Strangulated intestinal obstruction occurs when. Treatment methods and prognosis for strangulated intestinal obstruction

The frequency of strangulation types of intestinal obstruction is 40-50% of all cases of acute obstruction.

Volvulus is the twisting of the intestine with its mesentery around the longitudinal axis. They account for 4-5% of all types of intestinal obstruction. There are volvulus of the small intestine, sigmoid colon and cecum.

Among the causes of volvulus, predisposing and producing factors are distinguished.

Predisposing reasons include:

• a) excessively long mesentery of the intestine, incomplete bowel turn;
• b) cicatricial cords, adhesions, adhesions between intestinal loops, both congenital and acquired;
• c) sharp weight loss.

Productive reasons include:

• a) a sudden increase in intra-abdominal pressure, leading to a sharp movement of the intestinal loops;
• b) alimentary factors: irregular nutrition, prolonged fasting, followed by an overload of the intestine with a large amount of rough food.

Small intestine volvulus

Under normal conditions, the intestinal loops make significant movements in volume and often make turns up to 90 °, without causing any pathological disorders. When the intestine is rotated by more than 180 °, its lumen overlaps and the mesenteric vessels are compressed. Volvulus is promoted by intestinal overflow, increased peristalsis, adhesions. Volvulus may involve several loops, and sometimes the entire intestine.

Clinical presentation and diagnosis... Small intestine volvulus begins acutely. The disease proceeds with severe general and local clinical symptoms characteristic of acute high strangulation obstruction.

In the first hours of the disease, against the background of constant pain, cramping pains periodically occur, the intensity of which increases synchronously with peristalsis, reaching intolerable character. Often, patients become restless, scream in pain, take a forced position with their legs brought to the stomach. From the very onset of the disease, repeated vomiting occurs, which does not bring relief, at first - unchanged gastric contents and bile, and then it becomes fecaloid. Retention of stool and gas is an intermittent symptom of the disease: often at first there is a single stool due to emptying of the lower intestines, which does not bring relief.

The general condition of the patient is serious. Disorders of water-salt, protein and carbohydrate metabolism, microcirculatory and hemodynamic disorders, intoxication, and decreased urine output rapidly appear and grow. The abdomen is moderately swollen, sometimes bloating is manifested only by the smoothness of the hypochondria.

Often, a positive symptom of Will is found - a balloon-shaped loop of the jejunum fixed in the abdomen, above which high tympanitis and a splash noise are determined.

With an overview fluoroscopy of the abdomen, Kloyber's bowls are found, which appear 1-2 hours after the onset of the disease and are localized in the left half of the epigastric region and in the mesogastric region.

Treatment surgical. It consists in detorsion or "untying" of nodularity, removal of intestinal contents through a long nasointestinal probe. With no doubt the viability of the intestine is limited to detorsion. In case of intestinal necrosis, a non-viable loop is resected with an end-to-end anastomosis. The line of intersection of the intestine should be 40-60 cm above the obstacle and 10-15 cm below it.

Cecum volvulus

Cecum volvulus possible in cases where it has its own mesentery or a mesentery common to the small intestine. With volvulus of the cecum, symptoms are as acute as with volvulus of the small intestine. Pain (both constant and cramping) is localized in the right half of the abdomen and in the umbilical region. Vomiting is common. Most patients have stool and gas retention.

On examination, the asymmetry of the abdomen is revealed due to swelling in the umbilical region. At the same time, the retraction of the right iliac region occurs. On palpation of the abdomen, a positive symptom of Shimans-Dance (a feeling of "emptiness" on palpation in the right iliac region) and stiffness of the muscles of the abdominal wall are often found.

On auscultation of the abdomen, characteristic voiced, metallic-tinged peristaltic noises are noted. Later, with the development of peritonitis, peristaltic murmurs weaken.

On a survey radiograph of the abdomen, a spherical swollen cecum is revealed, which is localized in the right half of the abdomen or is displaced inward and upward. In the projection zone of the intestine, a large (up to 20 cm long) horizontal liquid level is visible.

Volvulus of the sigmoid colon

Volvulus of the sigmoid colon occurs more often in older people with long-term constipation. In addition to the considerable length of the mesentery, cicatricial wrinkling of the mesentery of the sigmoid colon during mesosigmoiditis contributes to volvulus. The consequence of this is the convergence of the adductor and outlet sections of the intestine, which are located almost parallel (like a "double-barreled"). With increased peristaltic contractions or overflow with dense and gaseous contents, the intestine easily twists around its axis, which leads to obstruction.

