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Question: Intestine shut down |
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What happens when both the small and large intestine shut down?
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Answer: |
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The obstruction of the small or large intestine is called ileus. An incomplete obstruction is a subileus. There can be several different causes for an ileus and there are two main types: mechanical ileus and functional ileus.
1) A mechanical ileus is caused by an obstruction which, from the outside or inside, impairs or blocks the natural passage of intestinal contents. This results in vomiting, colicky abdominal pain and an excessive accumulation of gas in the intestine (also called meteorism), as well as wind or stool passage. At the beginning of a mechanical ileus the intestinal movements are generally overactive. You can hear squirting sounds and the patient at this stage often has colicky pains. This overactivity of the intestinal movements can be felt and sometimes even seen as abdominal rigidity. A constant irritation of the muscles leads to intestinal paralysis through a reflex action.
Depending on the location of the blockage, there are symptomatic differences. In a high obstruction of the small intestines flatulence as well as wind or stool passage are often absent. In a low obstruction a later onset of vomiting is possible and the vomit is mostly brown and malodorous. In both cases the pain is colicky and located around the naval area. An ileus in the area of the large intestine initially causes less pain which then gradually increases. Since neither stool nor gas are being passed through the intestines, abdominal distension occurs rather quickly. Vomiting, however, begins very late in this case.
2) A functional ileus, on the other hand, is present when either a dynamic dysfunction or even a paralysis of the intestinal muscles prevent the passage of food through the intestines. Symptoms include a slow onset, moderate constant pain. The stomach is tender and bloated with gas. Only when the inflammation also affects the peritoneum does the stomach become hard and distended. In this type of ileus auscultation reveals a silent abdomen with missing bowel sounds, which is why this diagnostic finding is called "Grabesstille".
A simultaneous obstruction or blockage of both the small and large intestine is the rule in a functional ileus. In a mechanical ileus this would be an absolute rarity.
Author:
Dr. med. Stephan Wildi, Gastroenterologie, UniversitätsSpial Zürich
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