Intestinal Obstruction

Intestinal obstruction is a partial or complete blockage of the small or large intestine, resulting in failure to pass intestinal contents through the bowel normally. It is one of the surgical emergencies during the childhood period that needs prompt intervention.

Types of Intestinal obstruction

• Mechanical obstruction: bowel is physically blocked and its contents cannot get moved in a normal way cause varies from obstruction. It may be acute or chronic.
• Non-mechanical obstruction: also called a paralytic ileus is because of impairment of intestinal peristalsis activity and is common after abdominal surgery.

Causes of Intestinal obstruction

1.Congenital causes:

• Atresia
• Imperforated anus
• Meckel diverticulum
• Hirschprungs disease
• Stricture
• Malrotation
• Volvulus
• Meconium plug/ileus
• Annular pancreas

2. Acquired causes:

• Pyloric stenosis
• Intussusception
• Postoperative adhesion or stricture
• Tumor/hematoma
• Foreign body/worm mass
• Strangulated hernia
• Inflammatory disease
• Paralytic ileus

Pathophysiology

The essence of intestinal obstruction is that there is a blockage in the intestine. Impairment of the passage of material through the bowel results in cessation of a passage of flatus and feces. Blockage results in distension of the proximal intestine with solids, fluid, and gas; this result in pain, an increase in abdominal girth, and increased tension in the intestinal wall. Increased tension in the intestinal wall and or impairment of the blood supply of the intestine due to twisting and external pressure results in necrosis and perforation of the bowel. Blockage of the intestine with distension and/or impairment to its blood supply will result in activation of local and systemic inflammatory responses and translocation of bacteria through the wall of the intestine.

Clinical presentation

• Failure to pass meconium within the first two days of life in case of a neonate.
• Abdominal pain and cramps that come and go in a wave. Infant typically pulls up their legs and cry in pain. Then stop crying suddenly, and look normal between pains.
• A classic symptom is a passage of currant jelly stool by infants after a crying fit during intussusceptions.
• Vomiting that contains bile and fecal matter
• Distended rigid firm abdomen with diffuse tenderness. Initially, bowel sound is increased and decreases gradually with a progression of a disease.
• Dehydration, hypovolemic shock
• Fever may or may not be present.
• Constipation
• Regular bouts of colic pain
• Baby looks sick and toxic.

Diagnosis procedure

• History and physical examination
• Abdominal x-ray, barium meal/enema x-ray
• Serum electrolytes: sodium, potassium, chloride level
• Blood count: increased WBC level.

Management

Initial management is done with:

• Withhold oral feeding
• IV fluid therapy to correct fluid and electrolyte imbalance
• Decompression of bowel through nasogastric drainage
• Analgesic and antispasmodics to relieve pain
• Antibiotics to treat and prevent infection
• Management of causes and complication

Surgical management

Surgical management is done to relieve the obstruction. It depends on an underlying condition such as resection of bowel is done for obstructing lesions or strangulated bowel.

Nursing management

• Assess the child for abdominal pain, fluid and electrolyte status, stool pattern, peristalsis, abdominal girth, vital signs, and intake output.
• Keep the patient in fowler's position to minimize respiratory distress.
• Maintain fluid and electrolyte balance
• Administer parental fluid and electrolyte
• Maintain intake and output chart
• Relieve abdominal distention
• Keep patient nil orally
• Decompression with NG tube drainage
• Provide basic preoperative and postoperative care as in other general abdominal surgery.