Intestinal Obstruction

Diagnosis

Diagnosis of intestinal obstruction involves several tests and procedures to identify the blockage and determine its cause. A physical exam is the first step, where the doctor reviews symptoms, medical history and checks the abdomen for swelling, tenderness or lumps. Listening to bowel sounds with a stethoscope also helps in assessment.

Imaging tests are essential. An abdominal X-ray is often used to confirm obstruction, but some cases may not show up on standard X-rays. A CT scan provides more detailed images and is more accurate for identifying blockages. In children, ultrasound is commonly preferred, especially for detecting intussusception, which often appears as a bull’s-eye pattern.
For more detailed views of the colon, an air or barium enema may be recommended. This involves passing air or liquid barium into the colon through the rectum. In children with intussusception, this procedure can diagnose and also correct the condition without needing further treatment.

Treatment

Treatment for intestinal obstruction depends on the cause, severity and whether the obstruction is partial or complete. Hospitalization is generally required to stabilize the condition before further care.

Hospital stabilization may include:

• IV fluids through a vein

• A nasogastric tube to relieve pressure by removing air and fluids

• A catheter to drain urine and allow monitoring of kidney function

Treatment for intussusception in children often involves a barium or air enema, which can both diagnose and fix the issue.

For partial obstruction, after stabilization, further treatment may not be necessary. A low-fiber diet might be recommended to help the intestine manage food more easily. If symptoms don’t improve, surgery may be needed.

For complete obstruction, surgery is typically required. The procedure depends on the cause and location of the blockage and may involve removing the obstruction or any damaged part of the intestine. In certain cases, a self-expanding metal stent may be placed through an endoscope to open the blocked area. This is often used in people with colon cancer or those unable to undergo emergency surgery.

Treatment for pseudo-obstruction, also called paralytic ileus, includes monitoring in the hospital and managing the underlying cause. Food may be given through a nasogastric tube or IV to prevent malnutrition. If the condition doesn’t improve, medicines to stimulate muscle contractions may be used. In rare cases, surgery may be necessary.
If the colon becomes enlarged, decompression may provide relief. This can be done through colonoscopy or surgery, depending on severity and response to initial treatment.