Health Encyclopedia

Intestinal obstruction and Ileus

Definition

Intestinal obstruction is a partial or complete blockage of the bowel. The contents of the intestine cannot pass through it.

Alternative Names

Paralytic ileus; Intestinal volvulus; Bowel obstruction; Ileus; Pseudo-obstruction - intestinal; Colonic ileus; Small bowel obstruction

Causes

Obstruction of the bowel may be due to:

A mechanical cause, which means something is blocking the bowel
Ileus, a condition in which the bowel does not work correctly, but there is no structural problem causing it

Paralytic ileus, also called pseudo-obstruction, is one of the major causes of intestinal obstruction in infants and children. Causes of paralytic ileus may include:

Bacteria or viruses that cause intestinal infections (gastroenteritis)
Chemical, electrolyte, or mineral imbalances (such as decreased blood potassium level)
Abdominal surgery
Decreased blood supply to the intestines
Infections inside the abdomen, such as appendicitis
Kidney or lung disease
Use of certain medicines, especially narcotics

Mechanical causes of intestinal obstruction may include:

Adhesions or scar tissue that form after surgery
Foreign bodies (objects that are swallowed and block the intestines)
Gallstones (rare)
Hernias
Impacted stool
Intussusception (telescoping of one segment of bowel into another)
Tumors blocking the intestines
Volvulus (twisted intestine)

Symptoms

Symptoms may include:

Abdominal swelling (distention)
Abdominal fullness, gas
Abdominal pain and cramping
Breath odor
Constipation
Diarrhea
Inability to pass gas
Vomiting

Exams and Tests

During a physical exam, the health care provider may find bloating, tenderness, or hernias in the abdomen.

Tests that show obstruction include:

Treatment

Treatment involves placing a tube through the nose into the stomach or intestine. This is to help relieve abdominal swelling (distention) and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum.

Surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms. It may also be needed if there are signs of tissue death.

Outlook (Prognosis)

The outcome depends on the cause of the blockage. Most of the time, the cause is successfully treated.

Possible Complications

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.

In a newborn, paralytic ileus that destroys the bowel wall (necrotizing enterocolitis) is a life-threatening condition. It may lead to blood and lung infections.

When to Contact a Medical Professional

Contact your provider if you:

Cannot pass stool or gas
Have a swollen abdomen (distention) that does not go away
Keep vomiting
Have unexplained abdominal pain that does not go away

Prevention

Prevention depends on the cause. Treating conditions, such as tumors and hernias that can lead to a blockage, may reduce your risk.

Some causes of obstruction cannot be prevented.

References

Galandiuk S, Netz U, Morpurgo S, et al. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 52.

Gan T, Evers BM. Small intestine. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 50.

Mustain WC, Turnage RH. Intestinal obstruction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 123.

Review Date:5/4/2022
Reviewed By:Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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