How Do I Treat Ileus After Surgery?

Obstruction of intestinal contents caused by any reason is collectively referred to as intestinal obstruction. It is one of the common surgical acute abdomen. Sometimes the diagnosis of acute intestinal obstruction is difficult, the condition develops rapidly, and often the patient dies. Imbalances in water, electrolytes, and acid-base balance, as well as age and cardiopulmonary insufficiency are often the causes of death.

Basic Information

English name: intestinal obstruction
Visiting department: General surgery
Multiple groups: Patients with abdominal surgery or intra-abdominal inflammation

Common causes: Intestinal congenital adhesions or abdominal surgery or intra-abdominal inflammation, adhesions, intestinal tumors, etc.
Common symptoms: Abdominal pain, bloating, nausea and vomiting, stop exhausting bowel movements, etc.

Intestinal obstruction classification

The classification of intestinal obstruction is to facilitate the understanding of the condition, guide the treatment and estimate the prognosis. There are usually the following classification methods.

Classification by cause

(1) Mechanical intestinal obstruction The most common clinical disease is the intestinal content passage obstacle caused by various mechanical factors in the intestine, intestinal wall and extraintestine.

(2) Dynamic intestinal obstruction is caused by intestinal wall muscle motor dysfunction, without intestinal stenosis, and can be divided into two types of paralysis and spasm. The former is caused by the sympathetic nerve reflex excitement or the toxin stimulates the intestinal tract and loses the peristaltic ability, so that the contents of the intestine cannot run; the latter is caused by excessive excitement of the intestinal parasympathetic nerve and excessive contraction of intestinal wall muscles. Sometimes paralytic and spasticity can coexist in different intestinal segments of the same patient, called mixed dynamic intestinal obstruction.

(3) Hematogenous intestinal obstruction is due to the formation of blood clots in the mesentery and vascular embolism, which cause intestinal blood circulation disorders, leading to the loss of intestinal peristalsis and stopping the operation of intestinal contents.

2. Classified by intestinal wall blood circulation

(1) Simple intestinal obstruction There is intestinal obstruction without intestinal blood circulation disturbance.

(2) Strangulated intestinal obstruction With intestinal obstruction, blood circulation disturbances of the intestinal wall occur at the same time, and even intestinal ischemic necrosis occurs.

3. Classified by degree of intestinal obstruction

Can be divided into complete and incomplete or partial intestinal obstruction.

4. Classified by obstruction site

Can be divided into high intestinal obstruction, low intestinal obstruction and colonic obstruction.

5. Classification by severity

Can be divided into acute intestinal obstruction and chronic intestinal obstruction.

6. Closed loop intestinal obstruction

It refers to a person with pressure on both ends of a bowel loop and patency. This type of intestinal obstruction is most likely to cause intestinal wall necrosis and perforation.

The classification of intestinal obstruction is considered from different perspectives, but it is not absolutely isolated. Such as intestinal torsion can be both mechanical and complete, as well as strangulated and closed. Different types of intestinal obstruction can be transformed under certain conditions. If simple intestinal obstruction is not treated in time, it can develop into strangulated intestinal obstruction. Proximal intestinal dilatation of mechanical intestinal obstruction can eventually develop into paralytic intestinal obstruction. Incomplete intestinal obstruction can also develop into intestinal obstruction due to inflammation, edema, or delayed treatment.

Clinical manifestations of intestinal obstruction

Adhesive intestinal obstruction

which performed:

(1) A history of chronic obstruction symptoms and repeated repeated acute attacks.

(2) Most patients have a history of abdominal surgery, trauma, bleeding, foreign body or inflammatory disease.

(3) The clinical symptoms are paroxysmal abdominal pain, accompanied by nausea, vomiting, bloating, and stopping exhaust defecation.

Physical examination:

(1) General condition: There is no obvious change in early obstruction, and signs of fluid loss may appear in late stage. Systemic poisoning and shock can occur when strangulation occurs.

(2) Abdominal examination should pay attention to the following conditions: abdominal wall incision scars can be seen in patients with a history of abdominal surgery; patients can have abdominal distension, and the abdominal distension is mostly asymmetric; most can be seen intestinal type and peristaltic waves; Significant tenderness may occur as the disease progresses; Obstructive intestinal loops may be associated with tenderness masses; Increased abdominal fluid or intestinal strangulation may have peritoneal irritation or mobile dullness; intestinal obstruction develops to intestinal cramp Narrow and intestinal paralysis are manifested by hyperintestinal beeping sounds, and the sound of gas or water can be heard.

