An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage.

1. Intestinal obstruction

2.  Digested food particles must travel through 25 feet or more
of intestines as part of normal digestion. These digested
wastes are constantly in motion. However, intestinal
obstruction can put a stop to this. An intestinal obstruction
occurs when small or large intestine is blocked. The
blockage can be partial or total, and it prevents passage of
fluids and digested food.
 If intestinal obstruction happens, food, fluids, gastric acids,
and gas build up behind the site of the blockage. If enough
pressure builds up, intestine can rupture, leaking harmful
intestinal contents and bacteria into abdominal cavity. This is
a life-threatening complication.

3.  “Intestinal obstruction involves a partial or
complete blockage of the bowel that results
in the failure of the intestinal contents to pass
through”.
 Intestinal obstruction is a blockage of small
intestine or colon that prevents food and fluid
from passing through.

4.  Many conditions can cause intestinal
obstruction.
 "Mechanical" obstruction occurs when
something — such as a hernia or tumor — is
physically block the intestine. Blockage of
intestine can be partial or complete.
 Paralytic ileus (pseudo-obstruction), a
condition in which the intestines don't
function properly, may have the same signs
and symptoms as mechanical obstruction,
but no physical obstruction is present.

5. Mechanical obstruction:
 Adhesions, which consist of fibrous tissue that can
develop after any abdominal or pelvic surgery or after
severe inflammation
 Volvulus, or twisting of the intestines.
 Intussusception, a “telescoping,” or pushing, of one
segment of intestine into the next section.
 Malformations of the intestine, often in newborns, but
can also occur in children and teens.
 tumors within small intestine.
 Gallstones, although they rarely cause obstructions.
 swallowed objects, especially in children.
 hernias, which involve a portion of intestine protruding
outside of body or into another part of body.
 Inflammatory bowel disease, such as Crohn’s disease.

7. Mechanical obstruction:
Although less common, mechanical obstructions can
also block colon, or large intestine. This can be due to:
 impacted stool
 adhesions from pelvic infections or surgeries
 ovarian cancer
 colon cancer
 meconium plug in newborns (meconium being the
stool babies first pass)
 diverticulitis, the inflammation or infection of bulging
pouches of intestine.
 stricture, a narrowing in the colon caused by scarring
or inflammation.

8.  Paralytic ileus
 Paralytic ileus can cause signs and symptoms of intestinal
obstruction. In paralytic ileus, although there is no blockage,
the intestines don't function properly; movement of the
intestines is greatly reduced or absent. The intestines are
unable to move food and fluid smoothly through the
digestive system.
 Paralytic ileus can affect any part of the intestine.
 The most common cause of paralytic ileus is abdominal
surgery.

9.  Abdominal or pelvic surgery.
 Crohn's disease — an inflammatory condition that
can cause the intestine's walls to thicken,
narrowing its passageway.
 Cancer within abdomen, especially if patient’s had
surgery to remove an abdominal tumor or radiation
therapy.
 A history of constipation.
 Malrotation, a condition present at birth
(congenital) in which intestine doesn't develop
correctly.

11.  Any of the cause
 Accumulation of food, air, secretions
(gastric, biliary, pancreatic)
 Bowel congestion followed by failure of
absorption, vomiting and decreased oral
intake

12.  Volume depletion, electrolyte imbalance,
renal failure and shock
 Bowel distention causes increased
intraluminal pressure, with decreased
vascular perfusion, lymphatic drainage
which increases permeability to bacteria
 Bowel ischemia, necrosis, septicemia

13.  Depending on the level of obstruction, bowel
obstruction can present with
 Abdominal pain,
 Abdominal distension,
 Vomiting,
 Fecal vomiting, and
 Constipation.

14.  In small bowel obstruction the pain tends to be
colicky (cramping and intermittent) in nature, with
spasms lasting a few minutes. The pain tends to
be central and mid-abdominal. Vomiting occurs
before constipation.
 In large bowel obstruction the pain is felt lower in
the abdomen and the spasms last longer.
Constipation occurs earlier and vomiting may be
less prominent. Proximal obstruction of the large
bowel may present as small bowel obstruction.

