Intestinal Obstruction: Causes, Symptoms, and Treatment Options

Q: Intestinal Obstruction: Causes, Symptoms, and Treatment Options

Hello： 1. <br>X-rays may not be able to distinguish between paralytic ileus and adhesions, so a CT scan may be necessary to identify any obstruction points. <br>2. <br>Paralytic ileus does not require surgery; it only needs to rule out non-motility causes. <br>Mechanical bowel ob

Gastrointestinal issues

Due to a previous traditional abdominal surgery, I have been hospitalized twice for abdominal pain, which the hospital diagnosed as intestinal obstruction.
The first time, the doctor mentioned it was due to bowel paralysis, and I was hospitalized for 12 days before being discharged.
The second time, the doctor was concerned that it might be adhesions causing a small bowel twist.
Since I have a history of arrhythmia, I was hesitant to undergo surgery.
Fortunately, the pain lasted only one day, and I was only given a nasogastric tube.
Later, after a CT scan, the doctor said surgery was not necessary, and I was discharged after 13 days.

I would like to ask:
1.
Is bowel paralysis and small bowel twisting both associated with abdominal pain? During my first hospitalization, I was in pain for three days before I could get out of bed, while during the second hospitalization, I felt better after one day.
What are the differences in X-ray and CT scan findings between bowel paralysis and small bowel twisting?
2.
The doctor mentioned that because I am very thin, the pain from bowel paralysis and small bowel twisting is different.
Small bowel twisting causes continuous pain, and changing positions also induces pain, with hard points palpable on the abdomen.
If there is persistent vomiting and fever, a delay of 6-8 hours without surgery could be fatal.
However, bowel paralysis generally does not require surgery and can be observed for two weeks.
Is this correct? Is there a possibility that if it does not resolve in two weeks, surgery might still be necessary? Can minimally invasive or robotic (Da Vinci) surgery be performed?
3.
The doctor stated that small bowel twisting could lead to bowel necrosis and peritonitis.
How is peritonitis diagnosed? Is bowel congestion and edema indicative of necrosis?
4.
On the 11th day of hospitalization, the CT scan showed ascites, and the doctor prescribed antibiotics.
Does this indicate that my condition has become dangerous? Or did the hospital find an infection based on the white blood cell count? What white blood cell count indicates an infection?
5.
The doctor mentioned that my adhesions have caused a narrowing of the jejunum, which may require surgery at a certain point.
To what extent does small bowel narrowing necessitate surgery?
I would appreciate your assistance, and I would like your professional advice.
English responses are also welcome, as my son-in-law is a hematologist in the United States.
I have consulted him, but he could not provide answers and advised me to seek a gastroenterologist for further guidance.
Thank you.

Madam Zhu, 70~79 year old female. Ask Date: 2018/04/26

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
X-rays may not be able to distinguish between paralytic ileus and adhesions, so a CT scan may be necessary to identify any obstruction points.
2.
Paralytic ileus does not require surgery; it only needs to rule out non-motility causes.
Mechanical bowel obstruction, however, requires surgical intervention.
3.
Peritonitis may present with abdominal muscle rigidity (muscle guarding) and rebound tenderness; intestinal ischemia can cause the bowel to appear purplish-black and edematous.
4.
You can ask your physician for more detailed information.
5.
If there is a narrowing that leads to obstruction, surgery will be necessary.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2018/04/26

More Info

Understanding intestinal obstruction, particularly in the context of previous abdominal surgeries, is crucial for managing symptoms and determining appropriate treatment options. Intestinal obstruction can be classified into two main types: mechanical and functional (or paralytic). Mechanical obstruction occurs when there is a physical blockage in the intestine, while functional obstruction, such as paralytic ileus, involves a lack of movement in the intestines that prevents the passage of contents.

1. Differences Between Paralytic Ileus and Mechanical Obstruction:
- Paralytic Ileus: This condition often arises after surgery due to the manipulation of the intestines, leading to temporary paralysis of the bowel. Symptoms include abdominal pain, bloating, nausea, and vomiting, but the bowel may still be patent, allowing for some passage of gas or liquid stool. X-rays may show dilated loops of bowel without a clear obstruction.

- Mechanical Obstruction: This can occur due to adhesions (scar tissue from previous surgeries), hernias, or tumors. Symptoms are similar but may include more severe pain, inability to pass gas or stool, and a more pronounced abdominal distension. Imaging studies like CT scans may reveal a transition point where the bowel is obstructed.

2. Observation vs. Surgery:
- In cases of paralytic ileus, doctors often recommend conservative management, including bowel rest, hydration, and sometimes medications to stimulate bowel movement. If symptoms persist beyond a reasonable timeframe (usually 48-72 hours), surgical intervention may be necessary. In contrast, mechanical obstructions, especially those caused by adhesions, may require surgery sooner if there are signs of bowel ischemia or perforation.

3. Signs of Complications:
- Abdominal pain that is persistent and worsening, along with fever, tachycardia, and signs of peritonitis (such as rebound tenderness), may indicate complications like bowel necrosis or perforation. Abdominal imaging can help assess for free air or fluid, which may suggest perforation or significant infection.

4. Understanding Abdominal Fluid and Infection:
- The presence of abdominal fluid on imaging can indicate several conditions, including infection, inflammation, or malignancy. Elevated white blood cell counts (typically above 10,000 cells/mm³) can suggest an infectious process, but the context of the clinical picture is essential. A count significantly higher than normal, especially with a left shift (increased immature neutrophils), may indicate a more severe infection.

5. When to Consider Surgery:
- The decision to operate on a narrowed segment of the intestine due to adhesions depends on the degree of obstruction and the presence of symptoms. If imaging shows significant narrowing (stricture) with associated symptoms, surgical intervention may be warranted. Surgeons often prefer minimally invasive techniques, such as laparoscopic surgery or robotic-assisted surgery (like the Da Vinci system), which can reduce recovery time and complications.

In conclusion, managing intestinal obstruction, particularly in patients with a history of abdominal surgery, requires careful evaluation and monitoring. It's essential to communicate openly with your healthcare providers about your symptoms and concerns. If you experience worsening symptoms, do not hesitate to seek immediate medical attention. Your healthcare team can provide the most appropriate recommendations based on your specific situation and medical history.

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