Intestinal obstruction is the obstruction of the operation of intestinal contents in any section of the intestine from jejunum to rectum, which is characterized by the expansion of the intestine above the tightly obstructed part, the disorder of accumulation and peristalsis of intestinal contents, abdominal pain, abdominal distension, vomiting, inability to exhaust and defecate, etc. The incidence of intestinal obstruction is divided into priorities. Acute intestinal obstruction is very common, the incidence is second only to acute appendicitis, which can lead to death, so early diagnosis and comprehensive treatment are very important, and chronic intestinal obstruction is not uncommon. The urgency of the disease is related to the degree of obstruction. If only the intestinal cavity is partially blocked, it will show chronic or intermittent attacks among young people in China. Chronic intestinal obstruction is often caused by tumor adhesion tuberculosis and nonspecific inflammatory stenosis. According to the case data in China, the common causes of acute intestinal obstruction are: external abdominal hernia, abdominal adhesion, intussusception, volvulus and intestinal congenital ascaris. Sexual malformed intestinal tumor, intestinal tuberculosis, intestinal stenosis, hernia, intestinal obstruction, foreign body, mesenteric vessels, accounting for% of the digestive tract, others and unknown. Mechanical intestinal obstruction is the most common in clinical application. It is of great significance to distinguish simple intestinal obstruction from strangulated intestinal obstruction. Simple intestinal obstruction will not endanger life in a short time, while strangulated intestinal obstruction will inevitably lead to death if the surgical treatment area is not edited in time. Intestinal obstruction is often accompanied by mesenteric vascular obstruction, which begins to close and ooze at the same time. The continuous increase of liquid and gas can not develop from the rapid increase of discharge pressure of upper digestive tract to strangulated complete colon obstruction. Due to the existence of ileocecal valve at the proximal end, it should be regarded as closed intestinal obstruction. Pathophysiology: Keeping the intestinal tract unobstructed and its contents running unimpeded is the primary condition to ensure that the gastrointestinal tract can fully digest food and absorb water and various nutrients. Once intestinal obstruction occurs, obvious pathological changes will occur in the upper or affected intestine, and the whole body will also be seriously affected. The degree of collapse and expansion of the intestine above the dilated obstruction site depends on the location and time of obstruction. The longer the position, the more serious the flatulence will be. The digestive tract graduates every day, secreting more than ml of digestive juice, including gastrointestinal juice, bile and pancreatic juice. Carbohydrate mainly comes from swallowing air and also produces gas. In addition, nitrogen in foreign blood can also diffuse into the intestinal cavity, and the capillaries in the intestinal wall are constantly increasing due to the accumulated pressure of a large number of liquids and gases. Blood vessels are squeezed, blood supply is reduced, and finally ischemic necrosis of intestinal wall occurs. When vascular and dynamic intestinal obstruction occurs, the intestine loses its peristalsis function and expands due to gas-liquid accumulation. Chronic intestinal obstruction is generally incomplete mechanical obstruction, and the intestine is also dilated, but the muscular layer of the intestinal wall is thickened. Loss of body fluids and acid-base imbalance are mainly seen in acute intestinal obstruction, except for obvious loss of vomiting. A large amount of digestive juice accumulated in the intestinal cavity can not be used, which is actually equivalent to the loss of skills. At the same time, the intestinal wall. After the blood circulation is blocked, the first thing is the edema and exudation of intestinal wall caused by venous reflux disorder. When high intestinal obstruction occurs, vomiting is frequent. In the case of low intestinal obstruction, there is more effusion and exudation in the intestinal cavity. These can cause serious loss of body fluids, and secondary dehydration is accompanied by the loss of a large number of electrolytes in gastrointestinal fluids, such as sodium, potassium and chloride intestinal fluids. The retention of acidic metabolites caused by dehydration can lead to serious metabolic acidosis when strangulated intestinal obstruction occurs. There is bloody exudation in blood and abdominal cavity, which can cause blood loss. The longer the twisted intestine, the more blood loss and the more toxins absorbed. Usually, there are a large number of bacteria in the intestinal cavity, and the stagnation of intestinal contents is more conducive to the reproduction of bacteria. If the intestine has been strangulated, the decomposition products of the intestinal wall necrosis tissue mentor are also toxic in clinic. These toxins penetrate into an abdominal cavity and are absorbed by the peritoneum, leading to toxemia and toxic shock. Chronic intestinal obstruction will not produce obvious dehydration and electrolyte loss. There is no problem of toxin absorption and learning, but patients often can't eat normally, and their long-term digestion and absorption ability is seriously damaged, which will lead to malnutrition. Clinicians describe different types of intestinal obstruction. There are four main clinical manifestations of acute simple intestinal obstruction: ① Abdominal pain, mechanical intestinal obstruction, paroxysmal colic due to strong intestinal peristalsis above the obstruction site, which may be accompanied by abdominal sound, auscultation, audible high-pitched bowel sounds or dyspnea. On the abdominal wall, sometimes we can see paralytic intestinal obstruction caused by intestinal tube or peristalsis wave. There is no paroxysmal abdominal pain, but there is swelling pain and abdominal discomfort. ② Vomiting mostly occurs in the early stage of high intestinal obstruction. Early vomiting is gastric juice and bile. Vomiting occurred after low intestinal obstruction. Early vomiting is reflex. In the later stage, it will be contagious. In the case of colon obstruction, fecal