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Blockage in the Small Intestines
A small intestinal blockage (obstruction) can be partial or complete. It can also be simple (nonstrangulated) or strangulated. In the United States, it accounts for 20 percent of all acute surgical admissions. Causes of small intestinal blockages in the elderly differ some from cases seen in infants and children.
When a blockage occurs, intestinal contents are unable to get out of the body properly. Symptoms include abdominal distension, stomach pain and cramps, vomiting, constipation, diarrhea, and bad breath. This is a serious condition and some cases can be fatal if not treated in time.
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Causes of Small Intestinal Blockages in the Elderly
Small intestinal blockages may occur from mechanical causes that physically impede passage of intestinal contents or from paralytic causes (ileus) in which the passageway is open but peristalsis (wavelike muscle contractions that move food along the digestive tract) ceases.
Many things can mechanically obstruct the small intestines in the elderly, including:
- impacted feces
- foreign bodies (swallowed objects)
- the formation of scar tissue after surgery (adhesions)
- Crohn's disease.
The most common cause in developed countries is postoperative adhesions (about 60%). The surgeries that are most closely associated with small intestinal blockages are upper GI (gastrointestinal) procedures, colorectal surgery, appendectomy, and gynecologic procedures. Obstructions can develop within 4 weeks of surgery or decades later.
Common causes after postoperative adhesions are malignant tumors, Crohn's disease, and hernias.
Volvulus (twisted intestine) and intussusception (a condition in which one part of the bowel slips into the lower part) are other causes of mechanical blockages but both are mostly seen in infants.
Nonmechanical obstructions are also mostly seen in infants (and children). However, they can occur in the elderly. Causes can include medications that slow peristalsis (especially narcotics), kidney disease, and long-standing diabetes.
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A medical history and physical examination will help diagnose small intestinal blockages. Tests may include an abdominal x-ray, an abdominal ultrasound, and a CT (computed tomography) scan.
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Most mechanical causes (particularly adhesions, tumors, and hernias) require surgery. Other types of blockages may improve on their own. If so, close monitoring, intravenous fluids (IVFs), and a nasogastric tube (to remove fluids and gas above the obstruction) are normally involved.
According to records of elderly patients (70 years or older) who had surgery for mechanical blockages, those who surgeries were delayed (more than 48 hours after being admitted to the hospital) had longer hospital stays and more complications than those who surgeries were not delayed.
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Langone Medical Center: Small Bowel Obstruction - http://www.med.nyu.edu/patientcare/library/article.html?ChunkIID=96913
eMedicine: Obstruction, Small Bowel - http://emedicine.medscape.com/article/774140-overview
PubMed: Small bowel obstruction in the elderly - http://www.ncbi.nlm.nih.gov/pubmed/2729777
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Image courtesy of the National Library of Medicine (NLM).