Symptoms of partial intestinal obstruction, treatment. Intestinal obstruction: symptoms and treatment Acute intestinal obstruction symptoms

It is customary to distinguish between dynamic intestinal obstruction, when the motor function of the intestinal wall is disrupted (i.e., peristalsis is disrupted and the movement of contents through the intestine stops) and mechanical intestinal obstruction (in this case, mechanical blockage of the intestine occurs at some level).

Mechanical obstruction occurs much more often and can develop due to intestinal blockage, tumor, feces, as well as due to compression or strangulation of the intestine from the outside during the adhesive process in abdominal cavity, volvulus or knot formation.

Dynamic intestinal obstruction can develop with diffuse intestinal obstruction of any etiology, with long-term untreated biliary or renal colic, after surgery on the abdominal organs, with poisoning with salts of heavy metals, as well as injuries and tumors of the brain and spinal cord (when the innervation of the intestinal wall is disrupted).

The level at which it occurred is of great importance. intestinal obstruction. The higher the obstacle arises, the harder it flows, the more energetic therapeutic measures she demands.

Symptoms of acute intestinal obstruction

• strong, cramping or constant, occurring suddenly, regardless of food intake, without a specific localization;
• bloating;
• indomitable vomiting (the higher the level of obstruction, the more pronounced);
• retention of stool and gases (with high obstruction, there may be stool first due to bowel movements below the level of the obstruction).

Diagnostics

Acute intestinal obstruction an emergency doctor may suspect already during examination of the patient (examination includes questioning, palpation, percussion and auscultation of the abdomen, measurement blood pressure, auscultation of the heart and lungs).

Suspicion of obstruction is an absolute indication for hospitalization of the patient.

In the hospital emergency department, the first thing that is done is a plain X-ray of the abdomen. If signs of intestinal obstruction are detected, radiography with oral administration of a radiocontrast agent is performed to clarify the localization of the process. Colonoscopy (an endoscopic method for examining the large intestine) and other additional studies may also be performed.

What can you do

At the slightest suspicion of the occurrence of this terrible condition, you should call an ambulance. Clinical picture intestinal obstruction develops within a few hours. The timing of admission of such patients to medical institutions largely determine the prognosis and outcome of the disease.

How can a doctor help?

Therapeutic tactics for intestinal obstruction depend on the cause that caused it and the type of obstruction. In most cases, urgent surgery is necessary. However, all types of dynamic obstruction are subject to conservative treatment, which includes ensuring the patency of the gastrointestinal tract using enemas, removing intestinal contents with a nasogastric or nasointestinal tube, correcting water and electrolyte disturbances, monitoring hemodynamics, normalizing peristalsis, detoxification and antibacterial therapy.

Obstruction is a condition in which the movement of food through the intestines is disrupted.

According to clinical symptoms, acute and chronic course of the disease is distinguished. According to the development of pathology in medicine, there are also two types: dynamic and mechanical.

general information

In childhood, NK accounts for about 2% of all surgical diseases.

There is a congenital and acquired condition, accounting for 25% and 75% respectively.

Among adults, the disease occurs in 1.5-2 cases per 10 thousand people, which is 1.38% among all surgical pathologies.

Among acute diseases of surgical diseases, the percentage of the disease among adults is 4.50%.

NK affects middle-aged people, especially men in a ratio of 3:1.

In medicine, types of disease are divided into:

• etiology – congenital or acquired form of the disease;
• the cause of occurrence is mechanical and dynamic, which, in turn, can be spastic and paralytic;
• factors of dysfunction of the mesenteric root, the vessels of which feed the intestine. They can be compressive (strangulation), non-compressive (obstructive) and combined;
• clinical development - acute, subacute, complete, partial and chronic forms.

Causes

The causes of the mechanical form in adults include the following disorders:

• Volvulus;
• Nodular formation;
• Adhesive disease;
• The entrance of one intestine into another;
• Strangulated hernia;
• Blockage of the intestine with feces, a ball of roundworms, a neoplasm or a foreign body.

The dynamic stage develops for the following reasons:

• Reflex disorders of the gastrointestinal tract affecting intestinal motor function;
• Impaired functioning of the central nervous system;
• Acid-base and electrolyte imbalances.

Can cause intestinal obstruction adhesions or adhesions after abdominal operations, inflammatory processes.

The disease can develop in case of improper nutrition, increased peristalsis, compression of the intestine with increased pressure inside the abdominal cavity.

CI in children often develops due to mechanical obstacles. Less commonly, this surgical disease is associated with impaired intestinal motility.

In children, the disease can be of two types - congenital or acquired. To the reasons congenital pathology include abnormalities in the development of the esophagus.

The reasons for the acquired form are much more varied. Depending on the causes, the disease has two forms - mechanical and dynamic.

The latter develops in two forms, when prolonged tension of the organ occurs or, conversely, paralytic, when complete relaxation of the walls occurs.

The key reasons for the development of intestinal obstruction are:

• Postoperative complications;
• Consequences or complications after taking medications;
• Complications after inflammation of the appendix.

The main reasons for the development of the mechanical form include:

• Adhesive process;
• Compression of an organ by a tumor;
• Entry of a foreign body;
• Blockage with food bolus or worms;
• Prolonged fasting, eating a large amount of food after;
• Integration of one intestine into another due to the underdevelopment of the peristalsis mechanism (occurs in children under 10 months).

In children, the acute course of the disease is more common, except for variants of congenital pathology.

All forms occur in pregnant women intestinal obstruction, but most often observed acute form, expressed in volvulus of the small intestine.

Reasons contributing to the development of intestinal obstruction include:

• Adhesive processes after abdominal operations or inflammatory processes;
• Long mesentery;
• Internal hernia;
• Pathologies in the development of the gastrointestinal tract;
• Neoplasms;
• Growing uterus.

In pregnant women, the disease develops in the second trimester or during childbirth.

Classification of the disease

The causes of CI and the variety of its forms create some difficulties in diagnosing the surgical disease.

Based clinical manifestations disease, in medicine there are two types of its course - acute obstruction, which is the most common form, and a chronic form, which is quite rare.

The mechanism of development of the disease determines all its varieties.

Dynamic intestinal obstruction often occurs in elderly people, patients with acute myocardial infarction, acute pancreatitis, and after abdominal surgery.

Dynamic disease comes in spastic and paralytic forms.

CN is divided into obstructive, when the passage to the intestine is blocked by feces, gallstones or a foreign body, and strangulation, which occurs due to strangulation, volvulus, nodes and compressive vessels of the mesentery.

In the dynamics of the development of the disease, three stages are distinguished, in the event that help is not possible in the first or second stages.

