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Bardají Bofill Manel

Cirugía General Adultos

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Intestinal obstruction

What is intestinal obstruction?

Obstruction is considered to be any impediment to the normal transport of intestinal contents. The obstruction can be mechanical or functional (ileus).

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Obstruction
Obstruction of this type can result from:
1. Luminal occlusion.
2. Luminal obstruction due to alteration of the intestinal wall
3. Extrinsic lesions to the intestine.
Simple obstruction denotes no ischemia, while strangulated obstruction includes occlusion of mesenteric vessels. Closed-loop obstruction is the blockage of both "loops" of the affected intestine. Mechanical obstruction is frequently caused by bands of adhesions and is frequently followed by strangulated inguinal hernia and neoplasm. Carcinoma is the most common cause of colon obstruction.
Physiopathology
Losses of liquids and electrolytes, in the plane above the obstruction accumulate large amounts of liquids and gases. Net intestinal secretion is the primary cause of fluid loss and bloating. Loss of the intestine's ability to metabolize fluids evolves from a point adjacent to proximal bowel obstruction. As there is progressive distension, circulation through the intestine decreases and edema of the wall and even necrosis occurs. Edema and accompanying fluid exudate from the wall exacerbate water losses. Finally, vomiting adds to dehydration.
Intestinal gas
It is rather swallowed air, with 70% nitrogen, which diffuses very little and contributes to détente. Intestinal motility. At the beginning there is a greater motility due to the effort to overcome the obstruction but at the end the peristalsis occurs in "accesses", with quiet periods. The distal portion of the intestine becomes underactive.
Intestinal strangulation obstruction
It is a mechanical obstruction with occlusion of the mesenteric blood supply. Blocking the venous outflow allows the accumulation of bloody fluid inside the intestine and its wall. From the gangrenous intestine bacterial toxins leak that pass into the peritoneal cavity and thus septic shock arises, and eventually perforation.
Obstruction of the colon
Strangulation is rare, except in case of volvulus. The sequestration of liquids and electrolytes evolve more slowly. Progressive distension against a sufficient ileocecal valve is, in essence, a closed loop obstruction, and will culminate in perforation of the cecum, according to Laplace's law (tension = pressure x diameter x).
Ileus (Intestinal paralysis)
Adynamic ileus (ileus by inhibition) is characterized by absence of motility, due to neuromuscular inhibition with sympathetic hyperactivity. It is very common and arises after almost all abdominal techniques. Motility reappears in the small intestine at 24 hours, in the stomach at 48, and in the colon over the course of three to five days.

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Centro Médico Teknon

Bardají Bofill Manel

Consultorios Marquesa (despacho 34)

Marquesa de Vilallonga, 12

08017 Barcelona

93 290 64 34 / 93 417 23 02 (Fax)

Schedules

	Morning	Afternoon
Monday	09.00 - 13.00 h	16.00 - 20.00 h
Tuesday	09.00 - 13.00 h	16.00 - 20.00 h
Wednesday	09.00 - 13.00 h	16.00 - 20.00 h
Thursday	09.00 - 13.00 h	16.00 - 20.00 h
Friday	09.00 - 13.00 h	16.00 - 20.00 h

Carrer de Vilana, 12, 08022 Barcelona

932 906 200 / 900 301 013