INTESTINAL OBSTRUCTION

**INTESTINAL OBSTRUCTION **

1. Definition – Intestinal obstruction is a blockage of the intestinal lumen that prevents normal passage of contents.

2. Classification –
   a. Mechanical obstruction – physical barrier within the lumen.
   b. Non‑mechanical (functional) obstruction – paralysis of intestinal motility without a physical barrier.

3. Types –
   a. Small‑bowel obstruction (SBO).
   b. Large‑bowel obstruction (LBO).
   c. Complete obstruction – total blockage, no passage of gas or stool.
   d. Incomplete obstruction – partial blockage, some passage possible.

4. Causes –
   Mechanical causes → adhesions (most common), external or internal hernias, neoplasms, intussusception, volvulus, foreign bodies, strictures.
   Non‑mechanical causes → paralytic ileus, metabolic disturbances, drugs (opioids, anticholinergics).

5. Pathophysiology – obstruction → accumulation of fluid and gas proximal to the site → increased intraluminal pressure → bowel wall edema → venous congestion → arterial compromise → ischemia → necrosis if not relieved.

6. Clinical features –
   Abdominal pain → colicky early, becoming constant as obstruction persists.
   Vomiting → early in proximal obstruction, later in distal obstruction; may become bilious.
   Abdominal distension → more marked in distal obstruction.
   Constipation/obstipation → inability to pass flatus or stool.
   Bowel sounds → high‑pitched tinkling early, absent later.

7. Signs of strangulation – severe continuous pain, localized tenderness, guarding, rebound tenderness, fever, tachycardia, leukocytosis, possible metabolic acidosis.

8. Role of imaging –
   Plain abdominal X‑ray → dilated loops, multiple air‑fluid levels, absence of gas beyond obstruction.
   CT abdomen with contrast → precise site, cause (adhesion, tumor, volvulus), bowel wall thickening, mesenteric stranding, free air or fluid.
   Ultrasound → useful in children for intussusception, can show dilated loops and peristalsis.

9. Initial management –
   Fluid resuscitation → correct dehydration and electrolyte imbalance.
   Nasogastric tube insertion → continuous suction to decompress stomach and proximal bowel.
   Analgesia → adequate pain control, avoid excessive opioids that may worsen ileus.
   Bowel rest → keep patient NPO, monitor urine output.

10. Indications for surgery –
    Clinical suspicion of strangulation or perforation (peritonitis, fever, leukocytosis).
    Complete obstruction persisting >24–48 h despite conservative measures.
    Failure of non‑operative treatment (no improvement in pain, vomiting, distension).
    Obstructing lesion that cannot be resolved medically (tumor, hernia, volvulus, intussusception).

11. Surgical options –
    Adhesiolysis → for adhesive SBO.
    Resection and primary anastomosis → when necrotic segment present.
    Hernia repair → if obstruction due to hernia.
    Resection with stoma formation → when contamination or poor patient condition.

12. Homoeopathic treatment –
    Nux vomica → paralytic ileus with abdominal distension and vomiting after overeating.
    Opium → marked constipation/obstipation, feeling of fullness.
    Ginger (Zingiber officinale) → nausea, early gastric stasis, vomiting.
    Carbo vegetabilis → tympanitic distension, relief by belching.
    Arsenicum album → severe, restless abdominal pain with fear, suggestive of impending strangulation.

13. Complications – bowel ischemia → necrosis, perforation → peritonitis and sepsis, electrolyte disturbances (hypokalemia, metabolic alkalosis), short‑bowel syndrome after extensive resection.