Clinical picture... The pain comes on suddenly, is intense, is usually localized in the lower abdomen and in the sacrum, accompanied by one or two vomiting. Fecaloid vomiting, as a rule, occurs only with the development of peritonitis and paralytic obstruction. The leading symptom of volvulus of the sigmoid colon is stool and gas retention. The abdomen is swollen up sharply. Its asymmetry is noted - bulging of the upper parts of the right half due to the movement of the sigmoid colon up and to the right. In this case, the abdomen takes on a characteristic "skewed" appearance.

Due to the strong swelling of the colon, all internal organs and the diaphragm are pushed upward. This leads to difficulty breathing and heart failure.

Fluoroscopy reveals the colon (ascending, transverse, descending), which is sharply swollen with gases, which occupies almost the entire abdominal cavity (a characteristic symptom of a "light" abdomen), against which one can see 1-2 Kloyber cups with long fluid levels.

Treatment... For volvulus of the sigmoid colon, surgical and conservative methods of treatment are used.

Surgical treatment consists in straightening the wrapped bowel loops (detorsion) and emptying the bowel from its contents (decompression). In case of necrosis of the intestine, its resection is indicated according to the general rules adopted in the surgical treatment of acute intestinal obstruction. In order to prevent recurrence of the disease with volvulus of the sigmoid colon, mesosigmoplication according to Hagen-Thorn is performed. On the anterior and posterior leaves of the elongated mesentery from the root to the intestine, 3-4 parallel gathering sutures are applied. When they are tightened, the mesentery is shortened. This reduces the risk of re-winding. Some surgeons prefer to fix the sigmoid colon with several sutures to the anterior or posterior abdominal wall.

Intestinal nodulation

Intestinal nodulation(nodulus intestini) proceeds with severe circulatory disorders in the vessels of the mesentery and early necrosis of large areas of the small and large intestine. It is observed in 3-4% of all patients with acute intestinal obstruction.

- violation of the passage of contents through the intestine, caused by obstruction of its lumen, compression, spasm, hemodynamic or innervation disorders. Clinically, intestinal obstruction is manifested by cramping abdominal pain, nausea, vomiting, stool retention and gas discharge. In the diagnosis of intestinal obstruction, the data of physical examination (palpation, percussion, abdominal auscultation), digital rectal examination, plain radiography of the abdominal cavity, contrast radiography, colonoscopy, laparoscopy are taken into account. With some types of intestinal obstruction, conservative tactics are possible; in other cases, surgical intervention is performed, the purpose of which is to restore the passage of the contents through the intestine or its external abduction, resection of a non-viable section of the intestine.

General information

Intestinal obstruction (ileus) is not an independent nosological form; in gastroenterology and coloproctology, this condition develops in a variety of diseases. Intestinal obstruction accounts for about 3.8% of all emergencies in abdominal surgery. With intestinal obstruction, the movement of the contents (chyme) - half-digested food masses - along the digestive tract is disturbed.

Intestinal obstruction is a polyetiological syndrome that can be caused by many reasons and take different forms. Timeliness and correctness of the diagnosis of intestinal obstruction are decisive factors in the outcome of this serious condition.

The causes of intestinal obstruction

The development of various forms of intestinal obstruction is due to its own reasons. So, spastic obstruction develops as a result of reflex intestinal spasm, which can be caused by mechanical and painful irritation with helminthic invasions, intestinal foreign bodies, bruises and abdominal hematomas, acute pancreatitis, nephrolithiasis and renal colic, biliary colic, basal pneumonia, hemopoleuritis and pneumothorax, rib fractures, acute myocardial infarction and other pathological conditions. In addition, the development of dynamic spastic intestinal obstruction can be associated with organic and functional lesions of the nervous system (TBI, mental trauma, spinal cord injury, ischemic stroke, etc.), as well as dyscirculatory disorders (thrombosis and embolism of mesenteric vessels, dysentery, vasculitis), Hirschsprung's disease.

