Intussusception

Intussusception is a condition where there is an obstruction in the intestinal walls. Inflammation in the intestines then leads to blockage and decreased blood flow. This usually occurs in children. Symptoms of intussuspection include abdominal swelling, vomiting bile, stools with blood and mucus. The patient's condition will worsen with weakening pulse, lower blood pressure, rapid and shallow breathing and cramping abdominal pain. Intussusception in adults, the symptoms are rectal bleeding, nausea, vomiting and distention in the abdomen. There might increased urgency for bowel movements. Adults may develop Intussusception due to tumor growths, scar tissue or chronic diarrhea.

A physician will be able to notice the tenderness and swelling in the intestine. An abdominal ultrasound will be done to investigate the extent of swelling and damage if any. Barium enema may be introduced and x-ray taken of the intestines. Intussusception is treated with air or barium enema. In case of any damage to the intestine, surgery is considered to remove or ease the intestinal blockage.

Intestinal Obstruction

A complete or partial blockage of the bowel thereby preventing intestinal content to move through is termed as intestinal obstruction. The bowel comprises the large intestine and the small intestine. When there is a block in either of them, the condition shows up. Intestinal content like fluids, food and gas do not pass through completely or partially due to this condition.

Intestinal obstruction is also known as paralytic ileus, bowel obstruction or colonic ileus. The blockage or obstruction may cause pain that is intermittent. If left untreated, intestinal obstruction may lead to death of those parts of the intestine that are blocked leading to further complications. However if treated on time, intestinal obstruction can be treated effectively.

What causes intestinal obstruction?

Common causes for intestinal obstruction:

• Inflammatory bowel diseases such as Crohn's disease
  
  
• Tumors in the small intestine
  
  
• Intestinal adhesions, bands of fibrous tissue in the abdominal cavity that are formed after the pelvic or abdomen surgery.
  
  
• Intussusception
  
  
• Volvulus i.e. twisted intestine.

Mechanical causes for intestinal obstruction arise from

• Hernia
  
• Tumor, Colon cancer
  
• Stricture, narrowing of the colon caused by inflammation or scarring.
  
• Diverticulitis
  
• Impacted stool, noticed in people who get constipated for long periods.
  
• Post surgery scar tissues or adhesions.
  
• Gallstones in a few cases
  
• Inflammatory bowel diseases such as Crohn's disease.

Paralytic ileus or pseudo-obstruction is a major cause of intestinal obstruction in children and infants. Conditions that cause paralytic ileus include:

• Complications from an abdominal surgery or pelvic surgery.
  
• Kidney or lung disease
  
• Bacteria or virus that cause intestinal infections
  
• Decreased blood supply to the intestine
  
• Abdominal infections like appendicitis
  
• Chemical, mineral or electrolyte imbalance
  
• Substance abuse like use of narcotics
  
• Muscle and nerve disorders like Parkinson's.

Symptoms include abdominal pain and cramping, distention and bloating. There is reduced appetite and vomiting. An obstruction in the intestines can lead to either constipation, diarrhea or flatulence. After physical examination, Xray or CT scan of the abdomen might be suggested as also . In some cases, an enema or stent is required to open up a partial blockage. Nasogastric tube (tube from nose to stomach) is passed so as to relieve abdominal swelling and vomiting. Volvulus of the large bowel may be treated by passing a tube into the rectum.

Barium Swallow Test

Barium sulfate is a popular compound used in the diagnostic investigation of abnormalities of internal organs. This test is used to investigate issues of upper gastrointestinal tract. Most cases in this diagnostic category include abnormalities associated with esophagus and the digestive system. Barium swallowing procedure determines the presence of anatomical abnormalities such as narrowing of the esophagus, abnormal growths such as cancer, tumors, polyps and also for the presence of foreign objects as a result of ingestion. Barium swallow test also helps in the identification of conditions such as hiatal hernia. In this condition, the upper portion of the stomach protrudes into the chest cavity through the diaphragm opening called esophageal hiatus.

Preparation for Barium swallow test

Since barium swallow is a radiological procedure, patients are usually advised not to take any food the night before the test. This enables the radiologist to analyze and discover underlying abnormalities in the gastro intestinal tract. Presence of food particles can mask the diagnosis to a great extent. The radiologist may make general enquiry to ensure that the patient is not pregnant or on insulin. Before the test is performed, the patient is advised to drink a milky liquid. This liquid contains barium sulfate. Many patients complain about the chalky taste of this liquid.

In some cases, it induces nausea. In addition to the barium sulfate liquid, the patient is also advised to take few pills that produce bubbles or effervescence. The effervescence induced by the pills is necessary to facilitate the air in to the stomach to view the structures carefully. Patients are advised not to belch although the procedure induces it. This enables the radiologist to identify the underlying disorders better. The risks associated with barium swallow test are minimal. One of the most common side effects of this test is constipation. Other conditions include anaphylactic reactions and aspiration in which the ingested barium enters the windpipe. The entire procedure may last around 30 minutes. Fluoroscopy is often used during a barium swallow.

Barium enema

Barium enema is advised for patients who experience difficulties in bowel movements and also associated conditions such as weight loss and anemia. Barium sulfate is administered through the anus by using a tube to investigate the bowel disorders in the patient. This radiological examination gives a complete picture of the bowel beginning from the colon to the large intestine. Abnormalities such as colon cancer, polyps, peptic ulcer disease, GERD (Gastro Esophageal Reflux Disease), achalasia, strictures and tumors can be identified with this method. Drugs such as buscopan are given to the patients to relax the bowel.

Patients are advised not consume any solid foods or milk products as it may hinder the diagnosis. The recommended diet for the patients undergoing this test is usually clear fluids and juices. Although the test has minimal side effects, many patients experience the inconvenience of cramping during the procedure. The intensity of cramping varies from person to person. Bowel relaxation drugs are administered to prevent unprecedented events during the procedure. During the procedure, patients often experience the urge to defecate which has to be controlled in order to obtain proper diagnosis of the bowel. One of the significant risk factors associated with this procedure is the leakage of barium from previously perforated colon. The side effects of the leaking barium from the colon can be fatal. Hence, thorough preparation is done before the test to ensure and minimize the risk factors. Pregnant women are not advised to do this procedure. After this test, patients are asked to drink extra fluids and water to relieve the bowels of the barium.