Diagnosis and treatment of obstruction of the small intestine

Abstract

The diagnosis of obstruction of the small intestine depends largely upon an exacting clinical study of the patient, plus a critical analysis of such x-ray work as one is entitled to do. In order that the most advantageous type of management may be selected, the completed diagnosis should include the level of the intestinal tract involved, the type, the cause, the duration, and the complications. The strangulation obstructions constitute surgical emergencies regardless of the stage of the obstruction. Intubation as a postoperative procedure is a valuable adjunct to the management. Organic obstruction in which the vascularity of the bowel wall is not embarrassed may be individualized as follows from the standpoint of management: 1. 1. Obstruction occurring in the immediate postoperative period, usually associated with some degree of peritonitis, is best managed by intubation. In many cases the obstruction will subside without further intervention. 2. 2. Obstruction occurring months or years after intra-abdominal surgery or on other bases not associated with intra-abdominal inflammatory process may be managed (1) early in the process of developing distention, safely by immediate operation with intent to release the obstruction, and (2) late in the process of developing distention by intubation decompression until the distention has been controlled. Surgery can profitably be deferred until the patient has been rehabilitated. Adynamic ileus is best managed by intubation decompression.