Intestinal obstruction

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 abdominal distension, pain, vomiting, and cessation of bowel movements and gas passage.
• Main causes
  • Mechanical obstruction: postoperative adhesions, tumors such as colorectal or small-intestinal cancer, incarceration due to a hernia, intussusception, volvulus, Meckel's diverticulum, etc.
  • Paralytic (functional) obstruction: cases in which intestinal motility is lost due to acute peritonitis (e.g., gastric or duodenal perforation), acute pancreatitis, acute cholecystitis, abdominal trauma, medications that suppress intestinal motility after surgery, etc.
• Key pathophysiology: When intestinal contents become stagnant due to obstruction, increased intraluminal pressure → reduced blood flow → intestinal mucosal ischemia and necrosis → possible progression to perforation, peritonitis, and sepsis. In addition, dehydration and electrolyte abnormalities occur because unabsorbed digestive fluids accumulate.
• Main symptoms
  • Paroxysmal (cramping) abdominal pain (initially localized → gradually spreading throughout the abdomen)
  • Vomiting: severe vomiting in upper small-intestinal obstruction (yellowish-brown and bilious → fecal odor over time)
  • Abdominal distension and cessation of gas and stool passage (in severe cases, no bowel movements or gas passage at all)
  • Dehydration, tachycardia, hypotension, and fever (when infection is present)
  • Mechanical obstruction: increased bowel sounds / paralytic obstruction: absent bowel sounds

Treatment Methods

• Initial (emergency) treatment
  • Fasting (NPO), securing intravenous access, and sufficient fluid therapy to correct fluid and electrolyte imbalances
  • Gastric (or upper-intestinal) decompression: aspiration of gas and intestinal contents through a tube inserted through the nose (such as a Levin tube) — relieves abdominal distension and vomiting and reduces the risk of intestinal perforation
  • Pain control and, when necessary, antiemetics and electrolyte correction
• Medication treatment
  • Electrolyte and fluid correction; antibiotics are used when infection, intestinal ischemia, or perforation is suspected or there is a risk of these conditions
  • Correction of the cause of paralytic ileus (e.g., correction of electrolyte abnormalities and discontinuation of related medications)
• Imaging and endoscopic treatment
  • In some cases (especially to identify the cause of intestinal obstruction or for decompression), endoscopic decompression or stent insertion may be considered (e.g., as a bridge to planned surgery in colonic obstruction)
• Surgical treatment
  • Emergency surgery when mechanical obstruction does not respond to conservative treatment, or when intestinal ischemia, necrosis, or perforation is present or shock is suspected (removal of the cause of obstruction, resection of necrotic intestine, etc.)
  • Elective surgery: removal of the cause after the condition improves (e.g., tumor resection or adhesiolysis)
• Precautions, risk of complications, and self-management
  • Immediate medical evaluation is necessary: persistent or severe abdominal pain, persistent vomiting, fever, low blood pressure, and cellular stool (bloody stool), etc., are emergencies.
  • Ignoring fluid and electrolyte status increases the risk of shock and renal failure.
  • Postoperative intestinal adhesions may recur → prompt evaluation is needed if abdominal pain or obstruction recurs in the future.
  • Complications: intestinal ischemia and necrosis, perforation, peritonitis, sepsis, and shock
  • Lifestyle management: short-term fasting and fluid replacement may be necessary. Patients at risk of recurrence need management of the underlying cause, such as hernia surgery, cancer treatment, and prevention of postoperative adhesions.

Checklist Before an Outpatient Visit (Including Example Questions)

• Items to prepare
  • A list of all medications currently being taken (including prescription and nonprescription medicines, herbal medicines, and supplements)
  • History of previous surgeries (especially abdominal surgery) and hospitalization records
  • Recent test results (abdominal X-rays, CT scans, blood tests, etc.) or imaging files/reports, if available
  • Notes on when symptoms began and their progression (frequency and appearance of vomit, whether stool and gas are being passed, characteristics and changes in the intensity of pain, and whether fever is present)
  • History of allergies and underlying diseases (such as cardiovascular, kidney, or liver disease)
• Examples of information to report to healthcare professionals during the visit
  • "The time when the abdominal pain first started and how it has changed since then"
  • "The color and smell of the vomit (whether it is bilious or has a fecal odor)"
  • "Whether I have recently had abdominal surgery or have a history of hernia"
  • "The medications I usually take (especially medications that suppress intestinal motility, such as antispasmodics, opioids, and anticholinergics)"
• Items useful to check in advance at the outpatient visit
  • Changes in body weight, whether urine output has decreased (an indicator of dehydration), and whether fever or tachycardia is present
  • Whether blood or black-colored stool has been passed recently

Examples of General Questions to Ask the Doctor

• "What are the possible causes of this condition?"
• "Is surgery needed immediately, or how likely is it that the condition will improve with conservative treatment?"
• "What are the side effects of this medication (the prescribed medication)?"
• "What is the prognosis? How high is the risk of complications?"
• "What should I be careful about in my lifestyle? Are there any recommendations to reduce the risk of recurrence?"

Examples of Condition-Specific Questions

• "Once the location and cause of the obstruction are identified on CT, how is the timing of surgery determined? When is emergency surgery necessary?"
• "I have undergone abdominal surgery several times in the past. What preventive measures can be taken to reduce the risk of recurrent adhesive intestinal obstruction?"