Claustrophobia

Disease Description (Causes and Symptoms)

• Definition and synonyms: Intestinal obstruction (ileus) 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 abdominal distension, pain, vomiting, and impaired bowel movements and gas passage.
• Main causes
  • Mechanical obstruction: postoperative adhesions, cancer (such as colon or rectal cancer), strangulated hernia, intussusception, volvulus, Meckel’s diverticulum, etc.
  • Paralytic (or functional) obstruction: reduced intestinal motility due to peritonitis, acute pancreatitis, abdominal trauma, use of medications that suppress bowel movement after surgery, etc.
• Summary of pathophysiology: Intestinal contents accumulate above the site of obstruction, increasing intraluminal pressure → intestinal hypermotility (early stage) → when ischemia and inflammation develop, intestinal movement stops and the risk of intestinal wall necrosis and perforation increases → fluid and electrolyte loss, dehydration, and possible shock
• Main symptoms
  • Abdominal pain (paroxysmal or cramping)
  • Vomiting (severe vomiting early in upper obstruction; fecal-like discharge may occur over time)
  • Abdominal distension, reduced bowel movements and gas passage, or constipation with no stool or gas in complete obstruction
  • Dehydration, hypotension, tachycardia, and sometimes bloody stool (depending on the cause, such as intussusception)

Treatment Methods

• Initial (emergency) treatment (common standard in most cases)
  • Fasting (NPO), intravenous fluids (fluid and electrolyte replacement), and electrolyte correction
  • Decompression (suction) through insertion of a nasogastric tube (Levin tube or gastric tube) to relieve vomiting and abdominal distension
  • No smoking or alcohol, and no oral medications (discontinue oral administration)
  • Control of pain and nausea (antiemetics and analgesics as needed; opioids should be used cautiously because they may affect intestinal motility)
  • Monitoring: vital signs, urine output, electrolytes and blood tests, and abdominal physical-examination and imaging findings
• Drug treatment
  • Fluid and electrolyte correction (primary treatment)
  • Antiemetics and, if necessary, antibiotics (when intestinal ischemia, perforation, or peritonitis is suspected)
  • Prokinetic agents may be considered selectively depending on the cause (under specialist judgment in paralytic ileus)
• Procedures/Surgery
  • Surgery is indicated when conservative treatment (decompression, fluids, etc.) does not improve the condition, or when emergency signs are present, such as intestinal ischemia, perforation, necrosis, or worsening systemic condition due to left-sided colonic obstruction.
  • Surgical methods: removal of the cause (adhesiolysis, tumor resection, resection and anastomosis of necrotic bowel, etc.). Laparoscopic surgery may be possible in some cases.
  • For malignant colonic obstruction, an intracolonic stent (percutaneous stent placement) may be considered as temporary or palliative treatment (an option for tumor-related obstruction).
• Precautions (self-care and in-hospital)
  • Risk of dehydration and electrolyte imbalance: visit a medical institution immediately if symptoms such as reduced urine output, dizziness, or a rapid pulse occur.
  • If abdominal pain suddenly becomes severe or fever, persistent marked leukocytosis, abdominal tenderness, or abdominal rigidity develops, immediate emergency treatment is required because intestinal ischemia or perforation may be possible.
  • Medication use: use caution when taking medications that suppress intestinal motility, such as analgesics (especially strong opioids) and anticholinergic drugs.
• Complications
  • Intestinal necrosis and perforation, peritonitis, sepsis, shock, electrolyte abnormalities, and aspiration pneumonia (when vomiting)
• Prognosis
  • Varies depending on the cause and whether early diagnosis and treatment are provided. Mechanical complete obstruction or the development of intestinal ischemia or perforation can be fatal. Many cases improve with conservative treatment.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items and test records to prepare
  • A list of all medications currently being taken (including prescription drugs, over-the-counter medications, herbal medicines, and supplements)
  • Records of previous surgeries (especially abdominal surgery) and diagnosed conditions
  • Copies of recent test results, if available (abdominal X-ray, CT, blood tests, etc.)
  • Notes recording when symptoms began and how they progressed (time vomiting started and its appearance, whether stool and bowel movements have occurred, location, intensity, and intermittent nature of pain, etc.)
• Basic information to check during the outpatient visit (self-check)
  • Whether bowel movements and gas passage have occurred recently (time of the last bowel movement)
  • Contents of vomit (color, odor, and whether it smells fecal) and frequency
  • Whether accompanying symptoms such as fever, reduced urine output, dizziness, or chest pain are present
  • Possibility of pregnancy (for women)
• Items that are useful to show the doctor during the outpatient visit
  • Abdominal images (abdominal X-rays/CT, if available)
  • Whether anticoagulants or antithrombotic drugs are being taken (may affect the possibility of surgery)

General Example Questions to Ask the Doctor

• What are the main side effects and precautions for this medication (the prescribed medication)?
• What are the criteria for needing surgery in my condition, and what risks and recovery period should I expect if I have surgery?
• In what cases can I be observed as an outpatient without hospitalization, and when should I come to the emergency room?
• Are there any lifestyle changes or medications that need to be stopped or adjusted to prevent recurrence?

Examples of Disease-Specific Questions

• I have a history of abdominal surgery (or adhesions). Is it likely that my current symptoms are due to intestinal obstruction caused by adhesions? Could I recover with conservative treatment?
• If the obstruction is caused by colon cancer, please explain whether surgery can be delayed through stent placement (or temporary bypass), and what effect this would have on the long-term prognosis.