Paralytic intestinal obstruction is caused by intestinal paresis and paralysis, which can develop as a result of peritonitis, surgical interventions on the abdominal cavity, hemoperitonium, morphine poisoning, heavy metal salts, food toxicoinfections, etc.

With various types of mechanical intestinal obstruction, there are mechanical obstacles to the advancement of food masses. Obstructive intestinal obstruction can be caused by fecal stones, gall stones, bezoars, accumulation of worms; intraluminal bowel cancer, foreign body; detachment of the intestine from the outside by tumors of the abdominal cavity, small pelvis, kidney.

Strangulated intestinal obstruction is characterized not only by compression of the intestinal lumen, but also by compression of the mesenteric vessels, which can be observed with infringement of a hernia, volvulus, intussusception, nodulation - overlap and twisting of intestinal loops among themselves. The development of these disorders may be due to the presence of a long mesentery of the intestine, cicatricial cords, adhesions, adhesions between intestinal loops; a sharp decrease in body weight, prolonged fasting followed by overeating; a sudden increase in intra-abdominal pressure.

The cause of vascular intestinal obstruction is acute occlusion of mesenteric vessels due to thrombosis and embolism of the mesenteric arteries and veins. The development of congenital intestinal obstruction, as a rule, is based on anomalies in the development of the intestinal tube (doubling, atresia, Meckel's diverticulum, etc.).

Classification

There are several options for the classification of intestinal obstruction, taking into account various pathogenetic, anatomical and clinical mechanisms. Depending on all these factors, a differentiated approach is applied to the treatment of intestinal obstruction.

For morphological and functional reasons, there are:

1. dynamic intestinal obstruction, which, in turn, can be spastic and paralytic.

2. mechanical intestinal obstruction, including the following forms:

• strangulation (volvulus, infringement, nodulation)
• obstructive (intraintestinal, extraintestinal)
• mixed (adhesive obstruction, intussusception)

3. vascular intestinal obstruction due to intestinal infarction.

By the level of the location of the obstacle for the passage of food masses, there are high and low small intestinal obstruction (60-70%), colonic obstruction (30-40%). According to the degree of violation of the patency of the digestive tract, intestinal obstruction can be complete or partial; according to the clinical course - acute, subacute and chronic. By the time of formation of intestinal obstruction disorders, they differentiate congenital intestinal obstruction associated with embryonic intestinal malformations, as well as acquired (secondary) obstruction due to other reasons.

In the development of acute intestinal obstruction, several phases (stages) are distinguished. In the so-called ileus cry phase, which lasts from 2 to 12-14 hours, pain and local abdominal symptoms prevail. The stage of intoxication, which replaces the first phase, lasts from 12 to 36 hours and is characterized by "imaginary well-being" - a decrease in the intensity of cramping pains, a weakening of intestinal peristalsis. At the same time, there is no discharge of gases, stool retention, bloating and asymmetry of the abdomen. In the late, terminal stage of intestinal obstruction, which occurs 36 hours after the onset of the disease, severe hemodynamic disturbances and peritonitis develop.

Intestinal Obstruction Symptoms

Regardless of the type and level of intestinal obstruction, there is a pronounced pain syndrome, vomiting, stool retention and non-discharge of gases.

Abdominal pains are cramping unbearable. During the contraction, which coincides with the peristaltic wave, the patient's face is distorted from pain, he moans, takes various forced positions (squatting, knee-elbow). At the height of the painful attack, symptoms of shock appear: pallor of the skin, cold sweat, hypotension, tachycardia. The subsiding of pain can be a very insidious sign, indicating intestinal necrosis and the death of nerve endings. After an imaginary lull, on the second day from the beginning of the development of intestinal obstruction, peritonitis inevitably occurs.

Another symptom characteristic of intestinal obstruction is vomiting. Especially profuse and repeated vomiting, which does not bring relief, develops with small bowel obstruction. Initially, the vomit contains food residues, then bile, in the later period - intestinal contents (fecal vomit) with a putrid odor. With low intestinal obstruction, vomiting, as a rule, is repeated 1-2 times.

A typical symptom of low bowel obstruction is stool retention and gas discharge. A digital rectal examination reveals the absence of feces in the rectum, distension of the ampulla, and dehiscence of the sphincter. With a high obstruction of the small intestine, stool retention may not be; the emptying of the lower parts of the intestine occurs independently or after an enema.

