Mechanical intestinal obstruction

Mechanical intestinal obstruction is obturation and strangulation. With obstructive obstruction there is compression of the lumen of the intestine without compression of the mesentery and its vessels: swelling, fecal stones, compression of the gut from the outside by a tumor of the kidney or gynecological organs. With strangulation obstruction, in addition to the compression of the lumen of the intestine, there is compression of the mesenteric vessels, which causes circulatory disturbance, and then the development of necrosis of the intestinal wall and peritonitis. With strangulation obstruction the pain syndrome is more pronounced and the pain is permanent with cramping amplifications. A typical example of strangulation is the compression of the intestine with an injured hernia. Mixed nature of intestinal obstruction (elements of striation and obturation) occurs when intussusception of the intestine.

Adhesive intestinal obstruction can be both obturational and strangulatory.

There are high and low intestinal obstruction. With high intestinal obstruction in the clinical picture, vomiting predominates with stagnant contents, in the first hours of the disease there can be an independent chair, gases can escape. Massive vomiting leads to significant water-electrolyte disturbances, which can sometimes be the cause of the patient's death. With low intestinal obstruction, the first symptom is the absence of stools and the escape of gases. The eructation and vomiting of stagnant contents appear sometimes only on the 3rd-4th day of the disease.

Necrosis of the intestinal wall in case of obstruction can be caused either by a direct disturbance of blood flow during strangulation, or by a decrease in blood circulation in the intestinal wall as a result of an increase in intraluminal pressure in the leading loop. When the intraluminal pressure rises above 60 cm of water. Art. Blood flow in submucosal vascular plexuses completely stops, resulting in necrosis of the intestine. Changes in blood circulation and degenerative changes in the mucosa extend proximally to the macroscopically visible gut region by 40-60 cm.

Diagnosis of intestinal obstruction is based on anamnesis (surgery on the abdominal organs), objective examination data (bloating, asymmetry, visible peristalsis, increased intestinal peristalsis at the height of an attack of cramping pains) and radiographic data.