Dynamic intestinal obstruction: classification, causes, symptoms and treatment

Intestinal obstruction is a disease that combines a complex of symptoms that are characterized by an absolute or partial loss of bowel capacity, both thick and thin. It is inherent in the absence of movement of any type of food, including solid and liquid masses, as well as the presence of intense inflammation in the abdominal cavity. Intestinal obstruction can be dynamic and mechanical.

Features of the disease

Dynamic intestinal obstruction is a separate type of said disease and occurs in 10% of patients with intestinal obstruction. To this diagnosis, doctors often push the need to exclude mechanical obstruction, which has a need for urgent surgical operation.

The difficulty in diagnosing this disease is that the pathogenesis of dynamic intestinal obstruction is not characterized by the presence of an unambiguous obstacle to the movement of juices and food fragments along the intestinal tract. In this case, there is only a short-lived reduction in the processes of this body.

However, the danger of the disease lies in the fact that it can provoke neurohormonal dysfunction in the patient's body, as well as disrupt the functionality of the small and large intestine. Consider what factors affect the occurrence of such a disease as dynamic intestinal obstruction.

Causes of the disease

Although modern science is distinguished by huge achievements and achievements in medicine, it has not yet succeeded in unraveling the specific mechanisms that provoke the appearance of the disease in question. The appearance of such a problem as dynamic intestinal obstruction can be caused by the following factors:

• Peritonitis, which can provoke appendicitis or pancreatitis;
• Acute mesenteric infarction;
• Toxic megacolon (Crohn's disease, Hirschsprung 's disease, ulcerative colitis);
• Reflex circumstances (postoperative condition, colic, hemorrhage, abdominal injury, spinal fractures, as augmentation of mechanical intestinal obstruction);
• Diseases of a neurogenic nature;
• Changes in the hormonal background (eg, pregnancy);
• Metabolic diseases (hypokalemia, ketoacidosis, uremia, intoxication).

Classification of dynamic intestinal obstruction

In medicine, each diagnosis has its own individual code, name and generally accepted standards of medical care. The disease, like dynamic intestinal obstruction, is not an exception. ICD 10 (International Classification of Diseases) classifies the disease in question as follows:

• Class XI "Diseases of the digestive system" (K00-K93);
• Section "Other intestinal diseases" (K55-K63);
• The diagnosis code is K56.6;
• Name - "Other and unspecified intestinal obstruction".

In medical practice, two main types of dynamic intestinal obstruction are distinguished:

• Spastic;
• Paralytic.

Spastic obstruction of the intestine

In clinical practice is infrequent, usually it is paired with another disease. Often the cause of the disease is the infection of the body with worms or pilorospasm, as a consequence of birth trauma. Also among the other causes of this type of disease can be noted: diseases of the nervous system, neuroses, dyskinesia.

To get rid of this problem it is possible exclusively with the help of conservative methods, since resort to surgical intervention in this case does not make sense.

Spastic obstruction of the intestine: symptoms

In adults, this disease happens much more often than in children, but its symptoms are the same at any age. This disease is characterized by a sudden onset. The patient complains of short bouts of pain in the abdominal region, which do not have a specific place of localization.

Patients with this diagnosis report the following symptoms:

• Cramping like abdominal pain;
• Uneven swelling and a feeling of bursting;
• Nausea, possible vomiting, constipation.

When palpating the abdomen, the diseased segment of the small intestine is probed, the abdomen itself remains soft. Violations from other systems are not observed. The general condition of the patient is not critical.

Paralytic ileus

It is determined by paralysis of the peristalsis of the intestine, accompanied by a sudden regression of the functional vigor of the neuromuscular formations. There are reflex and postoperative paralytic ileus.

When the disease is reflexed, irritation of sympathetic separation of the autonomic nervous system is observed. Postoperative obstruction has a more complex genesis and is more common after various operations performed on the abdominal organs.

The following factors provoke the formation and development of the disease:

• Inflammatory processes in the abdomen;
• Bruising (phlegmon) of the retroperitoneal region;
• The general picture observed after such an operation as laparotomy;
• The consequences of such pathological diseases as pleurisy, pneumonia, myocardial infarction;
• Thrombosis of mesenteric vessels;
• Transferred infectious diseases, including toxic paresis.

There are several stages of this disease:

I stage. "Compensated disorders" - it is equivalent to the typical postoperative paresis of the intestine. The duration of symptoms lasts for 2-3 days.

II stage. "Subcompensated disorders" - characterized by the fact that there is a significant swelling, there are signs of intoxication and peritonism of the body. Noises of peristalsis are not listened. A lot of signs are observed on the radiographic photograph.

III stage. "Decompensated disorders" - the body is in a state of considerable intoxication. You can observe adynamia of the intestine, vomiting the contents of the intestine. There are symptoms of abdominal irritation, the abdomen is considerably swollen. X-ray examination shows a number of horizontal levels of fluid in the intestinal loops (thin and thick at the same time).

IV stage. "Paralysis of the gastrointestinal tract" - at this stage, there is a violation of all important for human life systems of organs. Negative systems are felt by patients continuously.

