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Intestinal obstruction

By Vision Reporter

Added 2nd August 2009 03:00 AM


WHEN her tummy grew unusually big, she said she was pregnant. But at 75, it sounded a little odd that Rose Mary Wobuyaga, a traditional herbalist from Sironko, wo


WHEN her tummy grew unusually big, she said she was pregnant. But at 75, it sounded a little odd that Rose Mary Wobuyaga, a traditional herbalist from Sironko, wo


By Stephen Ssenkaaba

WHEN her tummy grew unusually big, she said she was pregnant. But at 75, it sounded a little odd that Rose Mary Wobuyaga, a traditional herbalist from Sironko, would be soon giving birth in the evening of her life. Even some of her colleagues corroborated her story.

However, she only got worse, feeling more uncomfortable, which prompted expert medical intervention. And after a scan, it was discovered and declared that Wobuyaga was not pregnant, but sick.

After running a scan, Dr Peter Nabende, the Sironko district health officer, said Wobuyaga suffers from partial intestinal obstruction.

“It is a condition where intestines elongate and twist thereby blocking the normal flow of air. As a result, they balloon and distend the stomach,” he says.

Nabende dispelled the myth that Wobuyaga was pregnant, saying the accumulation of air in the intestines makes it look like a baby’s kick.

Intestinal obstruction is a serious problem affecting a number of people but one that is hardly known by many Ugandans. Dr. Moses Galukande, a surgeon at Mulago Hospital, says even though the community prevalence of this condition is not known, “rough estimates suggest an annual incident rate of 1 in 750. Meaning one person, out of 750 Ugandans, will suffer some form of intestinal obstruction in a year.”

Understanding the disease
Intestinal obstruction (also known as bowel obstruction) is a mechanical or functional obstruction of the intestines, preventing the normal transit of products of digestion.

“Simply put, it is a blockage of bowel. It can be the small bowel, large bowel or both at the same time. It can be a complete or partial blockage, sudden or acute. It can also be on and off (recurrent),” says Dr. Galukande.

He says the condition can occur within the intestine, intestine lumen and external to the intestine.

Galukande says there are two types of intestinal obstruction — small intestinal (bowel) obstruction and large (bowel) intestinal obstruction.

He says all those who have ever had abdominal surgery are at risk, while those who have hernia have an inherent risk if they do not have the hernia repaired. Those with redundant (excessively long) colons also have a risk of developing this condition.

Causes, signs, symptoms
Dr. Galukande says this condition has many causes. Small bowel obstruction is caused, among other factors, by hernia and adhesions (adhesions are scar bands that form on the inside of the abdomen as a consequence of previous surgery or surgeries).

The causes for large bowel obstruction are: excessively long bowel, especially a part called the sigmoid colon twisting on its self.

He says cancer of the colon is another common cause of obstruction, leading to a growth of a tumor into the lumen which prevents forward movement of stool and air.

Other causes include very hard stool and failure to pass it (faecal impaction) which is quite common in the elderly, bedridden and those on constipating drugs.

“Among children, absence of the anal opening or colon and ganglia (ganglia being tiny motors in the bowel that cause it to move stool and gas forward) also cause obstruction.”

He says intestinal twists and infection in the abdomen (peritonitis) are common causes for both large and small bowel obstruction.

Dr. Galukande says diagnosis is made based on the symptoms.

“The health worker is likely to do a physical examination and ask for some investigations such as an abdominal X-ray.

Accorsing to Wikipidia, the main diagnostic tools are blood tests, X-rays of the abdomen, CT scanning and/or ultrasound. If a mass is identified, biopsy may determine the nature of the mass.”

Contrast enema or small bowel series or CT scan can also be used to define the level of obstruction and to help define the cause.

Other diagnostic options include colonoscopy, small bowel investigation with ingested camera or push endoscopy, and laparoscopy (where operations in the abdomen are performed through small incisions).

Treatment options, according to medical experts, are in two broad approaches: Operative, which includes performing a surgical procedure to relieve the obstruction or the non-operative approach, where other means other than surgery are used. This includes inserting a nasal gastric tube to drain stomach contents, giving an enema, among others.

Fetal and neonatal bowel obstructions are often caused by intestinal atresia, where there is a narrowing or absence of a part of the intestine. These atresias are often discoveredat birth. If the area affected is small, the surgeon may remove the damaged portion and join the intestine back together.

Medline Plus, a medical encyclopedia, says that surgery may be needed to relieve the obstruction if the tube does not relieve the symptoms, or if there are signs of tissue death.

Dr. Galukande says, intestinal obstruction can be checked if people observed a few lifestyle rules. These include:

- Engaging in physical exercise

- Eating a balanced diet with lots of fruits and vegetables, and avoiding excesses such as alcohol

- Doing regular medical examinations even when one feels alright.

- Checking with your doctor whenever you feel something is not right.

He says we should not just wish ‘things’ away, perhaps like Mzee Wobuyaga. These are simple rules, but can go a long way in keeping us healthy.

Signs and symptoms
According to Wikipidia, bowel obstruction can present with abdominal pain, abdominal distension, vomiting, fecal vomiting and constipation.

The condition may be complicated by dehydration and electrolyte abnormalities (acid-base imbalance) due to vomiting; respiratory compromise from pressure on the diaphragm by a distended (swollen) abdomen, bowel ischaemia (inflammation and injury of the small intestine resulting from inadequate blood supply) or perforation from prolonged distension or pressure from a foreign body.

“In small bowel obstruction, the site notes, the pain tends to be colicky (cramping and intermittent), with spasms lasting a few minutes. The pain tends to be central and mid-abdominal. Vomiting occurs before constipation.”

“In large bowel obstruction, the pain is felt lower in the abdomen and the spasms last longer. Constipation occurs earlier and vomiting may be less prominent. Proximal obstruction of the large bowel may present as small bowel obstruction.”

Intestinal obstruction

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