With intestinal obstruction, attention is paid to the bloating and asymmetry of the abdomen, peristalsis visible to the eye.

Diagnostics

With abdominal percussion in patients with intestinal obstruction, tympanitis with a metallic tint (Kivul's symptom) and dullness of the percussion sound are determined. Auscultation in the early phase reveals increased intestinal peristalsis, "splash noise"; in the late phase - weakening of peristalsis, the noise of a falling drop. With intestinal obstruction, a stretched intestinal loop is palpated (Valya's symptom); in the later stages - the rigidity of the anterior abdominal wall.

Rectal and vaginal examinations are of great diagnostic importance, with the help of which it is possible to identify obstruction of the rectum, tumors of the small pelvis. The objectivity of the presence of intestinal obstruction is confirmed by instrumental studies.

Plain X-ray of the abdominal cavity reveals characteristic intestinal arches (gas-inflated intestine with liquid levels), Kloyber's bowls (dome-shaped enlightenment above the horizontal liquid level), and pinnation symptom (presence of transverse striation of the intestine). X-ray contrast study of the gastrointestinal tract is used in difficult diagnostic cases. Depending on the level of intestinal obstruction, an x-ray of the passage of barium through the intestine or an irrigoscopy may be used. Colonoscopy allows you to examine the distal parts of the large intestine, identify the cause of intestinal obstruction and, in some cases, resolve the phenomenon of acute intestinal obstruction.

An ultrasound of the abdominal cavity with intestinal obstruction is difficult due to pronounced pneumatization of the intestine, however, the study in some cases helps to detect tumors or inflammatory infiltrates. In the course of diagnosis, acute intestinal obstruction should be differentiated from intestinal paresis - drugs that stimulate intestinal motility (neostigmine); novocaine perirenal blockade is performed. In order to correct the water-electrolyte balance, intravenous administration of saline solutions is prescribed.

If, as a result of the measures taken, intestinal obstruction is not resolved, one should think about mechanical ileus, which requires urgent surgical intervention. Operation for intestinal obstruction is aimed at eliminating mechanical obstruction, resection of a non-viable section of the intestine, and preventing repeated obstruction.

In case of obstruction of the small intestine, resection of the small intestine can be performed with the imposition of enteroenteroanastomosis or enterocoloanastomosis; de-intussusception, unwinding of the volvulus of intestinal loops, dissection of adhesions, etc. In case of intestinal obstruction caused by a tumor of the colon, hemicolonectomy and the imposition of a temporary colostomy are performed. With inoperable colon tumors, a bypass is applied; with the development of peritonitis, transversostomy is performed.

In the postoperative period, the BCC is reimbursed, detoxification, antibacterial therapy, correction of protein and electrolyte balance, stimulation of intestinal motility.

Forecast and prevention

The prognosis for intestinal obstruction depends on the onset and completeness of the treatment. An unfavorable outcome occurs with late recognized intestinal obstruction, in weakened and elderly patients, with inoperable tumors. With a pronounced adhesive process in the abdominal cavity, relapses of intestinal obstruction are possible.

Prevention of the development of intestinal obstruction includes timely screening and removal of intestinal tumors, prevention of adhesive disease, elimination of helminthic invasion, proper nutrition, avoidance of injuries, etc. If intestinal obstruction is suspected, an immediate visit to a doctor is necessary.

A large number of people face intestinal obstruction, and most often this pathology is observed in the older age group. Its characteristic feature is a completely or partially impaired patency of the digestive system, which can lead to considerable problems, including death. Speaking about strangulated intestinal obstruction, experts mean the formation of nodes, the presence of infringement or volvulus. At the same time, the problem applies not only to the large intestine, but also to the small intestine.

There are three types of the disease, which include volvulus, pinching, and the formation of nodes. Each of these subspecies has its own characteristics and characteristics; In this case, bloat is diagnosed most often. Usually it forms in the ileal intestinal region, less often the phenomenon is observed in relation to the cecum or the transverse colon. The reasons due to which strangulations develop may be as follows:

• predisposing;
• producing.

The first include factors of a physiological nature - for example, excessive length of the mesentery or incomplete rotation of the organ. This group also includes adhesions or fusion of intestinal loops, which can be both congenital and acquired during surgery, or an excessive amount of scar tissue. An unnecessarily rapid decrease in body weight can also provoke pathology. In this case, there is a thinning of the adipose tissue, which, under normal conditions, separates the mesenteric areas.