• Non-reflexive stage. It lasts from 6 to 12 hours. Manifested by cramping pain, rumbling, increased peristalsis, vomiting, stool retention;
• Intoxication stage. The form is characterized by a change in symptoms - a decrease in pain, but its nature becomes constant, increased vomiting, tachycardia, decreased blood pressure;
• Stage of peritonitis. It occurs within 24 hours and manifests itself as severe intoxication. The patient begins to vomit, the masses of which have the smell of feces, there is a painful swollen abdomen, an increased reduction in heart rate, and a worsening of facial features.

Chronic cystitis - women at risk! Complex treatment of cystitis in women, removal acute pain- find out in.

Specific and nonspecific symptoms

It is quite difficult to independently determine the symptoms of intestinal obstruction, since they are the same for diseases of the abdominal organs.

TO specific symptoms diseases include:

Along with classic symptoms The following additional symptoms may occur:

• Lack of appetite;
• Aversion to food;
• Pallor;
• Increased or decreased temperature;
• Tongue coated with gray coating;
• Hiccups;
• Belching.

There are a number of symptoms and signs of intestinal obstruction in adults and children, which are identified by the surgeon when palpating and listening to the abdominal cavity, treatment of which is required urgently.

What to do: first aid, which doctor to go to

If you suspect this dangerous condition, you urgently need to call an ambulance. Disease develops quite quickly, and the time of admission of the patient to a medical institution determines the outcome of the disease.

Treatment tactics for NK depend on the causes of the condition. Most cases do not survive without urgent abdominal intervention.

But with the dynamic development of the disease, they use conservative methods treatment.

Anyway If symptoms are severe, you should consult a doctor who will prescribe adequate therapy.

Diagnostic measures

The diagnosis is made based on the following criteria:

• History of the disease;
• Clinical symptoms;
• Inspection data;
• Lab tests.

Diseases that could contribute to the occurrence of obstruction are of great importance when establishing a diagnosis.

These include hernias, abdominal operations, adhesions, gallbladder diseases, helminthic infestations, tumors, etc.

During the examination it is carried out rectal and vaginal examination, allowing you to identify an inflammatory area, tumor or blockage of the rectum.

A separate place is given X-ray examination of the abdominal cavity. Usually, initial radiography is sufficient to establish a diagnosis.

In some cases, additional diagnostic measures are used, which include:

• Observation under an X-ray machine;
• X-ray contrast examination of the small intestine using barium sulfate;
• Irrigoscopy.

Surgical intervention

After confirmation of the diagnosis, the patient is transferred to the hospital. The operation is performed only when peritonitis has begun.

In other cases, conservative treatment is prescribed, which is aimed at:

• Pain relief;
• Fight against intoxication;
• Restoration of electrolyte balance;
• Removing stagnation feces.

The patient is prescribed fasting and rest, after which they urgent measures:

• Inserting a flexible probe through the nose to release the upper sections digestive system from stagnant masses, thus it is possible to stop vomiting;
• Intravenous administration of solutions to restore electrolyte balance;
• Prescribing painkillers and antiemetics;
• With increased peristalsis, antispasmodics are prescribed;
• To stimulate intestinal motility, proserine is administered subcutaneously.

For paralytic obstruction, they are prescribed medications, which stimulate muscle contraction, which helps move food along.

The paralytic form is a temporary condition, with proper treatment her symptoms may disappear.

If conservative treatment does not bring results, surgery is performed. It is aimed at removing the blockage, removing the affected section and preventing a recurrence.

If a child has severe pain in the abdominal area, it is necessary to urgently consult a doctor.

It is dangerous to self-medicate, since wasted time will only worsen the condition and it will be much more difficult to treat intestinal obstruction.

The choice of treatment method depends on the timing of contacting a medical institution. When diagnosing congenital pathology, it is carried out surgical intervention.

The operation is also performed when adhesions are detected. In case of late treatment, intestinal necrosis begins to develop, which must be urgently removed.

When peritonitis develops, complex treatment is prescribed:

• Antiseptic drugs;
• Painkillers;
• Vitamins.

In addition, it is carried out detoxification therapy. The whole complex is aimed at eliminating symptoms.

In case of early treatment, conservative treatment of intestinal obstruction without surgery and, accordingly, consequences is prescribed.

Air is pumped into the intestine with a special device to straighten the bend of the intestine.

The procedure is done under an X-ray machine. Excess air is removed through a gas outlet tube.

If the dynamic form is diagnosed, then it is prescribed conservative treatment.

To do this, the following manipulations are carried out:

• Stimulation of peristalsis;
• Enemas;
• Electrical stimulation of the intestines;
• Replenishment of potassium deficiency;
• Reducing the load on the gastrointestinal tract;
• Intestinal intubation;
• Insertion of a permanent probe.

Since acute CI is more common in pregnant women, treatment is carried out together with a surgeon.

Therapeutic measures begin with conservative treatment:

• Stimulation of intestinal motility;
• Fighting paresis;
• Detoxification therapy.

If no improvement is observed within two hours, then an operation is performed to remove the blockage and empty the intestines.

After the operation it is prescribed antibacterial therapy, drainage is inserted. Intestinal contents are continuously sucked out and prescribed intravenous administration restorative drugs.

About the symptoms of intestinal obstruction, features of manifestation congenital disease in newborns, the famous doctor of medical sciences Elena Malysheva says:

Prognosis and prevention

A favorable outcome of the disease depends on the timing of treatment medical care.

To the question “what to do at the first symptoms of intestinal obstruction?” there is a simple answer - you need to see a doctor, since a poor prognosis is observed in cases of late diagnosis, in elderly or debilitated patients, as well as in patients with inoperable malignant tumors.

If there are adhesive processes in the abdominal cavity, relapses occur.

Preventive measures include timely detection and removal of tumors, removal of worms, prevention of adhesions and injuries.

Don't forget to eat right.

Intestinal obstruction is a condition in which the passage of food through the intestines is disrupted. In this case, a complete or partial disruption of the movement of intestinal contents may occur.

The following groups are most at risk of developing intestinal obstruction:

• aged people;
• persons who have undergone surgery on the intestines and stomach.

Types and reasons

Intestinal obstruction is divided into the following types:

• dynamic,
• mechanical,
• vascular.

The type is determined by the cause that caused this pathological condition.

Causes of dynamic obstruction:

• constant spasm of the intestinal muscles, which can occur with painful irritation of the intestines by worms, with acute pancreatitis, with traumatic injuries from foreign bodies;
• paralysis of the intestinal muscles, which develops during surgical interventions, poisoning with morphine-containing drugs, salts of heavy metals, as a result of food infections.

In case of mechanical obstruction, there must be some kind of obstacle:

• fecal stones, bile duct stones, foreign body, compression of the intestinal lumen from the outside by tumor formations and cystic formations of other organs, intestinal tumors growing into the lumen;
• volvulus of intestinal loops as a result of intestinal strangulation at the gates of abdominal hernias, adhesions and cicatricial processes, a knot of intestinal loops.

