Small Bowel Obstruction
If you have been diagnosed with, or suspect you have a, small bowel obstruction, you know how serious it is. Your immediate, and ongoing, health needs are unique. You need a team on who you can count to help you when you need it the most.
A small bowel obstruction (SBO) is a condition in which the small intestine becomes blocked. This can either be a partial or complete blockage. The digestive tract is one long muscular tube. It starts at the mouth and ends at the anus. The muscles push food through the digestive tract. During this time, your body either absorbs nutrients or expels the remaining. In a bowel obstruction, air, fluid, and food get stuck in the intestine and they cannot move through as normal.
Causes of small bowel obstruction
There can be many causes of bowel obstructions. The most common causes are:
- Previous surgery in the abdomen – This is the most common cause. After surgery, scar tissue, or adhesion, can form inside the abdominal cavity. This causes the intestines to stick to each other or to the abdominal wall. This can cause a narrowing or “kinking” of the intestines. Sometimes the intestine can get wrapped and tangled around the adhesion in such a way that they cannot untwist themselves.
- Cancer – Cancer can grow inside or outside the intestine and block it.
- Hernias – A hernia is an opening in the muscle or connective tissue that covers the abdominal muscle. Part of the intestine can push through the opening and get trapped. This can cause a blockage in the intestines.
- Twisting of the intestines– can be spontaneous, or also caused from adhesions as above.
Symptoms of a small bowel obstruction
Symptoms depend on where the blockage is in your intestine. It also depends on if you have a complete or partial obstruction. The most common symptoms include:
- Abdominal pain, often feels like severe gas pains or cramps.
- Abdominal swelling and bloating – The abdomen can get large, swollen, and feel hard when you touch it.
- Nausea and vomiting.
- Not being able to have a bowel movement or pass gas.
If you have any of these symptoms you should seek medical attention quickly. It is possible a more severe condition can result from untreated bowel obstructions.
Potential Complications from a bowel obstruction
A bowel obstruction, whether partial or complete, can lead to serious and life threatening conditions if left untreated.
The intestine can get swollen from the trapped air, fluid, and food. This swelling can make the intestine less able to absorb fluid. This leads to dehydration and kidney failure. Nausea and vomiting will also cause dehydration.
Excess swelling of the intestine can cause the intestine to rupture or burst. A ruptured intestine can lead to peritonitis, or a severe infection in the abdominal cavity.
When the intestine is blocked, the blood vessels that bring oxygen to the intestine get blocked, too. Without blood, parts of the intestine can die.
All these conditions need emergency surgery. These complications may be avoidable if we treat the obstruction early.
Testing for a bowel obstruction
Various tests may be necessary to determine if you have a bowel obstruction. It is possible there is other condition(s) causing your symptoms. Common tests may include:
- Blood tests to check for signs of infection or inflammation in the body, kidney and liver function, electrolyte abnormalities (levels of sodium/ potassium/ calcium, etc.).
- X-ray of the chest or abdomen.
- A CT scan or a specialized X-ray that creates a picture of the organs inside the abdomen. In some cases, we will ask you to drink a liquid called “contrast” beforehand. The contrast will show up in your intestines on the CT scan or X-rays. It can help the doctor see what’s causing the blockage and where the blockage is.
Treatment for a bowel obstruction
Treatment depends on the degree of blockage (partial or complete) and your symptoms.
If you have an SBO, we will treat you in the hospital. Your doctor will give you intravenous (IV) fluids and medicines. You will not eat or drink until the obstruction resolves as food and fluids make the condition worse.
You will also likely get a nasogastric tube. This is a thin, plastic tube that goes in your nose, down your esophagus, and into your stomach. The tube will suck up the fluid and air from your stomach, to help decompress your intestines. This will make your stomach feel better and help keep you from vomiting.
Sometimes, by releasing the pressure from inside the intestines, the blockage releases on its own.
Many people, especially those with a partial SBO, will not need any other treatment. That’s because, many times, an SBO gets better on its own, with bowel rest and decompression.
Surgery for bowel obstruction
Some people will not get better with decompression and will need surgery. You are likely to need surgery if:
- Your SBO gets worse
- You have a complete blockage
- The blockage is not resolved with the tube decompression
The goals of the operation are to:
- Diagnose and resolve the source of the obstruction if it is severe.
- Diagnose and resolve an obstruction not resolving on its own after 24-48 hrs
- Diagnose and resolve an obstruction where symptoms are worsening.
We complete the surgery while you are under general anesthesia, completely asleep.
During surgery, your surgeon will make an incision in the mid-portion of your belly. He or she looks through all your intestines to find the area of blockage.
If you have adhesions or scar tissue, you will cut through them to allow the intestines to open and release the blockage.
If there is a hernia causing your obstruction, we may need to repair it.
If there is any area of your intestine that appears unhealthy or not viable (alive), we will remove that part of your intestines. We will reconnected the two ends so they work normally.
Sometimes, there can be a tumor in the small intestine that is causing the blockage. Again, we would remove this segment of your intestine and your intestines will be reconnected.
Your may be a short surgery or it may take several hours to open all the intestines. The doctor will decide if you need other interventions while in the operating room.