1 Urgent Surgical Management of Intestinal Obstruction

When we take food through the mouth, it passes through the mouth into the esophagus. The same food is passed from the esophagus to the stomach, from the stomach to the small intestine, from the small intestine to the large intestine, and from the large intestine to the rectum and from there through the anus outside.

The food always moves slowly through the small and large intestines, which are 25 to 30 feet long. When there is obstruction in the part of intestine then it is called as intestinal obstruction. This is a kind of emergency.

It requires urgent surgical management of intestinal obstruction. So let understand the necessary information about intestinal obstruction and surgical management for intestinal obstruction.

What is intestinal obstruction?

Intestinal obstruction is an obstruction in the small or large intestine. This obstruction may be partial or complete. Intestinal obstruction causes food and gas to accumulate before the obstructed part of the intestine and as the pressure in that part of the intestine increases, the intestine may rupture. If the intestine ruptures, it is called as intestinal perforation.

Intestinal perforation spreads fecal matter from the intestines in the abdomen and causes infection of the abdomen which is called as peritonitis. This increases the emergency and increases the risk to the baby’s life. So it requires surgical management of intestinal obstruction. The incidence of obstruction in the small intestine is four times higher than in the large intestine.

What are the causes of intestinal obstruction?

Causes of intestinal obstruction can be mechanical as well as non-mechanical.

Let us first learn the mechanical causes of intestinal obstruction

Mechanical Causes

Mechanical reason may be through the intestinal obstruction or even from the outside.

1) Adhesion – If the baby’s abdomen has been operated before, the fibrous bands formed at the previously operated site in the abdomen can obstruct the intestine.

2) Intussusception – Intussusception is due to obstruction in the intestines as the small intestine telescopes  the large intestine.

3) Volvulus – There is obstruction in the intestine due to twisting of the intestine.

4) Hernia – In hernia, part of the intestine comes out from the weakened part of the abdomen. Occasionally there is a obstruction of the intestines in that area.

5) Due to foreign body (objects) – sometimes the baby swallows some objects from the mouth. It can also cause intestinal obstruction by stuck into the gut.

6) Having a tumor in the intestines – As a tumor is forming in the intestines, there may be a partial obstruction in the intestines.

7) Intestinal faeces – Meconium (early faeces) is trapped in the intestines of newborns, causing obstruction in the intestines.

Non-mechanical causes

The small intestine and the large intestine work in harmony with each other. In some diseases, this coordination is difficult. This causes obstruction in the intestines.

1) If baby had abdominal surgery before

2) If the baby has diarrhea

3) If the body has electrolyte imbalance

In some cases, the intestinal obstruction is chronic.

1) Hirschprung’s Disease – In this disease, there is obstruction due to lack of development of nerves in the large intestine.

2) Hypothyroidism – This disease causes constipation which can lead to intestinal obstruction.

What are the symptoms of intestinal obstruction?

The symptoms of intestinal obstruction depend on which part of the intestine is obstructed.

If there is an obstruction in the small intestine, vomiting is the first symptom.

If there is obstruction in the large intestine, diarrhea is a symptom and accompanied by vomiting.

Some of the symptoms of intestinal obstruction are as follows

• Flatulence

• Abdominal pain

• Nausea

• Vomiting

• Loss of appetite

Infants under one year of age have the following symptoms if they have intestinal obstruction

• Abdomen is bloated

• The baby takes his/her knee over abdomen

• Green vomiting

• Fever

• Abdominal pain makes the baby moan

• The baby becomes lethargic

• Crying out loud

• The baby’s poo is red jelly colour.

If above symptoms appear in the child, it is necessary to contact your doctor immediately.

How intestinal obstruction is diagnosed?

Doctors diagnose intestinal obstruction from a physical examination of the baby. Also the following tests can be done to confirm this diagnosis.

• X-ray of the abdomen – X-ray of the abdomen reveals the obstruction in the intestines. If there is an obstruction in the last part of the stomach, a single bubble is seen in the X-ray. If there is an obstruction in the early part of the small intestine, X-rays shows double bubble. Also, if there is an obstruction in the last part of the small intestine, triple bubble is seen.

