Treatment of Intestinal Obstruction

Nov 03, 2021 Source: Cainiu Health

Dr. Ma Jie

Introduction

Relieving the obstruction is one of the key therapeutic approaches for intestinal obstruction. Gastric and intestinal decompression—achieved by aspirating gas and fluid from the gastrointestinal tract—helps alleviate abdominal distension, reduce intraluminal pressure, decrease bacterial load and toxin accumulation within the bowel lumen, and improve blood circulation in the intestinal wall. These effects collectively promote resolution of local pathology and overall clinical condition. The obstruction should be relieved—or luminal patency restored—using the simplest possible method within the shortest feasible surgical timeframe.

(I) Fundamental Treatment

Continuous gastrointestinal decompression: Relief of obstruction is one of the key therapeutic approaches for intestinal obstruction. Gastrointestinal decompression removes gas and fluid from the gastrointestinal tract, thereby alleviating abdominal distension, reducing intraluminal pressure, decreasing bacterial load and toxin accumulation within the intestinal lumen, improving intestinal wall blood circulation, and facilitating both local lesion resolution and overall clinical improvement.

Intravenous fluid therapy to correct water-electrolyte imbalances and acid-base disturbances: The volume and composition of intravenous fluids must be tailored according to the frequency and volume of vomiting, clinical signs of dehydration, degree of hemoconcentration, urine output and specific gravity, as well as serum potassium, sodium, chloride levels and blood gas analysis results. When necessary, plasma, whole blood, or plasma substitutes should be administered to compensate for losses of plasma and blood into the intestinal lumen or peritoneal cavity.

Prevention and treatment of infection and sepsis: Antibiotics effective against enteric bacteria—including anaerobic organisms—are indicated, particularly in cases of strangulated intestinal obstruction and in patients undergoing surgical intervention.

Symptomatic management: Includes sedatives and antispasmodics; analgesics should be used cautiously.

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(II) Obstruction Relief

1. Non-surgical treatment: Mainly indicated for simple adhesive (especially incomplete) intestinal obstruction; intestinal obstruction caused by ascaris or fecal impaction; paralytic or spastic ileus; incomplete intestinal obstruction secondary to inflammatory conditions such as intestinal tuberculosis; and early-stage intussusception.

2. Surgical treatment: The principle and goal of surgery are to relieve obstruction or restore intestinal patency in the shortest possible operative time and by the simplest feasible method. Specific surgical techniques depend on the underlying cause, nature, location of obstruction, and the patient’s overall clinical status.

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What are the symptoms of intestinal obstruction?

Under normal circumstances, the main symptoms of intestinal obstruction include abdominal pain, vomiting, abdominal distension, cessation of defecation and flatus, and hyperactive bowel sounds. When intestinal obstruction occurs, the intestine above the obstructed segment will exhibit strong peristalsis, attempting to push intestinal contents through the obstructed area. This intense intestinal motility stimulates the intestinal nerves, thereby causing abdominal pain, which generally presents as paroxysmal colicky pain.