Disease Description (Causes and Symptoms)
- Definition summary: Intestinal obstruction is a condition in which part of the small or large intestine is partially or completely blocked, preventing intestinal contents (food, digestive fluids, and gas) from passing and causing accumulation and distention in the intestine, along with related symptoms.
- Main causes
- Mechanical obstruction: postoperative adhesions, small- or large-intestinal tumors (such as colorectal cancer), hernias, intussusception, volvulus, etc.
- Paralytic (decreased intestinal motility) obstruction: acute peritonitis, acute pancreatitis or cholecystitis, suppression of intestinal function after abdominal trauma or surgery, electrolyte abnormalities, etc.
- Pathophysiology summary: Contents accumulate above the site of obstruction, causing the intestine to distend → decreased blood flow to the intestinal wall → risk of intestinal ischemia, necrosis, and perforation. Reduced fluid absorption can cause dehydration and electrolyte imbalance, and vomiting can lead to acid-base abnormalities.
- Representative symptoms
- Abdominal pain: usually begins as paroxysmal pain (cramping or colicky pain) and spreads throughout the abdomen
- Vomiting: severe vomiting occurs early in upper small-intestinal obstruction (bilious vomiting → feculent vomiting may occur as time passes)
- Abdominal distention, decreased bowel movements or passage of gas, or no bowel movements (depending on the site of obstruction)
- Systemic symptoms: dehydration, tachycardia, hypotension, fever (in cases of infection or necrosis), and bloody stool (when caused by conditions such as intussusception)
- Differences between small-intestinal and large-intestinal obstruction (clinical distinction): Small-intestinal obstruction causes more prominent vomiting and severe pain, with dehydration developing quickly. Large-intestinal obstruction causes more severe distention, with cessation of bowel movements as the main symptom.
Treatment Methods and Precautions
- Initial (conservative) treatment
- NPO, with hydration, electrolyte, and nutritional supplementation through parenteral nutrition or intravenous fluids
- Gastrointestinal decompression: insertion of a nasogastric tube (such as a Levin tube) to aspirate gas and contents (usually observed for 48–72 hours)
- Control of pain and vomiting (antiemetics and analgesics), and correction of electrolyte abnormalities
- Antibiotics when necessary (if perforation or sepsis is suspected)
- Water-soluble contrast media for diagnostic and therapeutic purposes (e.g., Gastrografin) can help with diagnosis and treatment in some cases of adhesive small-intestinal obstruction
- Indications for surgical treatment
- Complete obstruction or obstruction that does not improve
- Suspected intestinal ischemia, necrosis, or perforation (such as persistent severe pain, fever and elevated white blood cell count, or metabolic acidosis)
- Closed-loop obstruction, signs of peritonitis, or the need to remove a mechanical cause (such as a tumor or severe hernia)
- Types of surgery: adhesiolysis, intestinal resection and anastomosis, or stent placement (for palliative purposes in colorectal cancer) and loop stoma, etc.
- Inpatient lifestyle management and precautions
- Follow NPO instructions and do not stop food or medications, especially oral medications, on your own
- Minimize motility-suppressing medications (anticholinergics, opioids, etc.)
- Immediately report signs of worsening (severe pain, fever, bloody stool, or signs of shock)
- Complications: intestinal ischemia and necrosis, perforation, sepsis, persistent nutritional deficiency, and cardiovascular problems caused by electrolyte abnormalities
- Prognosis: Varies depending on the cause and whether treatment is initiated early. Simple adhesive obstruction may improve with conservative treatment, but prognosis is poor after surgery when ischemia or perforation occurs.
Outpatient Visit Checkpoints (Including Items to Prepare, Records, and Sample Questions)
- Items to prepare (what to bring)
- List of current medications (including prescription drugs, OTC medications, and supplements) and allergy records
- Medical history: history of abdominal surgery, hernia or cancer, inflammatory bowel disease, etc.
- Recent test results, if available: abdominal X-ray, CT, blood tests, and endoscopy findings
- Symptom diary: date symptoms began and their progression, location and intensity of pain (pattern of changes), frequency and color of vomiting (bilious or feculent), whether stool and gas are being passed, and weight changes
- Items the doctor will check during the visit (organizing these in advance can make the visit smoother)
- Onset and characteristics of the pain (intermittent or continuous, and whether it is colicky)
- Presence, frequency, and characteristics of vomiting (bilious or feculent)
- Recent abdominal surgery, trauma, or infection
- Urine volume and urine color (to check for dehydration)
- Sample questions (items to ask the doctor first during an outpatient visit)
- “How can you be sure whether these symptoms are caused by an obstruction?”
- “Are there any findings that require immediate hospitalization or surgery?”
Examples of General Questions to Ask the Doctor
- What are the main side effects of this medication (the medication being prescribed), and what symptoms should I watch out for?
- Given my current condition, how likely am I to recover with conservative treatment (NPO and decompression)?
- If surgery is necessary, what type of surgery is expected, and how long will recovery take?
- To prevent recurrence without surgery, what should I adjust in my lifestyle, such as diet and exercise?
- After discharge, when can I resume eating and normal activities (exercise and returning to work)?
Examples of Condition-Specific Questions
- What is the suspected cause of the obstruction (adhesions, tumor, hernia, intussusception, etc.)? What additional tests are needed to confirm it?
- Are there any signs suggesting intestinal ischemia or perforation (or necrotic complications of the obstruction)? If so, should surgery be performed immediately?