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53. Spastic intestinal obstruction
Spastic obstruction intestine is relatively rare. Usually the cause of its occurrence is helminthic invasion.
clinical picture. The clinical picture of spastic intestinal obstruction is characterized by the occurrence of short-term attacks of severe abdominal pain without a specific localization.
Body temperature is normal or subfebrile. Sometimes there is a single vomiting. Gases usually move away, there is no stool, but it may be normal.
The abdomen is not swollen, symmetrical, sometimes sunken, on palpation - soft in all departments; in rare cases, it is possible to determine a spasmodic intestine.
X-ray examination. X-ray examination of the abdominal cavity has only differential diagnostic value.
Differential diagnosis. Differential diagnosis is made with mechanical obstruction and renal colic.
In cases of acute and severe intestinal spasms, it is sometimes difficult to exclude mechanical obstruction. Carefully collected anamnesis (indication of existing ascariasis) and objective examination data
Of certain importance is an x-ray examination of the abdominal cavity, which, with mechanical obstruction, helps to recognize the disease. Significant assistance in the diagnosis is provided by bilateral pararenal blockade or short-term epidural anesthesia.
The persistent disappearance of pain after the blockade makes it possible to exclude mechanical intestinal obstruction, in which pain attacks do not go away, but often intensify. In doubtful cases, surgery should be considered as a last resort.
Renal colic, in contrast to spastic obstruction, proceeds with excruciating attacks of pain, which are localized in the lumbar regions and are usually accompanied by typical irradiation.
In addition, dysuric disorders and pathological urinalysis are characteristic of renal colic, and shadows of calculi can be detected on plain x-rays.
Treatment. Treatment of spastic obstruction usually consists of conservative measures. The child is prescribed antispastic agents, a cleansing enema, and a heating pad is placed on the stomach.
In severe cases, a bilateral pararenal blockade according to A.V. Vishnevsky or prolonged (1-2 days) epidural anesthesia is performed several times. The cause of spastic obstruction (ascariasis, etc.) identified during the examination of the child is an indication for appropriate treatment (under the supervision of a surgeon).
Authors: Drozdov A.A., Drozdova M.V.
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