Vascular obstruction is always facilitated by disturbances in the blood supply (thrombosis, embolism) of the mesenteric blood vessels.

Symptoms of intestinal obstruction

Intestinal obstruction is acute condition, that is, all the symptoms of the disease develop quickly, within a few hours.

There are several characteristic features diseases:

• pain in the abdomen;
• stool retention;
• vomit;
• violation of the passage of gases.

Intestinal obstruction always begins with the appearance of abdominal pain. The cramping nature of the pain is explained by the presence of peristaltic contractions of the intestine, which contribute to the movement of food masses.

In the presence of intestinal volvulus, the pain is immediately intense, unbearable, and constant. If there is another type of intestinal obstruction, the pain may be cramping and gradually increase in intensity. The patient appears in a forced position - he presses his legs to his stomach.

The pain can be so severe that the patient goes into pain shock.

Vomiting develops early if the patient has an obstruction in the upper intestine (small intestine), and the patient experiences it repeatedly, but does not bring relief.

With obstruction in the lower intestines, it appears only with the development of general intoxication of the body, after 12-24 hours.

Impaired passage of stool and gases is especially characteristic of lower intestinal obstruction. The patient experiences bloating and rumbling.

If assistance is not provided to the patient, after about a day the patient develops general intoxication of the body, which is characterized by:

• increased body temperature;
• increased respiratory movements;
• peritonitis (damage to the peritoneum);
• septic process (spread of infection throughout the body);
• disturbance of urination;
• severe dehydration.

As a result of general intoxication, if left untreated, the patient may die.

Diagnostics

To make a diagnosis of intestinal obstruction, a number of laboratory and instrumental studies are required:

• general analysis blood - there may be an increase in leukocytes during inflammatory processes;
• a biochemical blood test may indicate abnormalities metabolic processes(violation of the composition of microelements, decrease in protein);
• An X-ray examination of the intestine is mandatory when making this diagnosis. By introducing a radiopaque substance into the intestinal lumen, the level of development of intestinal obstruction can be determined;
• colonoscopy (examination of the large intestine using a probe with a video camera at the end) helps with colonic obstruction, for examination small intestine used - irrigoscopy;
• Ultrasound examination is not always informative, since with intestinal obstruction, air accumulates in the abdomen, which interferes with the normal assessment of data;

In difficult cases, a laparoscopic examination of the abdominal cavity is performed, in which a sensor with a video camera is inserted into the abdominal cavity through a small puncture. This procedure allows you to examine the abdominal organs and make an accurate diagnosis, and in some cases immediately carry out treatment (volvulus, adhesions).

It is necessary to differentiate intestinal obstruction from:

• acute appendicitis (ultrasound, localized in the right iliac region);
• perforated ulcers of the stomach and duodenum (FGDS, radiography with a contrast agent);
• renal colic (ultrasound, urography).

To clarify the diagnosis, additional research methods are always necessary, since it is impossible to differentiate intestinal obstruction by symptoms alone.

Treatment of intestinal obstruction

If intestinal obstruction is suspected, the patient must be urgently hospitalized in the surgical department.

Important! Self-medication with painkillers and antispasmodics is not allowed.

In the early hours after the onset of the disease, in the absence severe complications conservative therapy is carried out.

For conservative treatment the following are used:

• evacuation of gastric and intestinal contents using intubation;
• for spasms - antispasmodic therapy (drotaverine, platyphylline); for paralysis - drugs that stimulate motor skills (prozerin);
• intravenous administration saline solutions to normalize metabolic processes;
• siphon enemas;
• therapeutic colonoscopy, which can eliminate intestinal volvulus and gallstones.

Most often, the patient undergoes surgery, the purpose of which is to eliminate obstruction and remove non-viable intestinal tissue.

The following interventions are carried out:

• unwinding of intestinal loops;
• dissection of adhesions;
• resection (removal) of part of the intestine with subsequent stitching of the ends of the intestine;
• if it is impossible to eliminate the cause of obstruction, a colostomy is performed (excretion of feces);
• In case of hernia formations, their plastic surgery is performed.

The duration and result of treatment directly depend on the cause of intestinal obstruction and the start date of treatment.

Complications

If hospitalization is not timely, the following dangerous conditions may develop:

• pain shock;

Prevention

Preventive measures include:

• timely diagnosis and treatment of tumor processes in the intestines and neighboring organs;
• treatment of helminthic infestations;
• prevention of adhesions after surgery;
• balanced diet;
• conducting healthy image life.

Symptoms, treatment and features of this disease will be presented below. We will also tell you about the causes of the disease in question and how it is diagnosed.

general information

Intestinal obstruction (symptoms in adults and children will be discussed below) is characterized by a partial or complete cessation of the movement of chyme through the intestines. This pathological condition requires urgent intervention from specialists, as it threatens the patient’s life.

Causes of development in babies

How does intestinal obstruction occur in children? The symptoms of this disease in newborns are not much different from the symptoms in adults.

According to doctors, all segments of the population are susceptible to this disease. This pathological condition can occur in both newborns and the elderly.

Usually in infants, intestinal obstruction is a consequence of abnormal intrauterine development. It can manifest itself as a result of narrowing of the intestinal lumen, or so-called stenosis, esophageal atresia, incomplete intestinal rotation, intestinal duplication (that is, duplication of the intestine) and neuronal dysplasia of the intestinal walls.

Why does it occur in adults?

Now you know why it develops. The symptoms of this disease will be presented below.

The development of such a disease in adults has many various reasons. The most common of them are the following:

Types of disease

The symptom of intestinal obstruction can vary. It often depends on the type of disease and the cause of its occurrence.

IN medical practice The disease in question is usually classified as follows:

• congenital;
• acquired.

Based on the causes of development and the mechanism of the disease, it should be clarified that the congenital form of intestinal obstruction is the result of intrauterine anomalies.

As for the acquired disease, it is the result of a developmental mechanism. The group of this type includes the dynamic or so-called functional type of obstruction with paralytic and spastic forms. The first is a consequence of paralysis and intestinal paresis. As a rule, it appears only in the secondary stage and may be the result of postoperative stress.

The spastic form of the disease is associated with reflex spasms of the intestines. This disease is a consequence of helminthic infestations or intoxications.

Intestinal obstruction: symptoms

Treatment in children and adults of this disease should be carried out immediately, otherwise it can be fatal.

Typically, the development of such a disease is characterized by painful sensations in the abdominal area. They can be sharp, cramping, and also increasing in nature. This condition contributes to nausea and subsequent vomiting.

After some time, the contents of the intestine (due to its overcrowding) enter the stomach. This phenomenon gives the vomit an odor characteristic of feces.

How is it recognized? The symptoms of this disease are as follows: the child experiences constipation and increased gas production.

