Intestinal Colic

摘要

Intestinal colic is a common surgical symptom indicating obstruction. There are several possible causes and the epidemiology varies considerably from region to region. The main clinical issue is to determine whether the obstruction affects the small bowel or the colon, since the causes and treatments are different. Delay in operative intervention may lead to an unnecessary bowel resection, an increased risk of perforation and an overall worsening of patient morbidity and mortality. This paper reviewed intestinal colic and emphasized the importance of history taking, examination and basic imaging in the early diagnosis of its cause and thus facilitate proper management. Intestinal colic is an intermittent, crampy abdominal pain that emanates from the increased gut peristalsis against an obstruction. This squeezing pain builds up and then eases off and usually comes in waves in an attempt to overcome the obstruction. The colicky abdominal pain increases in frequency and later becomes constant as peritonitis ensues. [1] The visceral pain of intestinal colic is usually referred towards the midline rather than being localised as the gut has a midline origin of development. The visceral sensory fibres are carried by the sympathetic nerves on their way to the spinal cord. Thus foregut (lower oesophagus to mid-second part of duodenum) colicky pain is carried by the greater splanchnic nerve (T5-T9 ) and referred to the epigastrium; mid-gut {mid second part of duodenum to proximal two-thirds of transverse colon) colicky pain is carried by the lesser splanchnic nerve (T10-T11) and referred to the umbilicus while hindgut {beyond the distal third of transverse colon ) colicky abdominal pain being carried by the least splanchnic nerve (T12) is referred to the suprapubic area. The other sources of pain are somatic (localized) from abdominal distension and peritoneal irritation when ischaemia or perforation supervenes.