How to prevent small bowel obstruction

How to prevent small bowel obstruction

One way of preventing an adhesion-related bowel obstruction surgery is Clear Passage, a manual physical therapy that uses no surgery or drugs. . Adhesions are bands of internal scar tissue that form after a surgery, trauma, infection or inflammation; there is no way of preventing adhesion formation as the body heals from these events. Clearing an existing obstruction and preventing re-obstruction requires decreasing the adhesions.

You should seek immediate medical care as soon as you begin experiencing symptoms of an obstruction. There are also steps you can take, in conjunction with the care provided by your medical team, to manage a partial obstruction and reduce your chances of developing a complete obstruction.

How to Prevent Complete Bowel Obstruction Through Dietary Changes

You will want to either minimize or completely eliminate fiber from your diet, depending on the severity of your obstruction. Dietary fiber is the edible component of plant foods that humans are unable to digest. Reducing fiber intake limits the amount of undigested material that passes through the large intestine, which decreases bowel movements and helps to ease other symptoms such as abdominal pain.

The three main diet tracks outlined below can help bowel obstruction patients relieve and manage their symptoms. We encourage you to download our complete Digestive Health Guide for a step-by-step explanation of each diet plan.

  • Cook vegetables thoroughly to minimize the amount of gas they produce after consumption.
  • Do not continue eating any foods that appear to make your symptoms worse.
  • If your symptoms improve, reintroduce a greater variety of foods into your diet one at a time, in conservative amounts. This will enable you to pinpoint foods that you cannot have.

Minimal Fiber Diet

  • Transition to this track from the Low-Fiber Diet if your bowel obstruction symptoms become worse or begin occurring more often.
  • This diet has less residue than the Low-Fiber Diet. However, if you continue to have abdominal or stomach pain and intestinal cramping while following this diet plan, you may need to work with your health care team to lower your residue intake even more.
  • Follow this diet, which has little to no residence, if you have severe symptoms with occasional or frequent vomiting after eating solid foods.
  • Avoid all solid foods when on a liquid diet.
  • Fluid intake is a crucial part of this diet track. Fluids are important for keeping your skin, eyes and the lining of your mouth moist, and for preventing dehydration.

Surgery and the Vicious Cycle

Our experience has shown us that surgery is not the solution for preventing future obstructions. The very surgery designed to remove the abdominal adhesions causing a patient to obstruct will almost always lead to more adhesions, leaving the patient trapped in a vicious cycle of adhesions-surgery-adhesions. Our therapy decreases adhesions without surgery, allowing patients to break the cycle and reclaim their lives.

Overview

What is the small bowel?

The small bowel, also called the small intestine, ranges from 20 to 30 feet long and is about 1 inch in diameter. It has many folds that allow it to fit into the abdominal cavity. One end of the small bowel is connected to the stomach and the other to the large intestine.

The small intestine consists of 3 parts: the duodenum, the jejunum and the ileum. Partly digested food passes from the stomach to the small intestine, where the final digestive processes occur. Nutrients, vitamins, minerals and water are absorbed by its lining.

What is small bowel obstruction?

Small bowel obstruction is a partial or complete blockage of the small intestine. If the small bowel is functioning normally, digested products will continue to flow onward to the large intestine. An obstruction in the small bowel can partly or completely block contents from passing through. This causes waste matter and gases to build up in the portion above the blockage. It could also interfere with the absorption of nutrients and fluids.

Symptoms and Causes

What causes small bowel obstruction?

Small bowel obstruction can occur in people of all ages. There are many common causes and risk factors, including:

  • Adhesions: These are bands of scar tissue that may form after abdominal or pelvic surgery. An earlier abdominal surgery is the leading risk factor for small bowel obstruction in the United States.
  • Hernias: Segments of the intestine may break through a weakened section of the abdominal wall. This creates a bulge where the bowel can become obstructed if it is trapped or tightly pinched in the place where it pokes through the abdominal wall. Hernias are the second most common cause of small bowel obstruction in the United States.
  • Inflammatory disease: Inflammatory bowel disorders such as Crohn’s disease or diverticulitis can damage parts of the small intestine. Complications may include narrowing of the bowel (strictures) or abnormal tunnel-like openings (fistulas).
  • Malignant (cancerous) tumors: Cancer accounts for a small percentage of all small bowel obstructions. In most cases, the tumor does not begin in the small intestine, but spreads to the small bowel from the colon, female reproductive organs, breasts, lungs or skin.

