Specific types of intestinal obstruction

Separate types of intestinal obstruction . Gall-stone intestinal obstruction. Gallstones, usually 3-4 cm in size, enter the duodenum through the cholecystoduodenal fistula. Characteristic: the age of patients 60-70 years, chronic calculous cholecystitis in history, intermittent pattern of intestinal obstruction (the stone irritates the intestinal wall, leads to spasm of the intestine and the appearance of its obstruction). After elimination of spasm, the stone moves further. Usually, he finally guts the gut about 1 m from the ileocecal angle - in the narrowest part of the small intestine.

Treatment operative - after displacement of the stone in the proximal direction above it, enterotomy is produced and removed. High lethality (about 30%) is due to the severity of the concomitant pathology in the elderly ballroom.

Tumor intestinal obstruction occurs more often when the tumor is located in the left half of the colon. Characterized by the elderly patients, gradually increasing constipation followed by the development of complete intestinal obstruction. When a physical examination, bloating is noted, in the initial stages there may be an asymmetry, a splash noise. Radiological picture: in the initial stage - colonic levels, then with the development of failure of the ileocecal valve (bauginia valve), there are also small intestinal levels.

If conservative therapy has no effect, surgery is indicated. Depending on the general condition of the patient, an unnatural anus on the colon segment is formed closer to the tumor or obstructive resection of the Hartmann type is performed (removal of the intestine with the tumor, the distal end of the intestine is sutured, and the proximal is removed as a single-stem unnatural anus).

Invagination is caused by the introduction of one segment of the gut in another. There are antegrade and retrograde invagination. The cause in childhood can be diarrhea of ​​different genesis, in adults, benign and malignant tumors of the intestine, which, irritating the intestine, increase its peristalsis and lead to intussusception.

Symptoms, course. Pain, vomiting, in the abdomen, a testicle formation is defined, moderately painful upon palpation. The admixture of blood in the feces (such as "crimson jelly"), with progressive ileocecal intussusception, digital rectal examination sometimes makes it possible to detect the head of the invaginate. The diagnosis in this case is confirmed with an irrigoscopy.

Treatment in most cases operative: in childhood, as a rule, disinvagination, in adults - the removal of invaginate.

The prognosis depends on the cause of intussusception.

Adhesive intestinal obstruction occurs in 30% of cases. Spikes can lead to compression of the gut and obstructive obstruction, in addition, massive scars can squeeze and mesentery of the intestine along with the intestinal wall - strangulation obstruction. Spikes also contribute to the development of a curvature. Adhesive intestinal obstruction is often recurrent: usually after overeating, there is an increase in pain syndrome, which is caused by stretching the intestinal wall, reducing the contractile capacity of the intestine and decompensating the passage of intestinal contents. After conservative treatment with aspiration of intestinal contents, the effectiveness of peristalsis can be restored and the obstruction is eliminated. Each re-operation on the abdominal cavity, including the obstruction, leads to an increase in the adhesion process. If the adhesive obstruction is obturation, it is possible to conduct a course of conservative therapy. If inefficiency or strangulation phenomena - surgery. In order to prevent the phenomena of obstruction in the course of the operation, it is possible to use splinting of the small intestine on a naso-intestinal probe 3-4 m long or a probe inserted through the gastrostomy. The shiny loops of the small intestine are carefully laid, the probe is removed no earlier than 2 weeks, when the position of the intestinal loops is already formed. Sometimes an operation like Noble (plication by holding ligatures through the mesentery of the intestine) is shown.

The forecast is doubtful; No operation, including an operation such as Noble, does not eliminate the possibility of recurrence of the disease.