At the very beginning of the disease, intestinal motility usually persists. Moreover, it can be observed even through the child’s abdominal wall. Subsequently, the patient with intestinal obstruction noticeably enlarges the abdomen, which takes on an irregular shape.

General signs

On different stages The development of a symptom of intestinal obstruction can manifest itself in different ways. During the diagnostic process, the following signs can be detected in a patient:

• drop in blood pressure;
• increased heart rate;
• dry tongue;
• intestinal loops filled with gas and liquid, as well as an increase in their size;
• increase in body temperature.

Symptoms of acute intestinal obstruction

This pathological condition develops suddenly. It manifests itself in exactly the same way as the process of intestinal dysfunction. As a result, the patient is concerned about the following symptoms:

• pain in the abdomen;
• rumbling and flatulence;
• diarrhea and constipation;
• vomiting and nausea;
• shock and increased peristalsis.

It should also be said that acute intestinal obstruction is characterized by very diverse symptoms. They usually depend on the level of obstruction of the affected organ.

Each symptom of intestinal obstruction worries a person simultaneously with others. However, the absence of any of them does not exclude the presence of the pathology in question.

Painful sensations when acute illness have a pronounced character, and from the very beginning of development. Most often, such sensations are localized in the pit of the stomach, that is, around the navel. The nature of the pain syndrome is spasmodic.

The symptom of intestinal obstruction in the form of vomiting is the most constant sign. However, experts say that this phenomenon is observed only if the obstruction in the intestines is high.

With obstruction of the colon, this sign is absent, although nausea remains. At the very beginning, vomit represents only the contents of the stomach. After some time, they acquire a yellowish tint, and then turn green and even greenish-brown.

How else does acute intestinal obstruction manifest? The symptoms (treatment of this disease should only take place in a hospital) of this pathology are reduced to severe constipation. As a rule, this sign of the disease is the latest.

It should also be noted that the pathology in question is almost always accompanied by large losses of fluid during vomiting, as well as intoxication with intestinal contents.

If treatment is not timely, a person’s blood pressure decreases and their heart rate increases. Signs such as these indicate the onset of shock.

Paralytic obstruction

This form of the disease can manifest itself in the form of a progressive decrease in peristalsis and intestinal tone. As a result, complete paralysis of the affected organ often develops.

Characteristic for:

• pain, uniform bloating and vomiting;
• gas and stool retention.

Pain with this disease affects the entire abdominal area. They have a bursting character and do not give anywhere.

Vomiting with paralytic intestinal obstruction visits the patient many times. At first it consists of gastric and then intestinal contents. In case of diapedetic bleeding from the walls of the intestines and stomach, as well as acute ulcers, the vomit is hemorrhagic in nature.

Severe gas formation causes chest breathing. Patients are also diagnosed with low blood pressure, tachycardia and dry mouth.

Adhesive obstruction

How does adhesive chronic intestinal obstruction manifest itself? All people predisposed to its occurrence should know the symptoms of this disease. This is due to the fact that this pathology is the most common. Today there is a tendency to increase its frequency. This is due to the large number of abdominal surgeries.

Adhesive intestinal obstruction is classified as follows:

• obstruction;
• strangulation;
• dynamic obstruction.

The first form of the disease is characterized by compression of the intestine by adhesions. At the same time, its innervation and blood supply are not disrupted.

With the strangulation type, adhesions exert strong pressure on the intestinal mesenteries. As a result, necrosis of the affected organ occurs. This form is divided into three different types: knotting, twisting and pinching.

Stages of the disease

How does intestinal obstruction occur in infants? Symptoms of this disease in children and adults depend on its stage.

According to medical practice, such a disease develops in three stages:

1. Initial. It lasts about 3-12 hours, and is also accompanied by pain in the abdomen, increased peristalsis and flatulence.
2. Intermediate. It lasts about 13-36 hours. In this case, the pain syndrome subsides and a time of imaginary well-being begins. During this period, symptoms of intoxication and dehydration increase.
3. Terminal. As a rule, this stage occurs two days after the formation of the disease. The person's condition is noticeably deteriorating. In this case, there is an increase in symptoms of dehydration, damage internal organs and NS.

How to diagnose?

How is complete or partial intestinal obstruction detected? The symptoms of this disease are quite similar to the signs of other diseases occurring in the gastrointestinal tract. Therefore, when making a diagnosis, it is impossible to rely only on external manifestations.

The main way to diagnose this pathology is an X-ray examination of the abdominal cavity, as well as a blood test. In addition, some specialists use ultrasound as an adjunct.

Upon objective examination, the patient’s tongue is dry and covered with a white coating. The patient also experiences uneven abdominal bloating.

Obstruction in animals

How does intestinal obstruction manifest in a dog? The symptoms of this disease in pets are practically no different from those in humans. At the first signs of illness, you should definitely take your pet to veterinary clinic. This is the only way you can save his life.

Treatment methods

What to do if a person has been diagnosed or has suspicions (even the slightest) of intestinal obstruction? In this case, he requires urgent hospitalization. Usually such a patient is immediately sent to the surgical department.

If a patient experiences progressive, onset, or catastrophic dehydration, the intestinal obstruction is treated immediately. With such a diagnosis, therapeutic measures should, if possible, be carried out during the transportation of the patient.

IN inpatient conditions Without pronounced signs mechanical obstruction is treated, which includes the following measures:

• The contents of the stomach and intestines are aspirated through thin probe, which is administered through the nose.
• With increased peristalsis, the patient is given antispasmodics.

If a patient is diagnosed with mechanical obstruction, and conservative methods do not help, then emergency surgery should be performed. Typically it includes:

• unwinding of the torsion;
• dissection of adhesions;
• bowel resection for necrosis;
• deinvagination;
• overlay (to release its contents in case of tumors in the colon).

After the operation, the patient will have a recovery period. It includes procedures aimed at normalizing protein and water-salt metabolism. For this purpose, specialists use intravenous administration of blood substitutes and saline solutions. They also carry out anti-inflammatory treatment and stimulate the motor-evacuation work of the gastrointestinal tract.

Nutrition

Now you know what they are, the same as in humans and other animals). In addition to drug and surgical treatment of this disease, the patient is also prescribed a special diet.

After surgery for intestinal obstruction, it is prohibited to eat or drink for half a day. Sometimes the patient is fed parenterally. Nutrient solutions are injected into him through a vein.

With this disease, a person is allowed to consume fermented milk products, as well as infant formula (in frequent and very small portions).

Some time after the operation, easily digestible liquid foods are introduced into the patient’s diet. At the same time, salt consumption is limited. Next, they switch to a diet that is close to table No. 4. This diet was developed to be as gentle as possible on the intestines, as well as to reduce the fermentation process in it.

