Intestinal obstruction: a medical emergency


Attention, intestine in pain. Medications or mechanical bodily disorders can cause this serious condition.

Intestinal obstruction is not simple constipation. “It is a diagnostic and possibly therapeutic emergency depending on what causes it”, confirms Pr Dominique Pateron, Professor of Emergency Medicine and Medical Director of the University Medical Department of the Sorbonne-University Hospital Group. It is not so rare in France: occlusion represents 10% of the causes of abdominal pain of a surgical nature, after appendicitis and infections of the gallbladder. Its frequency increases with age.

● Warning signs

Normally, the muscle cells located in the wall of the digestive tract contract all along in a coordinated manner, circularly and longitudinally, which allows food and then stool to pass through the digestive tract unhindered. But if this transit is blocked and nothing more comes out (not even gas), and if this severe constipation is associated with intense abdominal pain, a feeling of bloating, as well as nausea and vomiting, it you need to see a doctor urgently. “After clinical examination, if there is a strong suspicion, a radiological examination (scanner) is then indicated, details the specialist, both to confirm the diagnosis and to clarify the cause of the occlusion. »

● Identify the cause

The occlusion may have a functional origin. The intestine seems like “paralyzed”. “This can be seen, for example, by taking certain medications that cause severe constipation,” says the specialist. This undesirable side effect is also mentioned for nearly 4000 specialties, including antidepressants and analgesics. Or, this blockage may be linked to other pathologies, such as neurodegenerative diseases.

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The cause of the occlusion can also be “mechanical”, in other words, linked to an obstacle. “It can happen by strangulation of a part of the intestine that gets stuck in a hernia in the abdominal wall, explains Dominique Pateron, by a twist on itself of a segment of the intestine or by a tumor which obstructs the intestinal canal. »

Other causes of mechanical obstruction are possible. Feces may be retained in the rectum, or just above it in the terminal part of the colon. This is called a faecal impaction, common in the elderly, which obstructs the evacuation of stool.

● The operation is sometimes necessary

When the intestine, at one point in its course, is deformed, strangled or obstructed, its walls, in contact, put the intestine in pain. The consequences can then be dramatic: the segment concerned risks becoming necrotic, which leads to rapid dehydration, and can even lead to perforation of the intestine and generalized infection.

Once the diagnosis is made, treatment will be implemented as soon as possible, depending on the type of occlusion. “When it is functional, it will be necessary to act on the cause of the malfunction of the transit: stop the favoring drugs, treat a condition that causes intestinal paralysis”, explains Dominique Pateron. “When it is mechanical, the obstacle will have to be removed, most often by surgical intervention”, he completes. It will then be necessary to monitor that a new occlusion does not occur subsequently.

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