• Blood tests – Blood tests are done for testing hemoglobin, blood cells, liver and kidney function, and blood salts. If obstruction in intestine perforated then there may be sepsis in the blood. In such patients white blood cell counts are raised, platelet count may decrease and haemoglobin count may gets lower.

• CT scan – A CT scan reveals which part of the intestine is obstructed and to what extent.

Other tests such as barium enema or rarely colonoscopy are also performed. But since the disease is often an emergency, the decision to operate is made after X-rays and blood tests.

What is the treatment for intestinal obstruction?

Since intestinal obstruction is a kind of emergency, it is very important to get treatment in time. It also avoids danger to the life. A patient with intestinal obstruction has to be admitted to the hospital immediately. He/she need surgical management of intestinal obstruction.

If there is a partial obstruction in the intestines, saline, medicine and ryles tube is inserted through nose can be used to relieve the intestines. But if the bowel is completely obstructed, surgery is needed. Once admitted to the hospital, the patient is treated according to his clinical condition.

1) A tube is inserted through the nose – A Ryles tube is inserted through the nose of the patient. This allows water and gas to escape from the obstructed area through the tube.

2) The patient is kept hungry – The patient is kept hungry so that the intestines of the patient get relief, there are no further complications and there are no complications in the anesthesia before the operation.

3) Intravenous fluids are given – Even if the patient is starving, Intravenous fluids are required to be given intravenously to his/her  body and saline and injections are used to keep the salts in the patient’s body electrolyte balance.

4) Necessary medicine is given intravenously – Injections are given intravenously to reduce nausea, abdominal pain and infection in the abdomen of the patient.

5) Surgery is done to relieve the bowel obstruction – After the consent of the parents, the surgeon performs the operation to relieve the bowel obstruction. The operation is performed only after the baby is completely anesthetized.

The operation is done according to the condition of the intestines in the abdomen.

1) If the intestines stick to each other or stick to the site of the previous operation, the obstruction is to be removed.

2) If the intestines are twisted, it is relieved.

3) If there is intestinal obstruction in the intestine, it is released from the intestinal tract.

4) The obstructed intestine in the herniated area is relieved.

5) Sometimes due to obstruction in the intestines, the blood flow in that area is stopped and that part starts to form gangrene. So the decomposed part of the intestine is removed and the normal intestine is connected back to each other by tanks.

6) If the intestine is torn, part of the intestine is removed and the normal part is connected to each other by sutures. As the intestines rupture, fecal matter accumulated in the abdomen and peritoneal infection increases.

When it is not possible to connect the intestines to each other, then the stoma is made over the abdomen.

If the last part of the small intestine is removed as a stoma, it is called an iliostomy.

Also, if part of the large intestine is removed as a stoma, it is called a colostomy. This stomal opening is closed with surgery again after a few months.

Even after the operation, the patient is kept hungry for 3-4 days. For this, Intravenous fluid is given every 24 hours according to the weight of the baby. A tube is inserted into the patient’s urinary tract (catheter) so that the patient does not have to go for urination frequently.

From the second day after the operation, green discharge starts coming from the nasal tube. The patient is discharged from the hospital on the fourth or fifth day as the green discharge decreases and the intestinal tract begins to work and the baby begins to work.

What are complications of Intestinal Obstruction?

The following types of complications occur due to intestinal obstruction

• Electrolyte imbalance in the body

• Dehydration

• Intestinal perforation

• Spreading the infection in the abdomen (Peritonitis)

• Spreading the infection in the blood (Sepsis)

• Kidney failure

• Organ failure

• To lose one’s life

Having an intestinal obstruction in a baby can be very painful for parents. But it is very important to get diagnosed and treated at the right time. The right decision at the right time can save your child’s life.

Every intestinal obstruction patient is challenging for doctors as the course of every patient is not same it is totally depend on the responsiveness of his/her body.

Frequently Asked Questions

If you liked the information given in the above article about intestinal obstruction, please share it with the needy as it is not possible to say who will have such a time. Timely treatment by the right doctor can save a patient’s life.

Ref – UCSF