For any type of obstruction, a person must limit himself to fats, carbohydrates, smoked foods, spices, fiber, pickles and milk. All dishes served to the patient are well boiled or steamed, and then thoroughly ground.

After some time, the diet menu expands slightly. In this case, the patient completely switches to diet No. 4. By the way, it is designed specifically for those who have intestinal diseases.

The diet of people with diseases of the gastrointestinal tract should provide adequate nutrition, which will be especially gentle on the intestines. The diet for intestinal obstruction (after recovery) becomes more varied. In this case, the food is not pureed, and all dishes are boiled or steamed. This will allow the diseased organ to digest it more thoroughly.

Diets for acute and chronic obstruction do not allow putrefactive and fermentative processes to develop.

It should also be noted that with such a diagnosis, irritants of thermal, chemical and mechanical types should be completely excluded.

Let's sum it up

Intestinal obstruction is a rather insidious disease. If not treated in a timely manner, it often leads to fatal outcome. It should also be noted that very often the only way to treat this disease is surgery. After it, the patient is obliged to follow a number of doctor’s recommendations aimed at restoring the body.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

Other and unspecified intestinal obstruction (K56.6)

Gastroenterology, Surgery

general information

Short description

Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 from 12/12/2013

Acute intestinal obstruction(ACN) is a syndromic category characterized by a violation of the passage of intestinal contents in the direction from the stomach to the rectum and combines the complicated course of diseases and pathological processes of various etiologies that form the morphological substrate of acute intestinal obstruction.

I. INTRODUCTORY PART

Protocol name: Acute intestinal obstruction in adults.
Protocol code:

ICD 10 code:
K56.0 - paralytic ileus.
K56.1 - intussusception.
K56.2 - intestinal volvulus.
K56.3 - ileus caused by gallstones.
K56.4 is another type of closure of the intestinal lumen.
K56.5 - paralytic ileus.
K56.6 - other and unspecified intestinal obstruction.
K56.7 - paralytic ileus.
K91.3 - postoperative intestinal obstruction.

Abbreviations used in the protocol:
OKN - acute intestinal obstruction
ICD- international classification diseases
Ultrasound - ultrasonography
ECG- electrocardiography
ALT - alanine aminotransferase
AST - aspartate aminotransferase
HIV - AIDS virus
APTT - activated partial thromboplastin time

Date of development of the protocol: 11.09.2013
Patient category: adult patients over 18 years old
Protocol users: surgeons, anesthesiologists, resuscitators, visual diagnostics, nurses.

Acute intestinal obstruction may be caused by for numerous reasons, which are usually divided into predisposing and producing.

To predisposing reasons include: anatomical and morphological changes in the gastrointestinal tract - adhesions, adhesions that contribute to the pathological position of the intestine, narrowing and elongation of the mesentery, leading to excessive intestinal motility, various formations emanating from the intestinal wall, neighboring organs or located in the intestinal lumen, peritoneal pockets and openings in the mesentery. Predisposing causes also include a violation functional state intestines as a result of prolonged fasting. In such cases, eating rough food can cause violent peristalsis and intestinal obstruction (“hunger person’s disease”). The role of predisposing causes is reduced to the creation of excessive mobility of intestinal loops, or, conversely, its fixation. As a result, the intestinal loops and their mesentery will be able to occupy a pathological position in which the passage of intestinal contents is disrupted.

To producing causes include: changes in intestinal motor function with a predominance of spasm or paresis of its muscles, a sudden sharp increase in intra-abdominal pressure, overload digestive tract abundant rough food.
Depending on the nature of the trigger mechanism, ACI is divided into mechanical and dynamic, in the absolute majority - paralytic, developing on the basis of intestinal paresis. Spastic obstruction can occur with organic spinal disorders.
If acute disorder intestinal hemocirculation captures extraorgan mesenteric vessels, strangulation OKN occurs, the main forms of which are strangulation, volvulus and nodulation. Much more slowly, but with the involvement of the entire adductor intestine, the process develops with obstructive acute intestinal tract, when the intestinal lumen is blocked by a tumor or other space-occupying formation. An intermediate position is occupied by mixed forms of OKN - intussusception and adhesive obstruction - combining strangulation and obstruction components. Adhesive obstruction accounts for up to 70-80% of all forms of OKN.
The nature and severity of clinical manifestations depend on the level of OKN. There are small intestinal and large intestinal OKN, and in the small intestinal – high and low.
In all forms of OKN, the severity of the disorder is directly dependent on the time factor, which determines the urgent nature of diagnostic and treatment measures.

Note: The following grades of recommendation and levels of evidence are used in this protocol:

Level I - Evidence from at least one well-designed randomized controlled trial or meta-analysis
Level II - Evidence obtained from at least one well-designed clinical trial without adequate randomization, from an analytical cohort or case-control study (preferably from a single center), or from dramatic results obtained in uncontrolled studies.
Level III - Evidence obtained from the opinions of reputable researchers based on clinical experience.

Class A - Recommendations that have been approved by agreement of at least 75% percent of the multi-sector expert group.
Class B - Recommendations that were somewhat controversial and lacked consensus.
Class C - Recommendations that caused real disagreement among group members.

Classification

Clinical classification
In Kazakhstan and other CIS countries, the following classifications are most common:

According to Oppel V.A.
1. Dynamic obstruction (paralytic, spastic).
2. Hemostatic obstruction (thrombophlebetic, embolic).
3. Mechanical with hemostasis (pinching, rotation).
4. Mechanical simple (blockage, bending, compression).

According to Chukhrienko D.P.
by origin
1. congenital
2. acquired

According to the mechanism of occurrence:
1. mechanical
2. dynamic

According to the presence or absence of circulatory disorders:
1. obstructive
2. strangulation
3. combined

By clinical course:
1. partial
2. complete (acute, subacute, chronic, recurrent)

By morphological nature:
dynamic
1. paralytic
2. spastic.

Mechanical
1. strangulation
2. obstructive
3. mixed

By level of obstruction
1. small intestinal (high)
2. colon (low)

By stages:
Stage 1 (up to 12-16 hours) - violation of intestinal passage
Stage 2 (16-36 hours) - stage of acute disorders of intramural intestinal hemocirculation
Stage 3 (over 36 hours) stage of peritonitis.

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

List of basic and additional diagnostic measures:
1. General blood test
2. General urine test
3. Determination of blood glucose
4. Microreaction
5. Determination of blood group
6. Determination of Rh factor
7. Determination of bilirubin
8. Definition of AST
9. Determination of ALT
10. Determination of thymol test
11. Determination of creatinine
12. Determination of urea
13. Determination of alkaline phophatase
14. Determination of total protein and protein fraction
15. Determination of blood amylase
16. Coagulogram (prothrombin index, clotting time, bleeding time, fibrinogen, APTT)
17. Blood for HIV
18. ECG
19. Plain radiography of the abdominal organs
20. Plain radiography of the chest organs
21. Ultrasound of the abdominal organs
22. Computed tomography of the abdominal organs
23. Diagnostic laparoscopy
24. Contrast study of the gastrointestinal tract
25. Consultation with a resuscitator
26. Consultation with an anesthesiologist
27. Consultation with an oncologist
28. Consultation with a therapist

Diagnostic criteria

Complaints and anamnesis
OKN is characterized by a variety of complaints presented by patients, but the main and most reliable of them can be called the following triad of complaints: abdominal pain, vomiting, stool and gas retention .