Productive reasons include:

• an unexpected and sharp increase in intra-abdominal pressure, resulting in a pathological displacement of the intestinal loops;
• the presence of nutritional factors - usually this is an irregularity of food or prolonged fasting, followed by loading into the intestines of a significant amount of coarse dietary fiber;
• increased peristalsis of the organ, shifting the intestinal parts.

Pathology symptomatology and diagnosis

Usually strangulated intestinal obstruction manifests itself quickly and very sharply, there is no gradual increase in the intensity of signs. It doesn't matter which section of the intestine is affected, there are a number of common symptoms:

1. The pain that appears is characterized by intensity and constancy, is of a cutting nature, the appearance of cramping attacks is not uncommon. Often, the pain is localized in a certain part of the abdomen, which allows the specialist to quite accurately guess in which intestine the problem area is located. Young children who are unable to accurately describe their feelings show anxiety or scream in pain.
2. The victim takes a forced position, trying to improve the condition, which is also a clear sign of the problem. Lying on his side, the patient presses his knees to the abdomen.
3. There may be no particular problems with stool, although constipation is often noted.
4. Nausea and the urge to vomit appear, which is characterized by a reflex nature and cannot be removed using the usual methods. When examining vomit, the presence of pieces of recently eaten food is initially noted. Over time, bile appears in the vomit, when an organ is blocked, an admixture of feces is added to the masses - this phenomenon is defined by doctors as fecal vomiting.

The diagnosis of pathology is carried out as quickly as possible, since the disease is classified as an urgent problem requiring urgent intervention. On examination, bloating and asymmetry of the abdomen is determined, palpation reveals muscle rigidity in the abdominal zone. In children, palpation is impossible, given the severe pain. To confirm the diagnosis, instrumental examinations are prescribed:

• radiography with or without contrast;
• colonoscopy or sigmoidoscopy, which allow the specialist to assess the condition of the intestinal walls from the inside, identifying the affected areas;
• Ultrasound of organs located in the peritoneal cavity.

Only after all the required results of examinations and analyzes have been received, the attending physician begins to develop a treatment regimen.

Traditional pathology therapy

Strangulation intussusception is eliminated exclusively by surgical intervention... The use of conservative methods, including the use of enemas, antispasmodics and solutions that restore the water balance, will give a certain effect only at the beginning of the formation of pathology. As for the operation, we are talking about an open laparotomy, which consists of several stages:

1. The first stage is disinvagination, in which the problem area is straightened, followed by the removal of excess adhesive or scar tissue.
2. The mobility of the organ decreases for cecopexy, during which the terminal section of the intestine is fixed with interrupted sutures.
3. In case of a complicated condition and the impossibility of eliminating intussusception, a resection of loops, excision of an area with the presence of necrosis are prescribed.
4. The final stage is the purification of the organ from gases, accumulation of excrement.

In cases where strangulation intestinal obstruction is removed surgically, the victim remains in the hospital for some time. Postoperative measures are necessary to monitor the condition. To reduce the risk of a relapse of pathology or postoperative complications, certain pharmaceutical preparations are prescribed, and drugs are also prescribed to normalize intestinal functionality. These can be antimicrobials, probiotics, and antispasmodics.

An obligatory stage of the recovery period is a diet prescribed by a specialist.... You will need to remove soda, alcoholic drinks and kvass, spices and beans from the menu. Also, a taboo is imposed on baked goods, fried and spicy foods, fatty foods. Preference is given to low-fat types of fish and meat, steamed or boiled, cereals, baked fruits, low-fat milk products.

Traditional methods of treatment

Despite the fact that doctors speak out against the use of traditional medicine for strangulated intestinal obstruction, herbal medicines can be used in the recovery period and to prevent relapse. However, before you start taking such formulations, you need to consult with your doctor. If the reception of funds is carried out at the initial stage of the formation of pathology, the victim must constantly be under the supervision of specialists, since the rapid development of complications leading to a lethal outcome is possible.