15.  History taking
 Abdominal Examination
 The main diagnostic tools are blood tests, X-
rays of the abdomen, CT scanning and/or
ultrasound. If a mass is identified, biopsy
may determine the nature of the mass.
 Radiological signs of bowel obstruction
include bowel distension and the presence of
multiple gas-fluid levels on supine and erect
abdominal radiographs.

16.  Nasogastric suction.
 IV fluids.
 IV antibiotics if bowel ischemia suspected.
 Patients with possible intestinal obstruction should
be hospitalized.
 Supportive care is similar for small- and large-
bowel obstruction: nasogastric suction, IV fluids
(0.9% saline or lactated Ringer's solution for
intravascular volume repletion), and a urinary
catheter to monitor fluid output.
 If bowel ischemia is suspected, antibiotics should
be given (e.g., a 3rd-generation cephalosporin).

17.  Patient may need surgery if nonsurgical
treatment is not able to clear a partial
obstruction. If the bowel is completely
blocked or the blood supply to the bowel is
cut off (strangulation), surgery may be the
first treatment.
 During surgery, a general surgeon or a colon
and rectal surgeon removes the blockage or
the section of blocked intestine.

18.  Surgery for bowel obstruction, including
obstructions related to twisting of the
intestine, and some cancers, is often done
laparoscopically. This means that
surgery is done with a lighted scope and
instruments inserted through a small
incision.

19.  In a case of paralytic ileus, treatment may involve
inserting a flexible tube (nasogastric tube) down the
throat to drain fluids from the stomach as well as
correcting fluid and electrolyte imbalances.
 In most cases a partial blockage will not require
surgery, but a complete blockage will. The type of
surgery will depend on the type of blockage and its
location.
 A laparotomy, where an incision is made into the
abdomen while under general anaesthesia, may be
performed to search for the cause of an obstruction
and/or to remove or manage it.

20.  Laparoscopy, or keyhole surgery, in which a laparoscope
(a small tube with a light and camera on the end) is inserted
into a small incision, may be an option for treating a small
bowel obstruction or removing adhesions.
 Endoscopic stenting, where a self-expanding stent is
inserted to help keep the passageway open, may be
considered in the elderly and in palliative care of cancer
patients.
 A sigmoidoscopy or colonoscopy involves inserting a thin
flexible tube with a small camera and light attached on one
end through the rectum into the bowel, along with a flatus
tube (a long rubber tube), to decompress and untwist the
bowel.

21. Complications may include or may lead to:
 Electrolyte (blood chemical and mineral) imbalances
 Dehydration
 Hole (perforation) in the intestine
 Infection
 Jaundice (yellowing of the skin and eyes).
 If the obstruction blocks the blood supply to the intestine, it
may cause infection and tissue death (gangrene). Risks for
tissue death are related to the cause of the blockage and
how long it has been present. Hernias, volvulus, and
intussusception carry a higher gangrene risk.

22. Assessment
 Subjective Data
 Objective Data

23.  Pre-operative Nursing Diagnosis
 Fear & Anxiety related to surgical correction.
 Knowledge deficit related to disease and
surgery.

24.  Post-operative Nursing Diagnosis
 Pain related to surgical incision.
 Fluid volume deficit related loss of fluid due
to surgical correction.
 Impaired skin integrity related to surgical
incision.
 Nutritional deficit related to nausea and
anorexia.
 Knowledge deficit related to treatment plan
and follow up.

25.  A prospective descriptive study was conducted in department of surgery
at a tertiary care teaching hospital at Solapur ( Mahrastra) from June 2012
to June 2014. All the adult patients, irrespective of gender with diagnosis
of dynamic intestinal obstruction undergoing exploratory laparotomy were
included in the study. Laparotomy findings were recorded and in the
postoperative period patients were followed up for detection of
complications and treatment.
 Results: 50 patients were treated for mechanical intestinal obstruction.
Mean age was 49.5 years and male to female ratio was 1.7:1. External
hernia (50%) was the commonest cause of intestinal obstruction followed
by postoperative adhesion (39%).Wound infection was the commonest
postoperative complication. Conclusions: External hernia is the leading
causes of mechanical intestinal obstruction in our region. Old age,
delayed presentation, associated co-morbidities, increases the morbidity
and mortality in these patients.