dry, coated. The abdomen is relatively soft. When palpation - soreness of the abdominal wall in all departments without symptoms of irritation of the peritoneum. The weakly positive symptom of Schetkin can be caused by a sharp swelling of the intestinal loops (pseudoperitonism). With auscultation - complete absence of intestinal noises; Well conducted heart sounds and respiratory noises. At a roentgenological examination of the abdominal cavity organs, pneumatosis and multiple fine and topocecal levels. Oliguria is characteristic, in the blood-leukocytosis. When stimulating the activity of the intestine, there is no effect.

Treatment. Paralytic intestinal obstruction is always a secondary disease. The basis of treatment is the elimination of the root cause: removal of the focus of infection (appendectomy, suturing of perforated ulcers, etc.). With reflex and toxic intestinal obstruction, the elimination of sources of irritation in a conservative way, i.e., drug blockade of all impulses peristalsis of the intestine by epidural paravertebral blockade. Further - stimulation of the intestine: the introduction of reomacrodex, potassium chloride, 20% sodium chloride solution, proeryrin, clam, acetylidine, siphon enema (causes reflex enhancement of peristalsis). It is necessary to introduce a gastric probe, better than a Miller-Abbot probe for aspiration of gastric or intestinal contents. If these measures do not give an effect and there is a danger of shock development due to a decrease in bcc and hypoxia due to high diaphragm standing, emergency surgery is indicated-laparotomy with nasogastric intubation of the entire small intestine and subsequent treatment of disturbed metabolic processes.

The prognosis depends on the underlying disease.