What is the treatment for intestinal obstruction, ileus? Medications and surgery

Choosing the appropriate treatment for bowel obstruction is preceded by a correct diagnosis.

During the diagnostic process, it is very important to determine what type of blockage is involved, what is its cause and severity.

There are generally two methods used in the treatment of intestinal blockage conditions - conservative treatment and surgical treatment.

Treatment of mechanical intestinal obstruction

Mechanical intestinal obstruction is an acute condition that requires timely medical intervention in most cases.

Treatment of this condition focuses on eliminating physiological disturbances, providing rest for the patient, reducing distension of the bowel and eliminating the provoking cause.

For partial intestinal obstruction and less severe conditions where the patient's condition is stable, conservative treatment without surgical intervention is initially applied.

More serious conditions with complete intestinal obstruction, abdominal hernia, intestinal incontinence or dangerous strangulation require early and urgent surgical intervention.

Conservative treatment consists of several steps. Water and electrolyte replacement is necessary in the affected person. Their losses are really considerable in these conditions. Solutions are administered intravenously (into the vein), oral intake is not allowed.

A nasogastric probe is introduced, which effectively sucks accumulated fluid and air from the stomach. At the same time, it reduces intestinal distension.

Sometimes a catheter is inserted into the bladder to monitor urine output.

One of the steps in conservative treatment is the administration of antibiotics. This prevents the overgrowth of bacteria that would penetrate the intestinal wall and cause infection.

The success rate of conservative treatment is between 40 and 70% and reduces the length of hospital stay. However, it is also associated with a high rate of recurrence of intestinal obstruction because this treatment does not address the cause of the obstruction.

The basic and often necessary treatment for mechanical obstruction is surgery. The aim is to remove or bypass the obstruction preventing the passage of the bowel.

In addition to acute life-threatening cases, surgical treatment is also resorted to in patients who have deteriorated during hospitalization and in those in whom 3-5 days of conservative treatment has not been successful.

The observed presence of signs of inflammation in the abdominal cavity, increased or decreased white blood cell count and hyperacidity suggest the existence of bowel wall obstruction, bowel wall perforation or sepsis. This requires immediate surgical intervention.

Mechanical obstruction can be operated on by laparotomy (surgical opening of the abdominal cavity).

Nowadays, laparoscopy (surgery without opening the abdominal cavity through a conventional incision) is more commonly used because of lower complication rates, shorter hospital stay and also lower healthcare costs.

In patients with a tumour causing obstruction, the obstruction can be at least partially removed by implanting stents to widen the narrowed space in the bowel or by surgically diverting part of the bowel.

Treatment of paralytic and vascular ileus

The most important step in the treatment of ileus caused by peristalsis is to remove the primary cause for which the bowel is not functioning as it should.

This is again a conservative treatment.

This usually takes a longer period of time and consists of several steps:

• restriction of oral food and fluid intake
• intravenous administration of rehydration solutions to restore blood volume and keep the body hydrated
• correction of electrolyte imbalances (especially potassium) and acid-base balance
• limiting the administration of drugs that have a negative effect on intestinal peristalsis
• insertion of a nasogastric probe to aspirate accumulated fluid and air and reduce intestinal distension
• the patient is given parenteral nutrition
• the amount of urine excreted is monitored
• the patient's position must be changed regularly

Intestinal motility can be supported by the administration of appropriate drugs - parasympathomimetics, sympatholytics or prokinetics.

Antibiotics are also used, especially if inflammation in the abdominal cavity or rupture of the intestinal wall is suspected.

The administration of anticoagulants is also specific for vascular ileus, which is caused by blockage of blood vessels in the intestinal wall by a blood clot.

Conservative treatment is successful in up to 85% of cases.

In these forms of ileus, surgical treatment can also be resorted to. It depends on the general health of the patient, the cause of the ileus, the rate of development and degree of bowel obstruction, associated complications such as inflammation, rupture of the bowel wall, strangulation, etc.

The surgical treatment options are the same as those we present for mechanical obstruction.