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According to surveys conducted, 35-50% of the inhabitants of our country have come across such a concept as intestinal obstruction. This phenomenon most often occurs in people of advanced age and is a life-threatening disease, the main characteristic of which can be considered a complete or partial violation of the passage of food through the gastrointestinal tract. This ailment can not only cause severe complications in the work of the patient's body, but also lead to death. There can be many reasons for the occurrence: this is the development of intestinal peristalsis, and the consequences of surgical and drug intervention in the normal rhythm of the human body.

What is Strangulated Intestinal Obstruction

Strangulated intestinal obstruction, in turn, is an extremely aggravated form of the previously described disease, in which there is a violation of the passage through the intestinal tract. This process is due to the complete infringement of the mesentery of the colon around its own axis. For example, under normal conditions of functioning of the patient's organs, all intestinal loops carry out normal pathological movements, making turns up to 120 degrees. If the turn of the intestine is 180 degrees or more, in this case there is a sharp overlap of its lumens, due to which the vessels of the mesentery are compressed and are unable to function normally. In the most advanced cases, both several intestinal loops and the entire organ can participate in such a volvulus.

Types of strangulated intestinal obstruction

It is customary to distinguish three types of disease:

• volvulus;
• pinching;
• nodulation.

Volvulus is most often formed in the ileum, less often in the caecum and transverse colon. The appearance of the disease is facilitated by a large number of scars and adhesions, as well as prolonged starvation or strong organ peristalsis. At the initial stage of volvulus, the patient feels sharp pains in the abdomen and navel, constipation, profuse gas formation, and a decrease in blood pressure. Pinching and charring can form at any level of the intestine. At the beginning of these types of disease, the patient may feel the symptoms of Valya, Kivul and Mathieu-Sklyarov. It is possible to diagnose an ailment with the help of an X-ray image exclusively in the supine position of the patient.

Causes of the disease

The causes of the onset and development of strangulated intestinal obstruction can be divided into two main groups:

1. Predisposing reasons. These include an intestinal mesentery that is too long in size, the presence of large or thick cicatricial cords, adhesions, adhesions, an incomplete rotation of the small intestine, as well as a sharp decrease in the patient's weight or the presence of various congenital anomalies.
2. Productive causes: a constant increase in abdominal pressure and a sharp movement of the intestinal loops, provoked by an improper or irregular diet or fasting.

Symptoms of the disease

Symptoms of the disease of strangulated intestinal obstruction include:

• sharp and constantly increasing pain;
• discomfort in the navel;
• constipation, diarrhea;
• colaptoid state;
• incessant vomiting;
• increased body temperature;
• dizziness;
• general deterioration of a person's condition.

Strangulated intestinal obstruction in children

Strangulated obstruction is a fairly common and regular disease in children. In terms of frequency of occurrence, it ranks second after angina. With the development of an ailment in a child, mechanical ileus appears, a decrease in the lumen of the intestinal region, compression of adhesions and infringement of mesenteric vessels.

Signs of obstruction in children begin abruptly and sharply. The child feels constant pain, reminiscent of strong contractions, not only in the intestines, but also in the lumbar region. In addition, the baby's pulse quickens, the temperature rises and the blood pressure level decreases. If you notice these signs in your child, in no case do not rely on a self-diagnosed diagnosis, but urgently contact the nearest medical center. The sooner a qualified specialist can diagnose a disease, the earlier you will begin the correct and effective course of treatment.

Treatment of the disease

Any manifestation of strangulated intestinal obstruction is subject to emergency surgery. If you find any signs of this disease in yourself, contact your doctor immediately. Conservative therapies (all kinds of enemas, rehydration and antispasmodics) help only in the first few hours.

The operation is an open laparotomy, at the first stage of which there is disinvagination and excision and removal of excess adhesions or scars. Further, surgeons reduce the mobility of the intestinal region and, in order to prevent the recurrence of signs of the disease, perform cecopexy. Cecopexy is the process of fixing the terminal segment of the intestine with special interrupted sutures. If there is an advanced case of the disease and the invaginate cannot be corrected, then the loops of the large and small intestine are resected. Most often, surgery is performed under general anesthesia with novocaine.

The result of the operation and the prognosis of the patient's condition, suffering from intestinal obstruction, primarily depends on the correct and timely diagnosis. Assessment of the intestinal capacity should be carried out by doctors carefully and carefully, especially considering the fact that any necrotic changes initially appear in the mucous membrane, and only after that in the serous integuments. During the operation, it is mandatory to empty the adducting intestine from gases and other contents in it. Unfortunately, statistics show that the number of deaths in this case is 20% of all cases of surgical intervention. This is due to the fact that most patients go to specialized medical institutions too late. Take care of yourself and be healthy!