What are the symptoms of small bowel obstruction?

Symptoms of small bowel obstruction may include the following:

  • Abdominal (stomach) cramps and pain
  • Bloating
  • Vomiting
  • Nausea
  • Dehydration
  • Malaise (an overall feeling of illness)
  • Lack of appetite
  • Severeconstipation. In cases of complete obstruction, a person will not be able to pass stool (feces) or gas.

Diagnosis and Tests

How is small bowel obstruction diagnosed?

  • Medical history: The doctor will ask the patient about any previous abdominal or pelvic surgeries or relevant procedures that have been done.
  • Physical examination: The doctor will examine the abdominal area for signs of swelling, pain, masses, bulges or hernias, surgical scars, or tenderness.
  • Blood tests: A complete blood count and electrolyte analysis will be done.

In cases where patients have fever, low blood pressure, or rapid heartbeat, other lab tests may be needed, including:

  • Abdominal X-rays: Basic X-rays can sometimes show whether the small bowel is obstructed.
  • Computed tomography (CT scan): A CT scan may be done to confirm a diagnosis and give more accurate information about the cause and the site of obstruction.

Management and Treatment

How is small bowel obstruction treated?

  • Hospitalization: Patients with an intestinal obstruction are hospitalized. Treatment includes intravenous (in the vein) fluids, bowel rest with nothing to eat (NPO), and, sometimes, bowel decompression through a nasogastric tube (a tube that is inserted into the nose and goes directly to the stomach).
  • Anti-emetics: Medications may be required to relieve nausea and vomiting.
  • Surgery: If the small intestine is completely blocked or strangulated, surgery may be needed. The goals of surgery are to identify and treat the causes of bowel obstruction. At times, segments of the bowel may need surgery. The diseased segment may need to be re-sectioned and removed.

Last reviewed by a Cleveland Clinic medical professional on 03/20/2019.

References

  • National Institute of Diabetes and Digestive and Kidney Diseases. Anatomic Problems of the Lower GI Tract. (https://www.niddk.nih.gov/health-information/digestive-diseases/anatomic-problems-lower-gi-tract) Accessed 3/26/2019.
  • Merck Manual Consumer Version. Intestinal Obstruction. (https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/intestinal-obstruction) Accessed 3/26/2019.
  • U.S. National Library of Medicine/MedlinePlus. Intestinal Obstruction. (https://medlineplus.gov/intestinalobstruction.html) Accessed 3/26/2019.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Ostomy Surgery of the Bowel. (https://www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel) Accessed 3/26/2019.

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What is a bowel obstruction?

An intestinal obstruction, also known as a bowel obstruction or bowel blockage occurs when food or liquid are unable to pass through either the large or small intestine. If left untreated, life-threatening complications such as tissue death or infection, even death, can occur.

Tissue death occurs when the intestinal obstruction cuts off blood supply to a section of your intestine and causes the tissue to die. The dead tissue weakens your intestinal wall which can lead to a tear, allowing the contents of the bowel to spread throughout the abdomen, a condition called Peritonitis. This infection that occurs deep within the abdomen is life-threatening. Surgery along with direct application of antibiotics to the infected internal sites are often required to save the patient’s life.

How to prevent small bowel obstruction

Symptoms of a bowel obstruction or bowel blockage

  • Nausea and vomiting
  • Constipation and inability to pass gas
  • Abdominal distention, which can be confused with bloating
  • Fever
  • Tachycardia, which is a heart rate that exceeds normal resting rate
  • Loss of appetite
  • Recurring abdominal pain

Causes of mechanical bowel obstructions

Adhesions: The most common cause for small bowel obstruction is intra-abdominal adhesions. Adhesions caused by abdominal or pelvic surgery cause about 65% to 75% of all small bowel obstructions. Adhesions are scar tissue that can form after infection, radiation therapy, inflammation and most commonly, surgery. One of the reasons recurring bowel obstructions are so difficult to treat is because obstructions and blockages are often treated with surgery. Post-surgical adhesions can wrap around the intestine and squeeze it shut, similar to pinching a garden hose. In other cases, a stricture (narrowing) can occur, preventing liquids and food from passing through.