1. Stomach ache usually occur suddenly, regardless of food intake, at any time of the day, without warning. Intestinal obstruction is most characterized by cramping pain, which is associated with intestinal motility. There is no clear localization of pain in any part of the abdominal cavity. With obstructive intestinal obstruction, pain usually disappears outside of a cramping attack. In the case of strangulation intestinal obstruction, the pain is persistent, sharply intensifying during an attack. The pain subsides only after 2-3 days, when intestinal motility becomes exhausted. The cessation of pain in the presence of intestinal obstruction is a poor prognostic sign. With paralytic intestinal obstruction, the pain is constant, bursting, moderate intensity.

2. Vomit at first it is of a reflex nature, with continued obstruction, vomiting of stagnant contents develops; in the later period, with the development of peritonitis, vomiting becomes indomitable, continuous, and the vomit has a fecal odor. The higher the obstruction, the more pronounced the vomiting. In the intervals between vomiting, the patient experiences nausea, belching, and hiccups bother him. With low localization of the obstacle, vomiting is observed at large intervals.

3. Retention of stool and gas most pronounced with low intestinal obstruction. With high intestinal obstruction at the onset of the disease, some patients may have stool. This occurs due to the emptying of the intestines located below the obstruction. With intestinal obstruction due to intussusception from the anus, bloody discharge from the anus is sometimes observed, which can cause a diagnostic error when OKN is mistaken for dysentery.

History of the disease: it is necessary to pay attention to the intake of large amounts of food (especially after fasting), the appearance of abdominal pain when physical activity, accompanied by a significant increase in intra-abdominal pressure, complaints of decreased appetite and intestinal discomfort (periodic appearance of pain and bloating; constipation followed by diarrhea; pathological impurities in stool);

Anamnesis of life is also important. Previous operations on the abdominal organs, open and closed injuries belly, inflammatory diseases are often a prerequisite for the occurrence of intestinal obstruction.

Physical examinations:

1. General condition of the patient may be moderate or severe depending on the form, level or time elapsed from the onset of OKN.

2. Temperature does not increase during the initial period of the disease. With strangulation obstruction, when collapse and shock develop, the temperature drops to 36°C. Subsequently, with the development of peritonitis, the temperature rises to low-grade fever.

3. Pulse at the onset of the disease does not change; with an increase in obstruction, tachycardia appears. Noteworthy is the discrepancy between low temperature and rapid pulse.

4. Skin and mucous membranes: according to their assessment, one can judge the degree of dehydration: dryness skin and mucous membranes, decreased skin turgor, dry tongue.

5. Abdominal examination a patient who has intestinal obstruction should begin with an examination of typical sites of the hernial orifice to exclude the presence of an external strangulated hernia. Postoperative scars may indicate adhesive obstruction. The most consistent sign of OKN is bloating. However, the degree of swelling can vary and depends on the level of obstruction and the duration of the disease. With high obstruction, the swelling may be insignificant, but the lower the level of obstruction, the greater the swelling. Bloating is especially significant in cases of paralytic and colonic obstruction. At the beginning of obstruction, abdominal bloating may be slight, but as the duration of the disease increases, the degree of flatulence increases. Irregular abdominal configuration and asymmetry are characteristic of strangulation intestinal obstruction. It is often possible to see one or more distended intestinal loops through the abdominal wall. A clearly demarcated, distended intestinal loop contoured through the abdominal wall - Val's symptom - is early symptom OKN. On percussion, a high-pitched tympanitis is heard above it. When inverted sigmoid colon the stomach appears to be distorted. In this case, the swelling is located in the direction from the right hypochondrium through the navel to the left iliac region (Schiman's symptom). When examining the abdomen, you can see slowly rolling shafts or suddenly appearing and disappearing protrusions. They are often accompanied by an attack of abdominal pain and vomiting. Peristalsis visible to the eye - Schlange's symptom - is more clearly visible with slowly developing obstructive obstruction, when the muscles of the adductor intestine have time to hypertrophy.

6. Palpation of the abdomen painful. There is no tension in the abdominal wall muscles. Shchetkin-Blumberg's symptom is negative. With strangulation obstruction, Thevenard's symptom is positive - sharp pain when pressing on two transverse fingers below the navel in the midline, that is, where the root of the mesentery passes. This symptom is especially characteristic of small intestinal volvulus. Sometimes, when palpating the abdomen, it is sometimes possible to identify the tumor, the body of the intussusception, the inflammatory infiltrate that caused the obstruction. With a slight concussion of the abdominal wall, you can hear a “splashing noise” - Sklyarov’s symptom. This symptom indicates the presence of an overstretched paretic loop of intestine, overflowing with liquid and gaseous contents.

7. Percussion of the abdomen reveals limited areas of zones of dullness, which corresponds to the location of a loop of intestine filled with fluid and directly adjacent to the abdominal wall. These areas of dullness do not change their position when the patient turns, which is why they differ from free effusion. Dullness of percussion sound is also detected over a tumor, inflammatory infiltrate or intestinal intussusception.

8. Auscultation of the abdomen: V initial period OKN, when peristalsis is still preserved, numerous ringing noises are heard, resonating in the stretched loops. Sometimes you can hear the “noise of a falling drop” - the Spasokukotsky-Wilms symptom. Peristalsis can be induced or enhanced by effleurage of the abdominal wall. In the later period, as intestinal paresis increases, the noises become shorter and rarer, but of high tones. With the development of intestinal paresis, all sound phenomena disappear and are replaced by “dead silence,” which is an ominous sign. During this period, with sudden bloating, you can identify Bailey's symptom - listening to respiratory sounds and heart sounds, which are not normally heard through the abdomen.

9. Rectal digital examination can detect a rectal tumor, fecal impaction, head of intussusception and traces of blood. Valuable diagnostic sign, characteristic of low intestinal obstruction, is sphincter atony and balloon-like swelling of the empty rectal ampulla (Obukhov Hospital symptom) and small capacity of the distal intestine (Tsege-Mantefeil symptom). In this case, it is possible to introduce no more than 500 - 700 ml of water into the rectum; with further administration, the water will flow back out.

Laboratory research:
- general blood test (leukocytosis, band shift, accelerated ESR, signs of anemia may be observed);
- coagulogram (signs of hypercoagulation may be observed);
- biochemical blood test (violation of water-electrolyte and acid-base balance).

