Clinical presentation and course of acute intestinal obstruction

Clinical syndrome of acute intestinal obstruction includes a number of specific phenomena, which changes depending on the form and level of obstruction. The illness usually begins suddenly, sometimes slowly, but in a short period of time. In acute intestinal obstruction, emerging on the background of chronic (adhesive) obstruction, acute phenomena frequently preceded by attacks partial obstruction. In all cases of acute intestinal obstruction are marked abdominal pain; sometimes they iradionet in the back. At the onset of pain at strangulatio are usually permanent, and if obturation cramping nature; their intensity varies depending on the type of obstruction: the higher the place obstacles, the more involved in the process, the mesentery, the more intense and sharper the pain, the more clinical symptoms of shock or collapse. The greatest height of pain achieved by the inversion or ozloblennaya small intestine.
The sudden early pain, not accompanied by the discharge of gases that may indicate necrosis intestinal loops; but often severe pain continue under the new necrosis. In obstructive forms of mechanical intestinal obstruction stopping pain attacks and the transition of labour in flooded pain indicates bowel paresis above the obstacles.
General condition of the patient deteriorates rapidly at strangulation forms, with a high level of obstruction and dynamic intestinal obstruction on the grounds of thrombosis of vessels of a mesentery. When turning the patient takes a forced position, his face pale, sometimes cyanotic, suffering, covered with cold sweat.
The pulse at the beginning of the disease several ucase (up to 90 beats per 1 minute), with the deterioration of the heart rate increases to 120 beats; in the process of developing the disease, arterial pressure decreases.
An important symptom of bowel obstruction is the delay of gas and feces. Only when intussusception may experience bloody diarrhea in small portions, tenesmus.


Fig. 1. Bulging of the abdominal wall swollen intestinal loops in intussusception.

Vomiting is not permanent earliest symptom of bowel obstruction. It usually starts early at high location obstacles and may not be present when obstruction of the distal colon cancer, especially in obstructive forms.
In advanced forms of bowel obstruction in patients sometimes "fecal vomiting due antiperistaltic or passive movement in the stomach content of the intestine up from the place obstacles.
Characteristic of the inversion is uneven bloating, and swelling of the intestinal loops contribute through the abdominal wall in the relevant areas (Fig. 1). Seen peristalsis of the bowel is a typical symptom of obstructive bowel obstruction. Flatulence, usually marked by an obstruction of the colon and distal and rarely occurs at high obstruction.

Fig. 2. Partial inversion of the small intestine. Fig. 3. Inversion of the sigmoid colon. Fig. 4. Utoobasaurus between the small and the sigmoid colon.

Fig. 5. Invagination of the small intestine into the large: 1 - single; 2 - double.

Early palpation sign inversion (Fig. 2 and 3) and utoobasaurus (Fig. 4) is the symptom of Valya: the presence of abdominal on the limited space bloated loops of intestine, sometimes noticeable through the abdominal wall and giving by a slight push the sound of lapping. If percussion notes ringing tympanic with a metal shade. But in obstructive low located obstruction can detect the sound of the lapping of the liquid in a crowded the small intestine.
When intussusception (Fig. 5) sometimes can be felt in the abdomen tight, painful education - invagent. Research finger rectal (and women and vaginal examination) necessarily in intussusception, as it allows to detect the infiltration or a tumor in the pelvis, obturation feces and so on, Often with the inversion of the sigmoid colon is determined dehiscence and expansion of the rectal ampulla.
Auscultation of the abdomen in intussusception allows sometimes discover a peristaltic noise that often marked at the initial stage when obturation. In later phases, with the onset of bowel paresis under any form of intestinal obstruction noted the complete absence of intestinal sounds.
The body temperature is usually normal or reduced, blood picture at the beginning of the disease without modification; when expressed shock marked hemoconcentration and eritrotsitoz; if there toxemia noted leucocytosis with a shift leukocyte left in late phase leukocytosis replaced by radiation with the appearance of young forms and plasmic order has been revealed.
Clinical features of separate forms of acute bowel obstruction more clearly revealed in the initial stages of the disease; in the later period of the characteristic features of the erased due to bowel paresis, the disappearance of peristalsis and development of peritonitis.