Hernias: When the intestine protrudes through an opening in the abdominal wall, it is called a hernia. Hernias can squeeze the bowel shut, making it difficult or impossible for contents to pass through the intestine. This causes impacted stool, a stricture or a blockage to occur.

Crohn’s disease: This is a chronic inflammatory bowel disease that causes inflammation in the lining of the digestive tract. The constant inflammation leads to scarring and the formation of adhesions.

Malignancy: This is defines as the presence of a malignant tumor (cancer). A tumor can obstruct the intestine, causing a blockage.

Volvulus: This is an obstruction caused by the intestine being twisted or knotted. Once the intestine is twisted or knotted, nothing can pass through. This condition can also obstruct blood flow, causing tissue death.

Diverticulitis: Similar to Crohn’s disease, diverticulitis is an inflammation or infection in the small pouches of the digestive tract that can lead to scar tissue and constipation.

Food that can cause bowel obstructions

You may be wondering what food you can safely eat with a bowel obstruction. Here are some foods to avoid if you have been diagnosed with a bowel obstruction.

  • Fruits with a cellulose structure can cause, or contribute to an obstruction. One of the most common fruits reported to cause intestinal obstructions is persimmons, though a large number of cases have been reported with citrus fruits in general and other dried fruits.
  • Dried nuts and seeds.
  • Whole grain or other high fiber breads.
  • Tough or stringy pieces of meet.

Bowel obstruction prevention

  • Drink plenty of fluids – It is generally suggested that individuals drink 6 to 8 cups of water each day. Water helps food move more easily through the digestive tract.
  • Chew your food thoroughly – Not chewing food well increases the amount of work your digestive tract must do and can contribute to intestinal obstructions.
  • Clear Passage – A manual physical therapy that treats the adhesions causing recurring bowel obstructions – without surgery or drugs. By avoiding surgery, patients can often avoid repeat bowel obstructions because surgery is the primary cause of adhesions and bowel obstructions.
  • Diet change – Changing your diet may help prevent future bowel obstructions.

Bowel obstruction treatment

Fasting – Allows the bowel to rest and helps reduce risk of complications during surgery, if that becomes necessary.

Nasogastric intubation – An “NG Tube” is a tube that carries food and medicine down the throat and into the stomach and also pumps out excess stomach liquids in an effort to decompress the bowel.

Surgery – surgery may be required to remove infected or necrotic (dead) tissue or to repair perforations to the bowel.

How to prevent small bowel obstruction

What Is A Bowel Obstruction?

A bowel obstruction can be a serious condition, which can occur in the large or small bowel. A small bowel obstruction commonly occurs where loops of intestine can easily get blocked or twisted. A blockage can be partial or total, mechanical (caused by an object) or non-mechanical (caused by paralysis of movement to the bowel). A blockage can stop the passageway of all food, liquid and gas and cause considerable pain.

Small Bowel Obstruction Condition

There are many reasons why a small bowel obstruction may happen including:

  • Mechanical obstruction
  • Adhesions – fibrous tissues that develops usually after abdominal or pelvic surgery
  • Volvulus – otherwise known as a twisted bowel
  • Intussusception – ‘telescoping’ of the bowel, when a segment of bowel pushes into another segment causing it to collapse
  • Tumours – more likely in the large bowel. Small bowel cancer is still relatively rare
  • Hernias – which can cause strangulation of the bowel
  • Swallowed objects – Foreign objects swallowed by children can get stuck in the bowel
  • Inflammatory Bowel Disease – diseases like Crohn’s and Ulcerative Colitis can cause strictures or narrowing in the bowel which can cause obstructions
  • Impacted stool
  • Infection
  • Diverticulitis

Non-mechanical obstruction

A non-mechanical obstruction is also referred to as ‘ileus’ or ‘paralytic ileus’, this is when the natural movement of the bowel called peristalsis fails to happen. Ileus is usually temporary. Some medical conditions can cause this to have a long term effect and this is called ‘Intestinal pseudo-obstruction. This can be caused by:

  • Abdominal or pelvic surgery
  • Infections such as gastroenteritis or appendicitis
  • Opioid pain medications such as morphine or codeine
  • Parkinson’s Disease
  • Diabetes Mellitus
  • Hirschsprung’s Disease
  • Hypothyroidism

Symptoms of a bowel obstruction or a small bowel obstruction

Bowel obstruction symptoms of a bowel obstruction can be painful and distressing. You may experience the following symptoms:

  • Severe abdominal pain, cramps and bloating
  • Decreased appetite or inability to eat
  • Nausea and/ or vomiting
  • Inability to pass gas or stool
  • Constipation or diarrhoea
  • Abdominal swelling

A bowel obstruction becomes an emergency if your abdominal pain increases and you start to experience a fever. This could be a sign of intestinal rupture, which can become life threatening.

