Intestinal obstruction (medical term: ileus) is a partial or complete interruption of the transportation of food within the intestine. If left untreated, intestinal obstruction can be fatal.
Here you will find further information and selected ileus specialists and centers.
A basic distinction is made between the causes of paralytic and mechanical ileus.
In a mechanical ileus, an external or internal obstacle partially or completely obstructs the natural intestinal passage. The small intestine is affected much more frequently than the large intestine. Possible triggers of a mechanical ileus are
A blocked intestine is referred to as a mechanical intestinal obstruction © psdesign1 / Fotolia
Paralytic ileus, on the other hand, is a functional and not a structural disorder. The intestinal passage then comes to a standstill due to a lack of intestinal movement. This lack of intestinal peristalsis can be the result of vascular occlusion, for example.
The acute occlusion of a vessel supplying the intestine is also called a mesenteric infarction by doctors. Such a mesenteric vessel occlusion usually affects older people with cardiovascular disease.
Chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis can also cause paralytic ileus. The same applies to medications such as antidepressants or opiates as well as various poisons (toxins). For example, toxins can be excreted by pathogens of diarrheal diseases.
A reflex paralytic ileus can be caused by
be caused.
Electrolyte imbalances or severe kidney disease can also lead to paralysis of the intestinal muscles.
In paralytic ileus, parts of the intestine are completely paralyzed so that there are no signs of intestinal movement. No bowel sounds can be heard and the bowel is also very distended.
If peritonitis occurs as a result of the intestinal obstruction, the abdominal wall is hard and clearly sensitive to pressure. This is also referred to as a drum belly. In addition to diffuse pain in the abdomen, patients also suffer from hiccups. However, there is no stool or flatulence. Later in the course of the disease, vomiting occurs in a gush.
In mechanical intestinal obstruction, on the other hand, the bowel tends to be overactive. With the help of hyperperistalsis, the chyme is supposed to pass through the constriction in the intestine. For the patient, this means colicky pain.
When listening with a stethoscope, the doctor can hear
sounds in the area of the obstruction.
The blockage in the intestine leads to an increased accumulation of gas, so that the abdomen appears bloated. However, the intestinal gases cannot pass, and both stool and wind retention occur.
Severe nausea and massive vomiting are also among the characteristic symptoms of mechanical ileus.
If an intestinal obstruction is suspected, the doctor will ask the following questions when taking the patient's medical history
Further indications of an ileus are provided by auscultation, during which the doctor listens to the abdomen with a stethoscope.
In the case of mechanical ileus, splashing or ringing noises can be heard, whereas in the case of paralytic ileus, no bowel sounds can be heard at all. Doctors refer to this condition as "dead silence in the abdomen".
Intestinal obstruction can also be diagnosed with the help of X-rays. Bloated intestinal loops can be seen just a few hours after the onset of the disease. If the obstruction is located in the large intestine, an X-ray examination with contrast medium can also be carried out. The contrast medium is introduced into the intestine by means of an enema.
The exact localization of the intestinal obstruction is possible using ultrasound. Here, large amounts of gas can be visualized as well as accumulations of fluid.
If the diagnosis cannot be made with certainty after these examinations, spiral computed tomography provides information.
An intestinal obstruction is always life-threatening and therefore requires urgent emergency medical treatment. The type of treatment depends on both the cause and the exact location of the intestinal obstruction.
In order to reduce the pressure in the bowel, a tube is inserted into the patient's bowel via the mouth. This special tube, which is connected to a suction pump, allows the blocked chyme to be suctioned out.
In the case of paralytic ileus, bowel movements can often be stimulated with an enema.
In order for the chyme to pass through the intestine again, the constricting obstruction must be surgically removed in the case of a mechanical ileus. Dead intestinal tissue is also removed during the operation. The healthy sections of the intestine are then reconnected.
If the ileus lasts longer than a few hours, the doctor also administers antibiotics. This prevents inflammation of the abdominal cavity or blood poisoning caused by bacteria.
The best prognosis is for a mechanical ileus caused by a benign event. However, if the mechanical intestinal obstruction persists for a longer period of time, it can develop into a paralytic ileus.
A rapid diagnosis with early treatment is therefore very important. The earlier the diagnosis is made, the better the prognosis.
However, an untreated intestinal obstruction can cause serious complications. The intestinal contents can break through the intestinal wall and spread throughout the abdominal cavity. This usually leads to severe inflammation of the peritoneum, which can spread throughout the entire body (sepsis).
In the event of an obstruction, it is not only the transportation of food that is restricted. The absorption function of the organ is also impaired. The loss of fluid and electrolytes can lead to circulatory shock. The lack of electrolytes can also impair conduction in the heart and lead to cardiac arrhythmia .
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