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Intestinal Obstruction I: Introduction

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Intestinal obstruction is a partial or complete blockage of the small or large intestine that disrupts the normal flow of intestinal content through the intestinal lumen.

It is classified by cause as mechanical or functional. Mechanical obstruction results from a physical blockage.

For example, adhesions are bands of fibrous connective tissue that form between normally separate anatomical surfaces. These bands can tether loops of bowel to each other, to the peritoneum, or to adjacent organs, predisposing them to intestinal obstruction.

A hernia is the protrusion of an organ or tissue, most often a portion of the intestine or omentum, through a weakness or defect in the containing wall of the cavity, commonly the abdominal wall.

Intussusception involves one segment of the intestine sliding into another adjacent segment, which can develop anywhere in the intestine.

Volvulus involves a loop of the small or large intestine twisting around itself, cutting off the flow of digestive contents.

On the other hand, functional obstruction, or paralytic ileus, is a temporary loss of intestinal motility. It most often develops after abdominal surgery, or may result from medications such as opioids, or bowel ischemia.

Overview

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Intestinal obstruction is a partial or complete blockage of the small or large intestine that disrupts the normal flow of intestinal contents through the lumen. This interruption impairs digestion, absorption, and fluid balance, and may lead to serious complications if not treated promptly.

Mechanical Obstruction

Mechanical obstruction occurs when a physical blockage prevents intestinal contents from passing, arising from within the lumen or the bowel wall, or from external compression.

Adhesions, which are fibrous bands formed post-surgery or inflammation, can bind bowel loops together or to the abdominal wall and other organs, potentially kinking or compressing the intestine.
Hernias involve a segment of the intestine or omentum protruding through a weakness in the abdominal wall, risking obstruction and ischemia if trapped or the blood supply is compromised.
Neoplasms, especially malignant tumors, can narrow the intestinal lumen or compress it externally, leading to obstruction, particularly in the large intestine.
Intussusception occurs when one segment of the intestine slides into another, causing luminal narrowing and obstruction.
Volvulus involves the twisting of a segment of the small or large intestine, obstructing the flow and potentially compromising the blood supply.

Functional Obstruction

Functional obstruction, or paralytic ileus, is a temporary loss of coordinated intestinal motility without a structural blockage. While the intestinal lumen remains open, impaired peristalsis leads to gas and fluid accumulation, resulting in bowel distension and discomfort.

Paralytic ileus most commonly develops after abdominal or pelvic surgery due to manipulation of the intestines and the effects of anesthesia. It may also happen secondary to medications such as opioids, which reduce gastrointestinal motility, or as a consequence of bowel ischemia. Electrolyte disturbances, systemic infections, and severe illness can further impair the neuromuscular function of the intestine.

Transcript

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Intestinal Obstruction

Mechanical Obstruction

Functional Obstruction

Paralytic Ileus

Intussusception