Intestinal Narrowing

Narrowing of the intestines is a condition that frequently accompanies disease of the lower gastrointestinal tract. The situation causes many symptoms and it can even have life-threatening consequences.

Causes

Most cases are caused by scarring that accompanies various inflammatory processes, or by locally growing tumors. 

Colon Cancer

Colorectal cancer is a common cause of narrowing of the colon. In addition, it can cause anemia due to chronic blood loss from the tumor mass into the intestine.

Crohn's disease and ulcerative colitis

These non-infectious autoimmune intestinal inflammatory diseases may lead to scarring and narrowing of some of the affected sections of the intestine. It typically occurs in certain forms of the Crohn's disease.

Diverticulitis

Diverticulitis usually occurs on basis of diverticulosis. The infection of a diverticulum is painful and can be complicated by acute peritonitis or subsequent scarring and narrowing of the intestinal lumen.

Ischemic colitis

In this case, the intestinal inflammation is based on lack of oxygen in the intestinal wall. Less severe forms of ischemic colitis may be asymptomatic, but the damaged intestine may form strictures after some time.

Radiation colitis

Radioactive energy used in therapy of various tumors may damage the intestines and trigger reactive inflammatory response associated with hemorrhage and intestinal strictures.

Surgery

Surgery on the intestines and that is the particular removal of part of the intestine and resulting suture ends together, may result after some time to create a constricted space.

Symptoms

The constriction of the intestine disrupts the proper passage of stool. Small and partial narrowing may not cause any difficulties, but more significant stricture (especially in the end of the colon or in rectum where the stool is bulkier) may have symptoms. The condition manifests with abdominal pain and constipation, which is alternated with occasional diarrhea. The diarrhea is caused by accumulation of feces in front of the constriction, while a small portion of stool passes under pressure through the stricture. The fundamental complication of intestinal narrowing is development of complete intestinal obstruction (so-called mechanical ileus). This acute situation manifests with vomiting, severe abdominal pain and stoppage of defecation. Without medical help, it may quickly progress into peritonitis, sepsis and life-threatening circulatory shock.

Diagnosis

A stricture in the small intestine may be found by enteroclysis or by CT enteroclysis. The whole colon is best examinable by colonoscopy. The colonoscopy not only allows seeing the narrowed area, but also taking samples for histological examination to exclude tumorous processes. The use of capsule endoscopy is possible, but somehow risky as the device may jam in the narrowed place.

 

Strictureplasty
Strictureplasty - longitudinal cut through 
and subsequently transversely stitching the cut (read below)

 

Treatment

The therapy depends on the nature and severity of the narrowing. Benign narrowing, which does not acutely threaten the patient may be treated by therapeutic colonoscopy when the doctor uses special balloon to dilate the narrowed area. However, the effect may be far from satisfactory and the stricture may recur. Surgical method is either strictureplasty (the stricture is cut longitudinally and transversely sewn, which widens the lumen) or complete removal of the narrowed section.