Since in modern medicine there are no developed differential-diagnostic signs of various pathologies that appear in the postoperative period, therefore, early diagnosis of the disease is almost impossible

Paralytic obstruction of the intestine: symptoms

In adults, against the background of this disease, the general condition is significantly aggravated. He feels constant pain, which has a diffuse nature. However, it is not as intense as with mechanical intestinal obstruction. There is vomiting with a green admixture. The patient notes the increase in symptoms of exsicosis, toxicosis, as well as cardiovascular depression.

In case of paralytic obstruction, the stomach of the patient swells, an increase in the volumes of the loops of the non-irritating intestines can be seen through its front wall. If the peritoneal symptoms are absent, then the abdominal region is soft to the touch.

Since this disease is a staged process, the patient's condition worsens with an increase in the period of the disease. In later stages, one can note tachycardia and shortness of breath, bloating, sluggish peristaltic sounds, which are rarely auditioned. Vomiting is aggravated.

At the last stages there is a marked predominance of morphological changes in the neuromuscular apparatus. The patient complains of gas and stool retention, has a rare urination.

Dynamic intestinal obstruction in children

In children, there is a greater degree of acute dynamic intestinal obstruction, which is most often manifested in a paralytic form. It is possible to single out the following reasons provoking the development of the disease in childhood:

• Obturation or strangulation obstruction;
• Limited or diffuse peritonitis;
• Abdominal trauma;
• pneumonia;
• Empyema of the pleura;
• Disturbances of intestinal functions.

Quite often dynamic intestinal obstruction affects children in the postoperative period. Also, the cause of maturation of the paralytic form of this disease may be hypokalemia.

The danger of the disease in childhood consists in the possible loss of a large amount of fluid and salt due to constant vomiting, loss of appetite, the release of potassium by the kidneys, hypoproteinemia. The severity of the condition can be exacerbated under the influence of negative toxic and bacterial conditions.

Dynamic intestinal obstruction in newborns can be provoked by a number of the following reasons:

• Prematurity;
• Violation of intervention;
• Use of medicines (including mothers during pregnancy);
• Hypermagnesia;
• The use of a woman who gives birth to heroin;
• Using hexamethonium;
• Sepsis;
• Enteritis;
• CNS disease;
• Necrotic enterocolitis;
• Endocrine disorders.

Dynamic intestinal obstruction in children is not uncommon, but it is easily diagnosed and makes timely treatment possible. In the case of suspicion of the presence of such obstruction, the main thing is not to be tempted by self-treatment, but strictly adhere to the instructions given by the relevant specialist. Lethal outcome is a possible development of events with such a problem as dynamic intestinal obstruction.

Diagnosis of the disease

Symptoms of this disease are specific and vivid, which does not complicate the process of its diagnosis. The following diagnostic methods are used:

• Anamnesis collection;
• Examination of the patient;
• X-ray examination of organs in the abdominal region (the presence of gases above the level of fluid in the intestine is important);
• Ultrasound (not mandatory research, because it is not a sufficiently informative indicator);
• general blood analysis.

Dynamic intestinal obstruction: treatment

As a rule, the treatment of the disease is focused on eliminating the initial causes that provoke its development (infectious diseases, pneumonia, peritonitis, etc.). If the disease is a consequence of toxic or reflex circumstances, conservative treatment is appropriate, which consists in the drug therapy of all negative manifestations, which lead to the stopping of the standard intestinal peristalsis. Such therapy can be carried out by introducing into the human body such drugs as sodium chloride along with glucose. Then it is required to wash the intestines with an enema, if necessary - to perform the introduction of the gastric probe. With high pain, you can take painkillers.

In the case when during six hours of conservative treatment the patient's condition does not improve, surgery is performed. Also, emergency surgery is performed with congenital intestinal obstruction.

Usually the operation consists of a partial removal of the intestine, which no longer fulfills its functions. In especially severe episodes, it is necessary to impose a colostomy (an artificial anus in the abdominal wall, along which the stool masses move and have the opportunity to go into a special attached pouch).

Doing away without removing the segment of the intestine is possible only in case of intussusception. With this circumstance, the intestine can be expanded by letting air pass through the intestine and further monitoring the overall picture with the help of an X-ray.

Postoperative treatment consists of an individual diet, which depends on the amount of surgical intervention. The first two days after the operation, the patient is recommended to be in Fowler's position, and it is also necessary to perform respiratory gymnastics. Also at this stage it is necessary to undergo drug therapy, which includes detoxication therapy, normalization of electrolyte metabolism, the use of broad-spectrum antibiotics, stimulating GIT, with indications - hormone treatment.

With complications in the postoperative period, the wound can be aggravated, bleeding, peritonitis, peritoneal peritoneal disease.

With dynamic intestinal obstruction, as with any other disease, it is not so much the treatment that matters, but how much the prevention of the development of this problem. Preventative methods include:

• Electrolyte balance correction;
• Drug therapy with prokinetics;
• Taking antibiotics;
• A suitable diet that has a low amount of fats, dairy products and plant foods with a high content of components that are not digested by the human body.