Despite improvements in knowledge of the pathologic physiology of
intestinal obstruction, the introduction of gastrointestinal
decompression, and more effective
antibiotics, obstruction remains a serious disease with a high mortality rate. Although the diagnosis is often obscure, it can usually be made with a fair degree of accuracy by the history alone;
pain is fairly constant and characteristically is of a cramping type simulated by very few other lesions. Distention is present in low lesions but absent in high lesions; on the contrary,
vomiting is minimal in low lesions but prominent in high lesions. Visible peristaltic waves are almost pathognomonic of
intestinal obstruction. Increased peristaltic sounds, as noted by auscultation, are extremely helpful in diagnosis; they are absent in
paralytic ileus. Although
intestinal obstruction is a surgical lesion, it must be remembered that in the type produced by adhesions the obstruction can be relieved by gastrointestinal
decompression in 80 to 90 per cent of cases. Operation is usually indicated a short time after relief because of the probability of recurrence. In practically all other types of obstruction
decompression is indicated only while the patient is being prepared for operation. Obviously any type of strangulation demands early operation. Strangulation can usually be diagnosed, particularly if it develops while the patient is under observation. Increase in
pain, muscle spasm and pulse rate are important indications of development of strangulation.
Dehydration and electrolytic imbalance are produced almost universally in high obstruction. Usually, it is unwise to wait until these two deficiencies are corrected before operation is undertaken, but correction must be well under way at the time of operation. Resections should be avoided in the presence of
intestinal obstruction, but obviously will be necessary in strangulation. Operative technique must be expert and carried out with minimal
trauma.
Postoperative care is very important; important features are
decompression, for two to three days, accurate fluid and electrolytic replacement, and transfusions.