What Is Gallstone Ileus?

Large bowel obstruction (LBO) is a group of emergencies that require early identification and active intervention. Causes vary according to age and are divided into mechanical obstruction and dynamic obstruction (pseudo-obstruction). The main causes of middle-aged and elderly patients include tumors, inflammatory lesions (dividulitis), stenosis, fecal impaction or torsion. Newborns are mainly caused by anal dysplasia or other anatomical abnormalities, as well as meconium.

Basic Information

English name: large bowel obstruction; colonic obstruction
Visiting department: surgical
Common locations: the large intestine

Common causes: Caused by cancer, colon torsion, schistosomiasis, acute pseudocolon, colon caused by postoperative pelvic adhesions, etc.
Common symptoms: Local necrosis and perforation, severe flatulence, etc.

Causes of colorectal obstruction

Cancerous obstruction

The primary cause of colon obstruction.

2. Colon twist

The second most common cause can occur in the cecum, transverse colon, and sigmoid colon, but the sigmoid colon is the most common.

3. Schistosomiasis of the colon

In China's schistosomiasis endemic areas, schistosomiasis granulomatosis or associated colon cancer is still seen.

4. Acute pseudocolonic obstruction (Ogilvie syndrome)

Fariano believes that the disease is related to parasympathetic dysfunction of the palate. Matsui reported that part of the nerve conduction dysfunction caused the disease, and under the microscope, the number of ganglion cells in the intestinal wall was reduced, and the neurons had degenerative changes.

5. Colon obstruction caused by pelvic adhesions

The characteristics of this disease are: most often occur after pelvic surgery in middle-aged women; intermittent abdominal distension, chronic abdominal pain and constipation; no special lesions of barium enema; fiber colonoscopy shows the sigmoid colon is angled, and there is also stenosis, which prevents the colon Mirror enters.

6. Obstruction caused by extracolonic tumor compression or invasion

Such as pancreatic cancer or gastric cancer invading the transverse colon and causing obstruction; it is not uncommon for female pelvic tumors, especially ovarian tumors to cause sigmoid colon obstruction.

7. Gallstone obstruction

It accounts for 1% to 3% of all intestinal obstructions, and the preoperative diagnosis rate is only about 15%.

Pathogenesis of colorectal obstruction

In colonic obstruction, due to the closure of the ileocecal valve, the contents of the intestine can only enter and cannot go out, forming a closed diaphragmatic intestinal obstruction. Because the colon blood supply is not as abundant as the small intestine, and the wall is thin, even simple obstruction is prone to local necrosis and perforation. . The bacterial content in the colon is high, and the bacterial reproduction is accelerated after obstruction, which is likely to cause systemic infection and even produce toxic shock.

The severity of cancerous obstruction depends on the extent of tumor invasion. When the intestinal cavity is incompletely obstructed, its clinical manifestations and pathophysiological changes are not serious. When it is completely obstructed, there will be severe intestinal flatulence. Excessive intestinal dilation will make the intestinal wall thin. , Blood supply is reduced, so it is easy to necrotic perforation.

Intestinal obstruction caused by intestinal torsion is also divided into complete and incomplete. When incomplete, gas and fluid in the intestine are present at the same time; in complete obstruction, it is mostly acute torsion, and the obstruction is closed. Because the way of swallowing has been cut off, there is more fluid accumulation in the intestine, and the intestinal tube in this section is highly dilated, which is much thicker than the intestinal tube above the obstruction. The excessive expansion of the intestinal cavity in this section can cause tension damage to the intestinal wall. In addition, the mesenteric blood vessels have already suffered from blood flow disorders, resulting in intestinal bleeding, necrosis, exudation, and even perforation.

Acute pseudocolonic obstruction, obvious colon flatulence, and necrotic perforation are not uncommon.

Clinical manifestations of colorectal obstruction

The clinical manifestations of colon obstruction are basically similar to the general small intestinal obstruction. The clinical manifestations have the following characteristics: All patients have abdominal pain. The right half of the colon is mostly in the right upper abdomen and the left half is mostly in the left lower abdomen. Chronic obstruction is mild, and acute obstruction is severe. , But not as severe as intestinal torsion and intussusception; nausea and vomiting appear later, or even absent. In the later period, the vomit was yellow feces-like content, with a bad smell; small abdominal distension, obvious intestinal obstruction, protruding abdomen on both sides, and sometimes horseshoe-shaped; anus stopped defecation and exhaust, but most patients can still have a small amount of gas in the early stage of obstruction Discharge; physical examination showed obvious abdominal distension, horseshoe shape can be seen, percussion showed drum sounds, auscultation can be heard the sound of gas and water.

Colorectal obstruction

Imaging examination

Examination of abdominal X-ray, CT, magnetic resonance and other examinations are helpful to determine the obstruction site and the cause.

Blood test

Blood routine and blood biochemical tests can help understand whether it is strangulated obstruction and the presence of water and electrolyte disorders.

3. Colonoscopy

Helps to clarify the nature of the lesion (biopsy can be taken for pathological diagnosis if a tumor is found).

Colorectal Obstruction Diagnosis

The clinical manifestations of colonic obstruction are basically similar to the general small intestinal obstruction. The clinical manifestations have the following characteristics:

1. All patients have abdominal pain. The right half of the colon is mostly in the right upper abdomen and the left half is mostly in the left lower abdomen.

2. Nausea and vomiting appear late or even absent. The late vomit was yellow feces-like content with a foul odor.

3. Abdominal distension is small, intestinal obstruction is obvious, the abdomen on both sides is prominent, and sometimes it is horseshoe-shaped.

4. Anus stops defecation and exhaust, but a small amount of gas can still be discharged in the early stage of obstruction in most patients.

5. Physical examination showed obvious abdominal distension, which could show horseshoe shape, percussion was drum sound, and auscultation could smell the sound of gas and water.

6. X-ray plain film examination showed obvious fluid accumulation in the colon, gas accumulation, and liquid level.

In short, with the exception of colon torsion, the clinical manifestations of colonic obstruction are not as typical and severe as those of small intestinal obstruction.

Diagnosis of obstruction caused by gallstones: more common in elderly obese women; onset based on cholecystitis and cholelithiasis; symptoms of intestinal obstruction; plain radiographs: mechanical intestinal obstruction; Calcified stones); gas in the biliary tract.

Colorectal Obstruction Treatment

Surgical treatment

On the premise of excluding false bowel obstruction, surgical exploration was actively performed.

2. Medical treatment

Mainly symptomatic treatment, correction of water and electrolyte imbalance, gastrointestinal decompression, anti-infection and promotion of anal canal exhaust. If mechanical obstruction is ruled out, it should be treated as a dynamic intestinal obstruction.

Prevention of large intestinal obstruction

Middle-aged and elderly people are regularly screened for colorectal tumors. Early detection of tumor diseases and interventional treatment are the most effective methods to prevent cancerous obstruction.