Definition

Obstructive ileus refers to a condition where a blockage prevents food or fluid from passing through either the small or large intestine. Normally, digested material flows from the small intestine into the large intestine. In cases of obstructive ileus, a blockage, which may be partial or complete, disrupts this process, hindering the passage of intestinal contents through the digestive tract. This can result in an accumulation of food, gas, fluids, and waste products in the area of the intestine above the obstruction, interfering with nutrient and fluid absorption.

Obstructive ileus tends to occur more frequently in the small intestine compared to the large intestine. Without timely treatment, the blocked segment of the intestine may experience tissue death, leading to more severe complications. However, prompt medical intervention often results in successful treatment.

Causes

Obstructive ileus can cause blockages in both the small and large intestines. In the small intestine, the blockages are usually attributed to:

• Intestinal adhesions, composed of fibrous connective tissue, which can form following abdominal or pelvic surgery or severe abdominal inflammation
• Tumors in the small intestine
• Intussusception, a condition where one part of the intestine is pushed into the adjacent segment
• Volvulus, in which the intestine becomes twisted
• Hernia, where a section of the intestine penetrates a weakened area of the abdominal wall, obstructing the passage of food
• Inflammatory bowel diseases, like Crohn's disease, that can lead to intestinal narrowing
• Congenital deformities in the intestine, typically present in newborns but also seen in children and adolescents
• Gallstones, although rarely a cause of obstruction
• Ingesting foreign objects, particularly in children

Although less common in the large intestine, blockages in this area can result from:

• Impacted stool in the colon or rectum
• Intestinal adhesions formed due to pelvic infection or post-surgery
• Volvulus and intussusception within the colon
• Diverticulitis, which involves the inflammation or infection of pouches protruding from the colon
• Strictures in the colon, caused by scar tissue or inflammation
• Cancers such as ovarian or colon cancer
• Meconium blockage in newborns, where the first stool becomes obstructed

Risk Factor

Several conditions can increase the likelihood of developing obstructive ileus, including:

• Scar tissue from previous surgeries
• Crohn's disease
• Hernia
• Diverticulitis
• Cancers in the abdomen, such as colon, stomach, or ovarian cancer
• Metastatic lung cancer, breast cancer, or melanoma that has spread to the colon
• Abdominal radiation exposure

Symptoms

The symptoms of obstructive ileus may vary depending on the location, severity, and duration of the obstruction. Common symptoms, primarily affecting the digestive tract, include:

• Bloating
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Inability to pass gas in cases of complete obstruction
• Constipation, also seen in total obstruction
• Diarrhea in cases of partial obstruction
• Severe abdominal cramping
• Abdominal swelling

In severe cases, obstructive ileus may lead to peritonitis, a life-threatening infection and inflammation of the abdominal cavity, caused by the rupture of the intestine. This can result in fever and increasingly severe abdominal pain, requiring emergency surgery.

Diagnosis

The diagnostic process begins with the doctor conducting a detailed interview to gather information about symptoms such as bloating, abdominal pain, the ability to pass gas, and nausea or vomiting. Additionally, the doctor will inquire about risk factors, including previous surgeries or medical conditions like hernias, digestive tract tumors, or intestinal inflammation. A physical examination, focusing primarily on the abdomen, will follow. This involves checking for lumps or swelling, pressing on the abdomen to assess pain levels, and listening to bowel sounds using a stethoscope.

To further confirm the diagnosis of obstructive ileus, the doctor may recommend additional tests, such as:

• Blood tests
• Urine tests
• CT scans or X-rays to pinpoint the location of the obstruction
• A barium enema, where a special liquid containing barium is administered rectally. The barium spreads through the intestines and appears as a bright area on an X-ray, revealing any blockages.

Management

The treatment for obstructive ileus depends on the location and severity of the blockage. Generally, management occurs in a hospital setting.

Partial Blockage

In cases of partial blockage, the intestines are typically rested, and the patient is provided with intravenous fluids. Resting the intestines may involve withholding food or providing a liquid diet for a certain period. IV fluids are administered to prevent dehydration and address electrolyte imbalances. A urinary catheter may be used to monitor fluid output and ensure proper hydration.

A nasogastric tube (NGT) may also be inserted through the nose into the esophagus, stomach, and intestines to relieve pressure and reduce swelling, helping to alleviate vomiting. If the cause of the blockage is identified, the doctor will address it. Surgery may be necessary if symptoms worsen or if other interventions prove ineffective.

Complete Blockage

In the case of a complete blockage, surgery is usually required. During surgery, the doctor will either resolve the cause of the blockage or remove the affected and damaged intestinal tissue. Following the removal of the damaged section, the remaining intestine may be connected to an opening in the abdominal wall, known as a colostomy or ileostomy, where waste is collected in a disposable bag. In some cases, the intestines may be reconnected after recovery.

While medications cannot eliminate the blockage, they may alleviate symptoms. Doctors may prescribe antibiotics to reduce infection risk, anti-nausea drugs, and pain relievers to provide symptom relief before further intervention.

Complications

If left untreated, prolonged bowel obstruction can prevent adequate blood flow to the affected area of the intestine, leading to complications such as:

• Infection
• Tissue death
• Bowel perforation, where a hole forms in the intestinal wall
• Sepsis, a life-threatening infection that affects multiple organs
• Multi-organ failure
• Death

Prevention

Preventing obstructive ileus focuses on managing conditions or diseases that increase the risk of bowel obstruction. Adopting a healthy lifestyle, such as exercising regularly, can promote intestinal health. Consuming certain foods, like papaya, may also help maintain regular bowel movements.

When to See a Doctor?

It is important to consult a doctor if symptoms of obstructive ileus appear, particularly if you have recently undergone abdominal surgery or have a history of gastrointestinal disorders. Given the potential for serious complications, seek immediate medical attention if you experience severe abdominal pain, bloating, severe constipation, or loss of appetite. Do not ignore these symptoms or attempt to treat them at home.

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