Homeopathic Management of Acute Intestinal Obstruction: A Clinical Case Report

Abstract:

A 36-year-old woman presented with acute abdominal pain, vomiting and absolute obstinate constipation, suspected for intestinal obstruction. Radiological imaging on 14th April showed multiple dilated small-bowel loops with air–fluid levels, consistent with small intestinal obstruction. Using homeopathic analysis, Plumbum metallicum was selected and prescribed. No surgical intervention was performed.  The follow-up X-ray on the next day was much better. This case highlights the potential role of individualized homeopathic treatment in acute bowel obstruction, with full symptomatic and radiological recovery achieved without any surgical approach.

Keywords: Acute Intestinal Obstruction, homeopathy, plumbum metallicum, case report, homeopathic management, conservative management.

Introduction to Intestinal Obstruction:

-Intestinal obstruction is a serious condition in which there is complete or partial blockage of the large or small intestine.

 Acute obstruction can be life-threatening if not relieved, since trapped bowel segments may become ischemic and necrotic from compromised blood supply.

— Types of intestinal obstruction are: 

(a) Mechanical- due to any obstruction in the intestines. E.g. adhesions from prior surgery, hernias, tumours and volvulus.

(b) Functional: paralytic ileus. The most common causes of small-bowel obstruction in adults include postoperative adhesions, hernias and malignancy.

-Conventional management of confirmed obstruction typically requires hospital admission, IV fluids and gastric decompression (nasogastric tube) to stabilize the patient.

Complete obstruction is considered a surgical emergency due to the risk of ischemia. If conservative measures fail or if signs of strangulation appear, laparotomy is indicated to relieve the blockage and resect any nonviable bowel.

Sign and Symptoms:

• Abdominal pain, cramping or bloating.
• Nausea and vomiting.
• Lack of appetite.
• Malaise (an overall feeling of illness).
• Diarrhoea (usually a sign of a partial blockage).
• Difficult Defecation.
• Rapid heartbeat, dark-colored pee (urine) and other signs of dehydration.
• Severe constipation.

Case Presentation:

Patient: Rehnumabibi H. Pathan

Age/Gender: 36 / Female

Location: Godhra, Gujarat, India

Date: 14^th April 2024

▪︎Presenting Complaints:  

-Patient came with complaints of severe, colicky abdominal pain. She was unable to pass flatus for 5-7 days with persistent vomiting of ingested material. 

-Complained of cramping pain esp. in the umbilical region from which the pain spread in all directions. 

-She said: “Mane evu laage che jaane koi e pet dori bandhi che je pachal kaatiya sudhi khechay che” (someone is pulling the abdomen to the lower back)  

– On examination abdominal distention with diffuse tenderness was found. Absent bowel sounds.

-Since the complaint started, she is unable to rest in a bed in the same position, she constantly wants to go from one bed to another.

– Unbearable pain which aggravates especially after eating. Nausea and vomiting since 3-4 days.

▪︎History of Present Illness:

The patient came with her complaint of severe colicky pain which was cramping in nature, she took allopathic medications for 2 weeks with no relief. She also complained of persistent nausea and vomiting. She could not pass flatus from the last 5-7 days. Pt. was advised for X-ray where a diagnosis was confirmed via radiological evaluation.

▪︎Past Medical History: Appendectomy done 4 years ago.

▪︎Family History: Non-contributory

▪︎General Examination:  B.P.:110/80 mm hg, Pulse: 76/min R.R.:18/min

▪︎Radiological Findings:

• 14 April 2024 (Erect Abdominal X-ray): Multiple centrally located dilated small-bowel loops with several air–fluid levels, indicating obstruction. No free intraperitoneal air was seen.
• X-ray suggested acute small intestine obstruction.

Clinical Diagnosis:

Acute intestinal obstruction – most consistent with paralytic ileus or early mechanical small-bowel obstruction. (A definitive mechanical cause was not identified though)

Totality of Symptoms:

Inactivity of intestines – sluggish bowel movement.

Restlessness in bed – constantly wants to change position.

Cramping & gripping abdominal pain.

Drawing pain at the umbilicus.

Paralysis of intestines – marked muscular inactivity.

Retraction sensation – as if drawn inward by a string, pulled towards the spine.

Repertorial Sheet:

Prescription:

Rx, Plumbum metallicum 200C in water doses.

(Every 2 hours 2 teaspoons are given from half a glass of water.)

Follow-Up:

#14^th April: Within 6 hours, the patient passed stool.

#15^th April:  ▪Response to Treatment:

-Before treatment: Gross abdominal distension; severe colicky pain; no stool or flatus; X-ray showed high-grade obstruction (multiple dilated loops and air–fluid levels).

-After treatment (Day 1): 

Passed stool within 6 hours

Appetite returned. 

Her pain subsided up to 70%.

Great relief in restlessness. 

The follow-up X-ray was much better.

Surgical intervention was not required. The rapid resolution of both symptoms and radiological findings was found.

– RX,

 Plumbum Meta. 200c given O.D. for 2 days

Differential remedies: (Why ruled out?)

1. Nux vomica: 

No ineffectual urging, no irritability, and no signs of spasmodic effort.

2. Opium: 

Pain was present (not suppressed), patient was alert and anxious – not drowsy or unconscious

3. Rhus tox:

No joint stiffness or aggravation from rest; lacked typical motion-related modalities and paralytic symptoms

Conclusion:

This case illustrates that a classical homeopathic approach, with careful remedy selection based on the individualized symptom totality, can successfully manage an acute intestinal obstruction in selected cases. Plumbum metallicum was chosen for its specific affinity to paralytic intestinal conditions and matching rubrics. Also the pathological symptoms of intestinal obstruction were not given much importance. Under homeopathic management alone, the patient experienced rapid symptomatic and radiological recovery without surgery. These results suggest a potential complementary role for individualized homeopathy in acute abdominal emergencies, warranting further documentation and study in larger series.

References:  

1. Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. 3^rd rev. aug. ed. Based on 9^th ed. New Delhi: B. Jain Publishers; p. 465.
2. Clarke JH. A Dictionary of Practical Materia Medica. New Delhi: B. Jain Publishers; p. 710–714.
3. Allen HC. Keynotes Rearranged and Classified with Leading Remedies of the Materia Medica. 15^th reprint ed. New Delhi: B. Jain Publishers; 2017. P. 316.
4. Phatak SR. Materia Medica of Homoeopathic Medicines. 2^nd rev. and enl. Ed. New Delhi: B. Jain Publishers; [Plumbum section]
5. Schroyens F, editor. Synthesis Repertory [computer program]. Version 9.1. Belgium: Archibel; [accessed 2024 April].
6. Das S. A Concise Textbook of Surgery. 10^th ed. Kolkata: S. Das Publishers; 2018.