The incidence of such a pathology as strangulated intestinal obstruction is almost half of all cases of acute obstruction. The disease consists in twisting of the intestine along with the mesentery relative to the longitudinal axis. There are situations with a similar pathology for the blind, sigmoid colon or small intestine.

Intestinal obstruction classification

Since the intestine itself consists of two sections, the cases of pathology in it are divided into two options. Occurs:

• high intestinal obstruction (small intestine);
• low intestinal obstruction (large intestine).

By its nature, obstruction is:

• mechanical intestinal obstruction and its subspecies - obstructive intestinal obstruction;
• strangulation;
• mixed;
• dynamic intestinal obstruction and its subspecies - paralytic intestinal obstruction or spastic intestinal obstruction.

By origin, there is congenital intestinal obstruction or acquired. Moreover, congenital intestinal obstruction requires urgent surgery for the newborn.

If you study the types of intestinal obstruction, then there is an acute or chronic intestinal obstruction. Paralytic intestinal obstruction refers to an acute form of pathology, but obstructive intestinal obstruction often becomes chronic. This is due to the fact that obstructive intestinal obstruction develops due to partial overlap of the intestinal lumen due to various acquired or congenital factors.

Since we are interested in the strangulation type of intestinal obstruction, further we will consider only it.

Causes

Among the causes of pathology, producing or predisposing factors are distinguished.

The latter reasons include:

• too long mesentery, incomplete turn inside the intestine;
• adhesions, adhesions and cicatricial cords between the loops of the congenital or acquired form;
• sharp weight loss.

The producing causes are:

• a sharp increase in pressure in the peritoneum, causing the loops to move;
• irregular food, prolonged fasting, after which a person overeats rough food.

Under natural conditions, the intestinal loops perform significant movements, often turn even 90 ° and this does not cause pathological disorders. When the intestine unwinds more than 180 °, the lumen is blocked in it, the mesenteric vessels are compressed. More often, a similar phenomenon occurs if there is a high obstruction inside the intestine.

The main cause of this pathology is hematomas, tumors, and inflammatory infiltrates. These abnormalities, due to peristaltic contractions, begin to advance, dragging the intestinal wall along with them. Such intussusception in intestinal obstruction is caused by persistent spasm, after which the affected area of ​​the intestine is introduced through peristaltic contractions into another part of the intestine.

Symptoms

Twists, like provocateurs of intestinal obstruction, begin acutely. The pathogenesis of intestinal obstruction of this type is characterized by the presence of severe clinical manifestations. Initially, such intestinal obstruction is manifested by constant pain in the form of contractions, which are characterized by increasing intensity, becoming simply unbearable. Patients scream from pain attacks, become restless, take a forced posture with legs tucked into the peritoneum.

The pathogenesis develops as follows: first, frequent vomiting occurs, which does not provide any relief. After the eruption of gastric contents, and then bile, vomit becomes fecaloid in nature. There is a delay in the release of gases and feces - a single bowel movement is possible, which empties the lower intestine, which does not cause relief.

Consider the symptoms that characterize obstruction in various parts of the intestine.

Sigmoid colon

The considered type of intestinal obstruction is more often observed among the elderly, who are characterized by frequent constipation. In addition to the considerable length of the mesentery, its cicatricial wrinkling in mesosigmoiditis contributes to the volvulus.

Because of this pathology, the abducting and adducting intestinal areas, which are located almost in parallel, approach each other (a variant referred to by specialists as a "double-barreled gun"). When the peristaltic contractions increase or the intestines overflow with gaseous and dense contents. The intestine is twisted along the longitudinal axis. This is what causes strangulation obstruction. The symptoms are as follows:

1. The pains appear suddenly, become intense, palpable in the sacrum and lower abdomen, accompanied by vomiting.
2. With paralytic obstruction and peritonitis, fecaloid vomiting occurs.
3. The most characteristic symptom that determines the volvulus of this part of the intestine is gas retention and constipation.
4. The peritoneum swells up sharply.
5. The abdomen is asymmetric - in the upper right, it bulges out due to the movement of the sigmoid colon in this direction. The peritoneum takes on a characteristic, somewhat "skewed" appearance.
6. Due to the severe bloating of the intestines, the diaphragm and other internal organs are pushed upward. This condition causes difficulty breathing, leading to interruptions in cardiac activity.

