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Bowel obstruction

If the passage of the meal or faecal masses is affected, it is called obstruction. It is of two types:


Dynamic Obstruction:
Nerve fibres innervate the bowels such as Meissener’s (submucosal) and Aurebach’s (myenteric) plexus. Heavy meals such as mercury, arsenic etc. have their toxic effects on these plexuses and as a result, spasmolytic obstruction occurs. In this type of obstruction, there is no organic block but there is functional obstruction as the intestines fail to transmit peristaltic waves. Paralytic type of ileus occurs when there is some inflammatory process in abdominal cavity (appendicitis), due to its toxic effect on neuromuscular mechanism.

Mechanical Obstruction:
  1. If the lumen of the bowel is obstructed:
    • In the lumen (Intermural) due to foreign body, undigested bolus of food, faecolith, worms, gall stones etc.
    • In the wall (Intramural) due to inflammatory strictures particularly tubercular, thickening of gut wall e.g. Crohn’s disease, benign or malignant tumour i.e. carcinoma
    • Outside the wall (Extramural) due to hernias (external, internal or inguinal hernia), bands and adhesions, extrinsic tumour pressing on the gut
  2. If the loop or mesentery is twisted across its own axis then it is called strangulation or volvular obstruction.
  3. Invaginated type is common in children when they begin to change their mood of food from mother milk to solid meals. Here the walls are very sensitive to various damages and if the hard part of the food passes through then it causes obstruction.
Clinical Features:
  • Severe diffused pain
  • Nausea and vomiting
  • Distended stomach
  • Accumulation of the fluid in abdominal cavity
  • We can palpitate balloon like swelling
  • Constipation
  • Dehydration
Diagnosis:
X-Ray examination with or without barium contrast reveals inverted cups so called Clubber’s cups.

Treatment:
  • Replacement of fluids and electrolytes (approximately 10L/day)
  • Antibiotics to prevent complications from associated sepsis e.g. peritonitis. Usually broad spectrum (cephalosporin, gentamicin, metronidazole etc.)are given.
Surgery for mechanical obstruction:
Surgery is done by the resection of the affected area. First we take the proximal tube and create a stoma through muscular layer. Then we connect this loop to a bag temporarily for the excretion of the faecal masses. After sometime (4-6 months) when the inflammatory process is decreased, then we make the proximal and distal end anastomosis. This is called Hartmann type of operation. Hartmann performed this operation in 1921 due to tumour obstruction.

In small bowels we can make end to end anastomosis without creating any stomas.

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This article has been written by Dr. M. Javed Abbas.
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21:04 21/12/2002