2. Strangulated intestinal obstruction

which performed:

(1) Abdominal pain is persistent severe abdominal pain, frequently exacerbated frequently, without complete rest intermittent, and vomiting cannot relieve abdominal pain and bloating.

(2) Vomiting occurs early and frequently.

(3) Systemic changes occur early, such as increased pulse rate, increased body temperature, increased white blood cell count, or a tendency to shock early.

(4) Abdominal distension: Observation of abdominal distension in the lower small intestine obstruction is obvious, and closed obstructive small intestinal obstruction is asymmetric abdominal distension, which can touch the isolated intestinal swell without defecation.

(5) Continuous observation: Symptoms of septic shock such as elevated body temperature, increased pulse, decreased blood pressure, and disturbance of consciousness can be found, and bowel sounds have changed from hyperactive to weakened.

(6) Obvious signs of peritoneal irritation.

(7) Vomit is bloody or anal discharge of bloody fluid.

(8) Abdominal puncture is bloody fluid.

Intestinal obstruction

Adhesive intestinal obstruction

(1) Laboratory examination Generally, there are no abnormal findings in early obstruction. The white blood cell count, hemoglobin, hematocrit, carbon dioxide binding capacity, serum potassium, sodium, chlorine, and urine should be routinely checked.

(2) Auxiliary examination X-ray orthostatic abdominal plain film examination: 4 to 6 hours after the occurrence of obstruction, the flattened bowel diaphragm and most gas-liquid planes can be seen on the plain plain film. If the flat abdominal film shows a fixed coffee bean-like gas shadow, you should be alert for the presence of intestinal strangulation.

2. Strangulated intestinal obstruction

(1) Laboratory examination The white blood cell count increased, the neutrophil nuclei shifted to the left, and the blood was concentrated. Metabolic acidosis and disturbance of water-electrolyte balance. The serum creatine kinase is elevated.

(2) Auxiliary examination of the X-ray standing abdominal plain film showed a fixed and isolated bowel loop, which was coffee bean-shaped, pseudo-tumor-shaped and petal-shaped, and the intestinal space widened.

Intestinal obstruction treatment

Adhesive intestinal obstruction

(1) Non-surgical therapy For simple and incomplete intestinal obstruction, especially those with extensive adhesions, non-surgical treatment is generally used; for simple intestinal obstruction, it can be observed for 24 to 48 hours. For strangulated intestinal obstruction, early surgery Treatment, general observation should not exceed 4 to 6 hours.

Basic therapies include fasting and gastrointestinal decompression, correcting water and electrolyte disorders and acid-base balance disorders, preventing infections and toxemia.

(2) Surgical therapy Adhesive intestinal obstruction is not improved or worsened by non-surgical treatment; or strangulated intestinal obstruction, especially closed intestinal obstruction, is suspected; or repeated episodes of adhesive intestinal obstruction frequently affect the patient's life When it comes to quality, surgery should be considered. Adhesive tape or small pieces of adhesive lines are simply cut off and separated. Intestinal loops that are tightly adhered and clumped together cannot be separated, or the intestinal canal has been necrotic. Intestinal resection and anastomosis can be performed. If the intestinal edema is obvious, the first-stage anastomosis is difficult, or the patient's condition is not good, the fistula can be performed. If the patient's condition is extremely poor, or the blood pressure is difficult to maintain during the operation, external bowel surgery can be performed first. If the intestinal loop is tightly adhered and cannot be removed or separated, the anastomosis of the distal and proximal intestinal canals is feasible. Those who have extensive adhesions and repeatedly cause intestinal obstruction may perform bowel array surgery.

2. Strangulated intestinal obstruction

(1) Strangulated small bowel obstruction should be treated immediately after diagnosis, and the surgical method is determined according to the cause of strangulation during the operation.

(2) If the patient's condition is very serious, the intestine has been necrotic, and the blood pressure cannot be maintained during the operation. External bowel surgery can be used. When the condition improves, a two-stage anastomosis is performed.

Intestinal obstruction prevention

According to the causes of intestinal obstruction, certain preventive measures can be taken to prevent and reduce the occurrence of intestinal obstruction effectively.

1. Patients with abdominal wall hernia should be treated in time to avoid intestinal obstruction due to incarceration and strangulation.

2. Strengthen health publicity and education and develop good health habits. Prevention and treatment of intestinal roundworm.

3. After major abdominal surgery and patients with peritonitis should have good gastrointestinal decompression, the operation should be gentle, try to reduce or avoid abdominal infection.

4. Early detection and treatment of intestinal tumors.

5. Early activity after abdominal surgery.