Instrumental studies

1. Plain radiography of the abdominal organs
Kloiber's bowl is a horizontal level of liquid with a dome-shaped clearing above it, which looks like a bowl turned upside down. With strangulation obstruction, they can appear within 1 hour, and with obstructive obstruction - after 3-5 hours from the moment of illness. The number of bowls varies, sometimes they can be layered one on top of the other in the form of a stepped staircase.
Intestinal arcades. They occur when the small intestine becomes distended with gases, while horizontal levels of fluid are visible in the lower arcades.
The symptom of pinnateness (transverse striations in the form of an extended spring) occurs with high intestinal obstruction and is associated with stretching of the jejunum, which has high circular folds of the mucosa.

2. Ultrasound examination of the abdominal cavity
For mechanical intestinal obstruction:
- expansion of the intestinal lumen by more than 2 cm with the presence of the phenomenon of “fluid sequestration” into the intestinal lumen;
- thickening of the wall of the small intestine more than 4 mm;
- the presence of reciprocating movements of chyme in the intestine;
- increase in the height of kerkring folds by more than 5 mm;
- increasing the distance between kerkring folds by more than 5 mm;
- hyperpneumatization of the intestine in the adductor region
with dynamic intestinal obstruction:
- absence of reciprocating movements of chyme in the intestine;
- the phenomenon of fluid sequestration into the intestinal lumen;
- unexpressed relief of kerkring folds;
- hyperpneumatization of the intestine in all sections.

3. Contrast study of the gastrointestinal tract used less frequently and only when there are difficulties in diagnosing intestinal obstruction, the patient’s stable condition, or the intermittent nature of intestinal obstruction. The patient is given 50 ml of barium suspension to drink and a dynamic study of the barium passage is carried out. A delay of up to 4-6 hours or more gives reason to suspect a violation motor function intestines.

4. Diagnostic laparoscopy(used only when the previous methods are low in information instrumental diagnostics).

5. Computed tomography(used only when the previous methods of instrumental diagnostics have little information, as well as to identify various formations of the abdominal organs that cause OKN) (level of evidence - III, strength of recommendation - A).

Indications for specialist consultations:
- Resuscitator: to determine indications for treating a patient in an intensive care unit, to coordinate tactics for managing the patient in terms of eliminating disturbances in water-electrolyte and acid-base balance.
- Anesthesiologist: to determine the type of anesthesia if surgical intervention is necessary, as well as agree on the tactics of managing the preoperative period.
- Oncologist: if there is a suspicion of abdominal tumors that caused OKN.
- Therapist: identification of concomitant somatic pathology, which complicates the course of acute insufficiency, and can also complicate the course of the operation and the postoperative period.

Differential diagnosis

Treatment

Treatment Goals: elimination of intestinal obstruction; complete restoration of the passage of intestinal contents; elimination of the cause that caused OKN (if possible).

Treatment tactics

Non-drug treatment:(mode 1, diet 0, decompression of the upper digestive tract through a nasogastric tube (level of evidence - I, strength of recommendation - A) or an intestinal tube inserted using FGDS, performing siphon enemas).

Drug treatment:

List of main medicines:
1. Antispasmodic drugs
2. Antibacterial drugs(cephalosporins II-III generation)
3. Analgesic drugs
4. Crystalloid solutions for infusion

List of additional medicines:
1. Anesthesia
2. Consumables for laparoscopic or open surgery
3. Antibacterial drugs (beta-lactamase inhibitors, fluoroquinolones, carbopenems, aminoglycosides).
4. Novocaine solution 0.5% -1%
5. Narcotic analgesics
6. Colloidal plasma replacement solutions
7. Fresh frozen plasma
8. Blood components

Other types of treatment: bilateral perinephric novocaine blockade (as a method of influencing the autonomic nervous system) (level of evidence - III, strength of recommendation - A).

Surgical intervention:
1. Surgery for acute insufficiency is always performed under anesthesia by a three-medical team.
2. At the stage of laparotomy, revision, identification of the pathomorphological substrate of obstruction and determination of the operation plan, the participation in the operation of the most experienced surgeon of the duty team, as a rule, the responsible surgeon on duty, is mandatory.
3. For any localization of obstruction, access is midline laparotomy, if necessary, with excision of scars and careful dissection of adhesions at the entrance to the abdominal cavity.
4. Operations for OKN involve sequential solution of the following tasks:
- establishing the cause and level of obstruction;
- elimination of the morphological substrate of OKN;
- determination of the viability of the intestine in the obstruction zone and determination of indications for its resection;
- establishing the boundaries of resection of the altered intestine and its implementation;
- determination of indications and method of intestinal drainage;
- sanitation and drainage of the abdominal cavity in the presence of peritonitis.
5. Detection of an area of ​​obstruction immediately after laparotomy does not relieve the need for a systematic audit of the condition of the small and large intestines along their entire length. The revision is preceded by mandatory infiltration of the root of the mesentery of the small intestine with a solution of local anesthetic (100-150 ml of 0.25% novocaine solution). In case of severe overflow of the intestinal loops with contents, before the revision, decompression of the intestine is performed using a gastrointestinal tube.
6. Clearing the obstruction is the key and most difficult component of the intervention. It is carried out in the least traumatic way with a clear definition of specific indications for the use of various methods: dissection of adhesions; resection of altered intestine; elimination of torsions, intussusceptions, nodules or resection of these formations without preliminary manipulations on the altered intestine.
7. When determining the indications for intestinal resection, visual signs are used (color, swelling of the wall, subserous hemorrhages, peristalsis, pulsation and blood filling of the parietal vessels), as well as the dynamics of these signs after the introduction of a warm solution into the mesentery of the intestine) of a local anesthetic. If there are doubts about the viability of the intestine, especially over a large extent, it is permissible to postpone the decision on resection, using a programmed relaparotomy or laparoscopy after 12 hours.
8. When deciding on the boundaries of resection, one should retreat from the visible boundaries of the impaired blood supply to the intestinal wall towards the adductor section by 35-40 cm, and towards the efferent section by 20-25 cm (level of evidence - III, strength of recommendation - A). An exception is made for resections near the ligament of Treitz or the ileocecal angle, where it is possible to limit these requirements if the visual characteristics of the intestine in the area of ​​the intended intersection are favorable. In this case, control indicators of bleeding from the vessels of the wall when crossing it and the condition of the mucous area are necessarily used.
9. Indications for drainage of the small intestine are:
- overflow of afferent intestinal loops with contents;
- the presence of diffuse peritonitis with cloudy effusion and fibrin deposits;
- extensive adhesions in the abdominal cavity.
10. In case of colorectal tumor obstruction and the absence of signs of inoperability, one- or two-stage operations are performed depending on the location, stage of the tumor process and the severity of the manifestations of colonic obstruction. It is permissible to complete emergency right hemicolectomy in the absence of peritonitis by applying a primary ileotransverse anastomosis. In case of obstruction with a left-sided obstruction focus, resection of the colon is performed with removal of the tumor, which is completed according to the Hartmann operation. Primary anastomosis is not performed (level of evidence - III, strength of recommendation - A).
11. All operations on the colon end with devulsion of the external anal sphincter.
12. The presence of diffuse peritonitis requires additional sanitation and drainage of the abdominal cavity in accordance with the principles of treatment of acute peritonitis.

