Intestinal obstruction involves a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.
Bowel obstruction can be caused by many different things. These include:

  • Scar tissue in the belly, often called adhesions. This tissue can wrap around a piece of bowel. The contents of the bowel are prevented from moving normally through the intestine.

  • Bowel that twists on itself or develops a bad kink. This is often called volvulus.

  • Fecal impaction, or hard stool that cannot pass through the bowel

  • Cancer, such as colon cancer or cancer of the pancreas

  • Infection of the bowel. This can be from colitis, which is an infection of the colon lining, or diverticulitis, which is an infection of small pouches that can develop in the wall of the colon.

  • Inflammation or swelling of the bowel from any cause. An example is inflammatory bowel disease, a condition without a known cause that results in inflammation of the intestines.

  • Lack of blood supply to the bowel, such as from a condition called ischemic colitis

  • Symptoms & Signs

    The symptoms and their severity depend on where in the bowels the blockage is located. Symptoms are also determined by the underlying cause, and may include:-

    • Nausea and vomiting
    • Abdominal distress
    • Swelling of the abdomen, known as ascites
    • Loss of appetite
    • Fever
    • Constipation

    Diagnosis & Tests

    The person's medical history and physical exam often suggest a bowel obstruction. Standard x-rays of the abdomen are most commonly used to confirm the diagnosis. In some cases, other tests may be needed to find the cause of the blockage. For example, a special x-ray test called an abdominal CT scan may be used if diverticulitis is suspected.

    Prevention & Expectations

    Usually, nothing can be done to prevent a bowel obstruction. A person who has had an obstruction from hard stools may be given stool softeners to prevent a repeat obstruction.
    The bowel may develop a tear, called an intestinal perforation, or have its blood supply cut off. A lack of blood supply to the bowel can cause the tissue to die. A condition know as gangrene may develop as a result. These are both serious complications that may result in severe infections and death.

    Intussusception of the bowel results in the bowel telescoping onto itself (A and B). To repair it, an incision is made in the baby's abdomen to expose the bowel (C). If the surgeon cannot manipulate the bowel into a normal shape manually, the area of intussusception will be removed and remaining bowel sutured together (D).

    Treatment & Monitoring

    A person with a bowel obstruction may require fluid through an intravenous line, or IV. This is a needle that is placed in a blood vessel in the arm or had to deliver fluids directly into the blood stream. Antibiotics may be needed as well.
    A nasogastric tube is often put through the nose into the stomach to help decompress the bowels. The person is usually advised not to eat or drink anything. An enema, or fluid injected into the bowel to cause the bowels to move, may be used for hard stool.
    Sometimes a procedure called endoscopy is used if volvulus is the cause. This involves inserting a small tube through the anus and into the bowel. The tube allows the bowel to decompress and untwist itself in some cases. Surgery may be required to fix an obstruction. This may involve destroying scar tissue wrapped around the bowel or even removing a segment of the bowel.

    Side effects

    Antibiotics may cause allergic reactions, stomach upset or other side effects. This depends on the antibiotic used. Surgery carries a risk of bleeding, infection and even death.

    If the underlying cause of the bowel obstructiion is fixed, no further monitoring may be needed. Repeated x-rays may be done in some cases. Any new or worsening symptoms should be reported to the healthcare provider.

    Repair Of Intestinal Obstruction

    RepairOfIntestinalObstruction thumb Repair Of Intestinal Obstruction Reestablishment of intestinal patency in nay number of conditions that create a blockage of the intestinal tract.
    • Intestinal obstruction is the most frequent gastrointestinal emergency requiring immediate surgical intervention in the newborn.
    • Symptoms may include emesis, abdominal distention, and failure to pass flatus and meconium.
    • The repair of an intestinal obstruction may include:
    Untwisting of a volvulus.
    Division of intestinal band.
    Release of an internal hernia.
    Resection of bowel with anastomosis.
    Creation of an intestinal stoma.
    • Surgical intervention should be performed within the first few hour of life, since delay may severely increase the risk of major complications.
    Supplies/ Equipment
    Thermal blanket with control unit
    Thermal sheets, head covering
    Basin set
    Handheld cautery
    Needle counter
    Dissector sponges
    1. The abdomen is open through an appropriate incision related to the anatomic area that is obstructed.
    2. With atresia or stenosis, the entire bowel is examined to rule out multiple areas of involvement.
    3. For duodenal artresia, a paramedian or transverse incision is made in the upper abdomen.
    4. Bypass of the obstructed duodenal segment is usually preferred over resection.
    5. An antecolic duodenojejunostomy is usually the procedure of choice, in which a loop of the proximal jejunum is brought anterior to the transverse colon and to the side of the distended proximal duodenum.
    6. A side to side anastomosis is fashioned in one or two layers according to the surgeons preference and size of the small jejunal lumen.
    7. The abdomen is closed in a routine fashion.
    Perioperative Nursing Considerations
    Separate all instruments associated with the anastomosis and follow bowel technique protocol.
    Check all equipment to promote safety and avoid prolonging anesthesia.
    Patient needs to be prepared physically and mentally.
    Circulator should confirm the operative side with the patient.

    Nursing Diagnosis

    Acute Pain may be related to distention/edema and ischemia of intestinal tissue, possibly evidenced by verbal reports, guarding/distraction behaviors, narrowed focus, and autonomic responses (changes in vital signs).
    Diarrhea/Constipation may be related to presence of obstruction/changes in peristalsis, possibly evidenced by changes in frequency and consistency or absence of stool, alterations in bowel sounds, presence of pain, and cramping.
    Risk for deficient Fluid Volume: risk factors may include increased intestinal losses (vomiting and diarrhea), and decreased intake.
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