Intestinal impassability

Intestinal impassability consists in partial or complete cessation of advance of contents (chyme) on intestines. Intestinal impassability demands urgent medical intervention as it is a state, life-threatening.

Types and reasons of intestinal impassability

On character of a current distinguish acute intestinal impassability and chronic, also intestinal impassability can be full or partial.

By origin can be inborn or acquired. Inborn intestinal impassability is caused in children by anomalies of development of intestines or obstruction by its dense meconium – the stake which is formed during pre-natal fetation.

Depending on the reason which caused it intestinal impassability is divided into two look: dynamic and mechanical.

Dynamic intestinal impassability is caused by frustration of an innervation and blood circulation in intestines.

In turn is divided into the following forms:

• Paralytic intestinal impassability. Results from paralysis of a muscular layer of intestines because of what the peristaltics – the movements advancing a chyme on intestines stops. Is a peritonitis complication (a peritoneum inflammation). Paresis (partial paralysis) of intestines occurs at renal and bilious gripes, bad attacks of pancreatitis, injuries of a basin, a backbone and hematomas of an abdominal cavity, and also can be post-operational;
• Spastic intestinal impassability. The enterospasm as a result of poisoning with some medicines and salts of heavy metals is the reason of spastic intestinal impassability.

Mechanical intestinal impassability - the most often found type of intestinal impassability. It is divided into the following subspecies:

• Obturatsionny intestinal impassability. Arises in the presence of a new growth, partially or completely blocking a gut gleam (fecal stones, tumors, cysts, balls of helminths), gradual increase of symptoms is characteristic of it;
• Strangulyatsionny intestinal impassability. It is connected with a prelum or infringement of a mesentery of a gut (torsion of guts, nodes of guts), rapid development, 4-6 hours from the moment of the beginning to full impassability is peculiar to this look;
• Mixed, or the combined intestinal impassability. Arises at invagination when the gleam of intestines is corked with the implemented other gut, at the same time the mesentery of the implemented loop is squeezed. Invagination – the most frequent reason of intestinal impassability at children.

Intestinal impassability is also classified by level:

• Thinly intestinal impassability;
• Thickly intestinal impassability;
• High intestinal impassability;
• Low intestinal impassability.

Symptoms of intestinal impassability

At each type of intestinal impassability symptoms differ, however there are signs, the general for all cases:

• Emergence of a sharp abdominal pain;
• Emergence of vomiting;
• Termination of a passage of flatus and delay of a chair.

These three symptoms of intestinal impassability have the features inherent to this state therefore it is worth talking about them slightly in more detail.

• Pain. Has skhvatkoobrazny character, painful pains match a vermicular movement rhythm. At the initial stage in an interpainful interval of the patient can disturb in general nothing, and there can be a mild aching dull ache. During an attack pain becomes so intensive that patients rush about, trying to find situation in which it would decrease. The patient cannot neither shout at dive of pain, nor speak, and one of characteristic symptoms of intestinal impassability is the low moan ("ileusny groan"). At this time cold sweat acts, pulse becomes frequent – signs of painful shock appear.
• Vomiting. In case of thinly intestinal impassability repeated, exhausting, plentiful, not giving relief, in the beginning containing the remains of undigested food, then consisting of intestinal juice with bile impurity. In the next period, at accession of peritonitis, there is painful vomiting the congestive contents of lower departments of intestines having an appearance and a smell of fecal masses – "fecal vomit". At thickly intestinal impassability vomiting can be no more than one – two times, the fecal vomit at the same time is not observed.
• The symptom of a delay of a chair and passage of flatus also varies depending on a disease form. At low, or thickly intestinal impassability the chair and gases can be absent completely within several days before acute intestinal impassability. But at high, or thinly intestinal impassability at the initial stage there can be an independent chair, or the chair caused by an enema. In this case lack of a chair and gas generation can be already late symptoms of intestinal impassability.

Treat other symptoms of intestinal impassability: thirst, the blown-up stomach, a hyperperistalsis at the beginning of a disease, and its complete cessation in process of an aggravation of symptoms. At the beginning of a disease, because of a strong vermicular movement, loud intestinal noise are heard, then the peristaltics stops, and there comes complete silence – a symptom of "death silence".

During acute intestinal impassability allocate three stages:

1. Initial, or the period of "ileusny groan", lasts from 2 to 12 hours. It is characterized by a pain syndrome, abdominal distention, a hyperperistalsis;
2. Intermediate, from 12 to 36 hours. Pain stops at all, or loses the pristupoobraznost and intensity because of what this stage is called a stage of imaginary wellbeing. Dehydration and intoxication accrue. The peristaltics stops;
3. Terminal, or late. Comes in 36 hours after emergence of the first signs of acute intestinal impassability. At this stage the condition of the patient is considerably made heavier, there comes insufficiency of all life-supporting systems of an organism.

Diagnosis of intestinal impassability

Diagnosis of acute intestinal impassability has to be immediate. The initial diagnosis is made on the basis of careful survey, definition of characteristic symptoms and tests, and also on the basis of X-ray inspection.

Treatment of intestinal impassability

Treatment of intestinal impassability begins with emergency measures on completion of the lost liquid and removal of painful shock. Upper parts of digestive tract exempt from the contents remains by means of the probe, lower parts – by means of siphon enemas. For the termination of a hyperperistalsis in an initial stage enter the spasmolysants weakening a muscular wall. Sometimes for treatment of intestinal impassability of a dynamic form these measures are sufficient for recovery of normal function of intestines.

If therapeutic methods of treatment of intestinal impassability in its dynamic form are inefficient, and in all cases of mechanical intestinal impassability, resort to an operative measure which consists in elimination of a cause of illness, in case of the occurred necrosis of the site of intestines – its excision and recovery of intestinal passability.