fluid can be vomited. Vomiting is mostly reflex, because there is ileocecal valve to prevent reflux. ③ The lower the position of abdominal distension obstruction, the more severe the abdominal distension. Abdominal distension is not obvious when there is obstruction. Abdominal distension caused by colon obstruction is characterized by severe paralytic intestinal obstruction around the abdomen. ④ Stop defecation and exhaust. Complete intestinal obstruction generally has no exhaust or early defecation, especially high intestinal obstruction. The accumulated feces or gas can still be discharged, but strangulated intestinal obstruction will stop soon after defecation and exhaust, thus guiding clinical manifestations. Abdominal pain becomes more serious, and there is still strong peristalsis in the intestine above the persistent ischemia site, so abdominal pain is accompanied by paroxysmal cooperative abdominal cavity aggravation. Stimulating peritoneum during bloody exudation is also a cause of persistent abdominal pain. Abdominal peritonitis is characterized by tenderness, extensive muscle tension and rebound pain. If there is a closed loop, abdominal distension is asymmetric. A segment of intestinal loop can be felt in the obvious part of the bulge, and sometimes vomiting and bloody or coffee-like intestinal contents are also very serious. In addition to dehydration, there is an increase in body temperature, rapid pulse and even shock, and the white blood cell count is also significantly increased. The manifestations of vascular intestinal obstruction are similar to strangulated intestinal obstruction. According to its key clinical manifestations and signs and X-ray examination, it is not difficult for doctors to diagnose intestinal obstruction. Abdominal X-ray examination is an important method to diagnose intestinal obstruction many times. Under normal circumstances, the small intestine has no gas. If there is gas, abdominal plain film shows that there is liquid level in abdominal cavity. According to the liquid level, estimate the position of intestinal obstruction. If there is a lot of liquid level in the upper abdomen, it is mostly high obstruction. The manifestation of colonic obstruction is closed-loop intestinal obstruction. When the fluid in the loop of intestine is fixed horizontally, sometimes obstruction can be seen, and the expansion is more obvious. Barium meal examination is not suitable for acute intestinal obstruction, so as not to aggravate intestinal obstruction. Barium meal examination should also be cautious for chronic intestinal obstruction. If colon obstruction is suspected, such as ileocecal intussusception of sigmoid colon, barium enema examination is very helpful for diagnosis. Chronic middle-aged intestinal obstruction has intermittent abdominal cramps with abdominal sounds due to intestinal wall hypertrophy, and symptoms are relieved after frequent abdominal distension, exhaust or defecation. Intestinal barium meal or barium enema examination can often be seen in the abdomen, which can indicate the obstructive position. Acute intestinal obstruction should be differentiated from other acute abdominal diseases, such as acute appendicitis, acute enteritis, acute pancreatitis, abdominal purpura and intestinal ascaris. Note that acute enteritis and acute pancreatitis sometimes appear liquid level due to local intestinal stasis, but only after establishing the diagnostic branch of acute intestinal obstruction, it is more important to distinguish whether simple or strangulation is high or low and whether it is colon obstruction. Finally, we should consider whether it causes intestinal obstruction. The reason is the history of abdominal surgery or inflammation, which is the most likely to cause adhesion. In the elderly, tumors should be considered. For elderly patients with sigmoid colon obstruction, fecal obstruction caused by habitual constipation should also be considered. At this time, anal digital examination often helps to diagnose the key points. Inguinal examination is a common cause of acute intestinal obstruction. Congenital malformation is the most common cause of intestinal obstruction in newborns, intussusception is the most common cause of intestinal obstruction in children under one year old, except ascaris lumbricoides. Many simple acute intestinal obstruction are treated by non-surgical cognitive theory, including gastrointestinal decompression, intravenous infusion to supplement water and electrolyte, and appropriate antispasmodic drugs. Some mechanical intestinal obstruction (such as stricture caused by volvulus or adhesion with inflammatory edema, mild volvulus and intussusception, etc.). ), the more intestines above intestinal obstruction, the more serious the obstruction. After gastrointestinal decompression, intestinal dilatation above obstruction can be reduced or eliminated, and intestinal peristalsis can be straightened out. Inflammatory edema in stenosis can reduce intestinal obstruction by reducing volvulus or intussusception. The Ministry of Health can automatically relieve patients of defecation and exhaust. If simple intestinal obstruction is still not relieved after ~ hours of rich surgical treatment, it should not be delayed. Before the surgical treatment is announced, antibiotics can be given appropriately to prevent abdominal exudate from complicated with bacterial infection. After laparotomy, the obstruction site should be found first, and the junction between the expanded intestine and the collapsed intestine is the obstruction site, and then the obstruction should be relieved according to the obstruction reason. Restore intestinal patency. If the intestine is necrotic or suspected of necrosis, this part of the intestine should be removed. Acute colonic obstruction should generally be removed as soon as possible unless it is caused by fecal obstruction. Because there are many bacteria in the colon that are not prepared by antibiotics, sanitary anastomosis is easy to be infected and leaked. Therefore, unless there is not too much fecal pollution in the colon, colostomy should be performed first to relieve obstruction, and then acquired surgery should be performed according to the situation. When chronic intestinal obstruction is found in the hospital, it is generally necessary to give birth to a surgical treatment tutor to remove the cause of obstruction.