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II./2.4.: Intestinal obstruction (ileus)
II./2.4.1.: General information
Intestinal obstruction (ileus):
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Ileus means the cessation of the bowel content transmission (passage), irrespectively of the cause, which can include the morphologic narrowing or obstruction of the intestinal lumen, or a functional disorder (decreased or terminated peristaltic bowel movement).
Ileus can affect any bowel stretch at any length. Longer existence and broad expansion is a potential life threatening state. It is most commonly present in the small intestine.
Based on pathogenesis:
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- Obstructive (mechanical), and
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- Non-obstructive (paralytic and vascular) forms can be differentiated.
Clinical symptoms are the following:
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- abdominal pain,
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- vomiting,
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- constipation
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- constipation of bowel gas
It is important to know that as time passes, ileus of any origin will lead to bowel dilatation, causing the stricture of small blood vessels in the intestinal wall and thus the microcircular lesion of the wall. If this happens, the prognosis deteriorates irreversibly, and - especially if long stretches are affected – this can lead to the patient’s death.
Most common causes of ileus:
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1) mechanical (obstructive) ileus – adhesion, stricture, strangulation, atresia, hernia, volvulus, intussusceptio, tumour, gallstone, foreign body, faecolith, meconium (in mucoviscidosis);
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2) non-mechanical (pseudoobstructive) ileus – paralytic ileus, state after abdominal cavity opening (operation or trauma), acute abdomen, renal colic, uraemia, vascular ileus, blood vessel occlusion, thrombosi, embolism, blood vessel clamping, neurogenic/myogenic causes.
II./2.4.2.: Mechanic (obstructive) ileus
Most common cause of bowel passage stalling is some type of physical obstruction, i.e. mechanical obstacle. Obstruction can develop due to congenital or acquired reasons, the latter being more common.
The most important causes:
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- congenital atresia,
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- stricture,
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- intestinal developmental disorder,
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- meconiumileus,
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- anus atresia,
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- adhesions,
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- hernias,
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- volvulus,
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- a part of the intestine’s invagination into another section of intestine (intussusceptio seu invaginatio),
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- different types of tumours,
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- gall stones causing obstruction,
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- faecolith (skybala – skybalon),
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- foreign bodies.
II./2.4.3.: Paralytic ileus
Paralytic stopping of bowel movement and passage is not caused by the above mentioned „anatomical” lesions, but functional and neural mechanisms. Several powerful stimuli (such as acute abdomen, early postoperative stage of abdominal surgery, kidney stone induced renal colic, uraemia etc.) can trigger this syndrome.
II./2.4.4.: Vascular ileus
Stricture of the blood vessels supplying the bowels can cause functional disorder of varying severity, while a complete vascular occlusion may lead to complete necrosis of the intestinal wall, subsequent stopping of bowel movements and ileus.
The margin of the necrosis is usually exquisite, with hemorrhagic infarct, the serosa is unglazed, the bowel content contains blood, and the intestinal wall is thin and sleazy. Vascular occlusions are caused by thrombosis, embolization, vasculitis, clamping (by e.g. tumour, strangulation).
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