Preventive actions
In order to prevent acute intestinal obstruction, it is necessary to find and remove intestinal tumors in a timely manner. Prevention of intestinal obstruction also includes the fight against constipation. The patient's food should contain foods rich in fiber and vegetable oil. Animal fats require severe limitation.
You need to exclude from your diet: cottage cheese, cheese, cookies, dry goods. Rice can be eaten in combination with various vegetables. It is also necessary to take laxatives (bisacodyl tablets and suppositories, senna herb). It is necessary that there is stool at least once every three days, and if there is none, then an increase in the dose of the laxative drug, its replacement, a cleansing enema or an urgent consultation with a surgeon is required.
Prevention of complications in operated patients diagnosed with “acute intestinal obstruction” comes down to adequate and correct management of the postoperative period (see paragraph 15.6).

Further management.
Enteral nutrition begins with the appearance of intestinal peristalsis through the introduction of glucose-electrolyte mixtures into the intestinal tube.
Removal of the nasogastrointestinal drainage tube is carried out after the restoration of stable peristalsis and independent stool on 3-4 days (level of evidence - III, strength of recommendation - A). In order to combat ischemic and reperfusion damage to the small intestine and liver, infusion therapy is carried out (aminoplasmal solution, sodium chloride solution 0.9%, glucose solution 5%, ringer's solution). Antibacterial therapy in the postoperative period should include cephalosporins (level of evidence - I, strength of recommendation - A). To prevent the formation of acute gastrointestinal ulcers, therapy should include antisecretory drugs.
Complex therapy should include heparin or low molecular weight heparins to prevent thromboembolic complications and microcirculation disorders.
In case of uncomplicated postoperative period, discharge is made on the 10-12th day. The presence of a functioning artificial intestinal or gastric fistula in the absence of other complications allows the patient to be discharged for outpatient treatment with a recommendation for re-hospitalization to eliminate the fistula if it does not close on its own.
If adjuvant chemotherapy is necessary and in the absence of contraindications to it in patients with a tumor cause of ACI, it should be carried out no later than 4 weeks after surgery.

Indicators of treatment effectiveness:
1. Elimination of symptomatic manifestations of the disease (no abdominal pain, no nausea and vomiting);
2. Positive x-ray dynamics;
3. Restoration of intestinal patency (regular passage of stool and gases through artificial (colostomy, ileostomy) or natural openings;
4. Healing of the surgical wound by primary intention, no signs of inflammation of the postoperative wound.

Drugs (active ingredients) used in treatment

Groups of drugs according to ATC used in treatment

Hospitalization

Indications for hospitalization indicating the type of hospitalization:
An established diagnosis or a reasonable assumption of the presence of OKN is the basis for the immediate referral of the patient to a surgical hospital by ambulance in a lying position on a stretcher, followed by mandatory emergency hospitalization.

Information

Sources and literature

1. Minutes of meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. 1. V. S. Savelyev, A. I. Kiriyenko. Clinical surgery: national manual: in 3 volumes - 1st ed. - M.: GEOTAR-Media, 2009. - P. 832. 2. Ripamonti C, Mercadante S. Pathophysiology and management of malignant bowel obstruction. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford Textbook of Palliative Medicine. 3rd ed. New York, New York Oxford University Press Inc., New York 2005. p. 496-507. 3. Frank C. Medical management of intestinal obstruction in terminal care. Canadian Family Physician. 1997 February;43:259-65. 4. Letizia M, Norton E. Successful Management of Malignant Bowel Obstuction. Journal of Hospice and Palliative Nursing.2003 July-September 2003;5(3):152-8. 5. BC Cancer Agency Professional Practice Nursing. Alert Guidelines: Bowel Obstruction. ; Available from: http://www.bccancer.bc.ca/HPI/Nursing/References/TelConsultProtocols/BowelObstruction.htm 6. M.A. Aliev, S.A. Voronov, V.A. Dzhakupov. Emergency surgery. Almaty. - 2001. 7. Surgery: trans. from English, additional / Ed. Lopukhina Yu.M., Savelyeva V.S. M.: GEOTAR MEDICINE. – 1998. 8. Eryukhin I.A., Petrov V.P., Khanevich M.D. Intestinal obstruction: A guide for doctors. – St. Petersburg, 1999. – 443 p. 9. Brian A Nobie: Small-Bowel Obstruction Treatment & Management. ; Available from: http://emedicine.medscape.com/article/774140-treatment/ 10. Thompson WM, Kilani RK, Smith BB, Thomas J, Jaffe TA, Delong DM, et al. Accuracy of abdominal radiography in acute small-bowel obstruction: does reviewer experience matter?. AJR Am J Roentgenol. Mar 2007;188(3):W233-8. 11. Jang TB, Schindler D, Kaji AH. Bedside ultrasonography for the detection of small bowel obstruction in the emergency department. Emerg Med J Aug 2011;28(8):676-8. 12. Diaz JJ Jr, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for management of small bowel obstruction. J Trauma. Jun 2008;64(6):1651-64.

Information

III. ORGANIZATIONAL ASPECTS OF THE INTRODUCTION OF THE PROTOCOL

List of developers:
1. Turgunov Ermek Meiramovich - Doctor of Medical Sciences, professor, surgeon of the highest qualification category, head of the Department of Surgical Diseases No. 2 of the RSE at the Karaganda State Medical University of the Ministry of Health of the Republic of Kazakhstan, independent accredited expert of the Ministry of Health of the Republic of Kazakhstan.
2. Matyushko Dmitry Nikolaevich - Master of Medical Sciences, surgeon of the second qualification category, doctoral student of the RSE at the Karaganda State Medical University of the Ministry of Health of the Republic of Kazakhstan

Reviewer:
Almambetov Amirkhan Galikhanovich - Doctor of Medical Sciences, surgeon of the highest qualification category, head of the department of surgery No. 2 of JSC "Republican science Center emergency medical care."

Disclosure of no conflict of interest: There is no conflict of interest.

Indication of the conditions for reviewing the protocol: deviation from the protocol is unacceptable; This protocol is subject to revision every three years, or when new proven data on the diagnosis and treatment of acute intestinal tract becomes available.

Attached files

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