Fluoroscopy reveals the colon, which is swollen with gases and occupies almost the entire peritoneal cavity.

Cecum

Pathology is possible if the cecum has a common mesentery with the small intestine, or its own. Strangulated obstruction of this section is characterized by the same symptoms that are characteristic of volvulus of the small intestine. The pains are localized on the right in the peritoneum and near the navel. There is vomiting, there is a delay in the release of gases and feces.

Examining the patient, the doctor notices the asymmetry of the peritoneum, expressed by swelling near the navel. In this case, the iliac region of the right side of the peritoneum sinks at the same time. Palpation of the abdomen can reveal a feeling of some kind of emptiness in the right iliac region, as well as a stiffness of the muscles that make up the abdominal wall. Auscultation of the abdomen determines the characteristic peristaltic murmurs. When peritonitis begins to develop, they are somewhat weakened.

When performing a plain X-ray, the cecum, which is swollen in the form of a ball, located to the right of the navel, is revealed. It can also be displaced upward and into the peritoneum.

Diagnostics

Examining the peritoneum, the specialist notices the visually visible peristalsis. On palpation, the abdomen is soft, but by performing a deep indentation, it is possible to find a painful cylindrical inactive formation, which is located on the right in the iliac region, above the navel or in the right hypochondrium.

Rectal examination reveals an empty and dilated rectal ampulla; in children with deep intussusception, the head of the intussusception is sometimes palpated, descending directly into the rectum. Usually, bloody discharge is detected in the rectal lumen.

The diagnosis of intussusception accompanying strangulation obstruction is based on the following characteristic features:

• cramping pain;
• cylindrical formation on the right in the peritoneum;
• bloody issues.

Treatment

Only surgical intervention helps to save from such a pathology as the formation of a node. It consists in unleashing a nodular formation, as well as removing intestinal contents through a special naso-intestinal probe. When the viability of the intestine is beyond any doubt, the surgeon during the operation is limited to detorsion. If intestinal necrosis is detected, excision of the non-viable loop is performed, equipping an anastomosis instead of the removed part of the intestine. The intersection line is located 40 cm above the node and 10 cm below it.

Sigmoid colon treatment

In case of a problem with the sigmoid colon, in addition to the surgical method, conservative treatment is also used. The operation consists in the fact that the surgeon straightens all wrapped intestinal loops and performs the emptying of intestinal contents. If intestinal necrosis is detected, resection of this area is necessary according to the rules that are adopted for the surgical treatment of intestinal obstruction. To prevent a possible recurrence of the disease, mesosigmoplication is performed using the Hagen-Thorn technique. To do this, several parallel sutures are applied to the posterior and anterior mesenteric leaves from the intestine to its root. When they are tightened, the mesentery is shortened. This minimizes the risk of re-winding. Sometimes surgeons prefer to perform fixation with several sutures of the sigmoid colon to the posterior or anterior wall of the peritoneum.

Treatment of intussusception

Emergency surgery is required. Very rarely, conservative treatment of this type of pathology is effective. It consists of prescribing antispasmodics, injecting gas into the colon, performing siphon enemas.

During the operation, if it is performed in a timely manner, it is possible to organize disinvagination by gentle and very careful squeezing out of the intestinal contents. After that, in order to reduce unnatural intestinal mobility, as well as to prevent a possible recurrence of pathology, cecopexy is performed. The essence of this technique is to fix the terminal segment in the ileum and cecum with independent interrupted sutures to the posterior part of the parietal peritoneum.

In a situation where it is not possible to straighten invaginate in any way or the disinvaginated intestine is completely unviable, excision of the intestinal loops is performed.

Survival prognosis

With regard to the prognosis of survival in patients, the following can be emphasized - everything depends only on the timely diagnosis and the urgency of organizing the surgical intervention. The presence of concomitant diseases, as well as the age of the patient, has a relatively unfavorable character for the prognosis of survival. Average mortality rates after operations with strangulated obstruction reach more than 20%. This is due to the late appeal of a person to specialists, delayed diagnosis. Because of this, precious time is lost when surgery can be more favorable.