How is a bowel obstruction diagnosed?
Your doctor may feel around your stomach to feel for any obvious signs of swelling or a lump. You may be sent for x-rays or a CT Scan to see if there is anything causing an obstruction. You may also have a colonoscopy, which is a camera inserted via the rectum to view the inside of the colon to check for any abnormalities.

To find out about treatments for a bowel obstruction and further resources, click the links above to navigate to the pages.

Affiliation

  • 1 Department of Surgery, University of Calgary, Calgary, Alta, Canada.
  • PMID: 17897517
  • PMCID: PMC2386166

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Authors

Affiliation

  • 1 Department of Surgery, University of Calgary, Calgary, Alta, Canada.
  • PMID: 17897517
  • PMCID: PMC2386166

Abstract

Intraabdominal adhesions develop after abdominal surgery as part of the normal healing processes that occur after damage to the peritoneum. Over the last 2 decades, much research has gone into understanding the biochemical and cellular processes that lead to adhesion formation. The early balance between fibrin deposition and degradation seems to be the critical factor in adhesion formation. Although adhesions do have some beneficial effects, they also cause significant morbidity, including adhesive small bowel obstruction, infertility and increased difficulty with reoperative surgery. Several strategies have been employed over the years to prevent adhesion formation while not interfering with wound healing. This article summarizes much of our current understanding of adhesion formation and strategies that have been employed to prevent them.

Les adhérences intra-abdominales font leur apparition après une chirurgie à l’abdomen dans le cours des mécanismes de guérison normaux suivant un dommage au péritoine. Au cours des deux dernières décennies, on a effectué beaucoup de recherches afin de comprendre les phénomènes biochimiques et cellulaires à l’origine de la formation d’adhérences. L’équilibre précoce entre le dépôt de fibrine et sa dégradation semble jouer un rôle critique dans la formation d’adhérences. Même si les adhérences ont certains effets bénéfiques, elles causent aussi une morbidité importante, y compris l’occlusion de l’intestin grêle, l’infécondité et les difficultés accrues dans le cas d’interventions chirurgicales ultérieures. On a suivi au fil des ans plusieurs stratégies pour prévenir la formation d’adhérences sans nuire à la guérison de la plaie. Cet article résume une grande partie des connaissances actuelles au sujet de la formation d’adhérences, ainsi que les stratégies que l’on a suivies pour les prévenir.

Figures

How to prevent small bowel obstruction

FIG. 1. Biological events involved in peritoneal…

The treatment for a bowel obstruction will depend on what is causing it. For a total mechanical blockage, surgery will most likely be required. Most bowel obstructions will need some form of hospital intervention to relieve the problem. If you suspect that you have a bowel obstruction, you should seek medical advice as soon as possible to avoid the situation becoming life-threatening.

CONSERVATIVE TREATMENTS

Nasogastric Tube (NG Tube)

In order to help you feel more comfortable and release any pressure, your doctor may insert a small tube through your nose and down into your stomach. The tube will remove any fluids or gas trapped in your stomach and relieve any pain and vomiting. You will not be able to have anything to eat or drink to avoid adding any pressure or bulk to the blockage.

Watchful Waiting

If a paralytic ileus is suspected then your condition maybe monitored for a few days to see if it resolves on it’s own accord. Mose cases of ileus just require the bowel to be rested. You will be given fluids via a drip to keep you hydrated.

MEDICINAL

Therapeutic Enema

A barium or enema may be used to diagnose and treat an intussusception. During the procedure air or a liquid containing contrast is injected through the rectum into the bowel. The air or liquid will create pressure in the large bowel which will hopefully push out the folded piece of bowel. This is not always successful though and further surgery may be required.

SURGICAL

For a total blockage or severe stricture, surgery will be required to rectify the problem. There are several surgical procedures that can be performed depending on the cause of the blockage. It is common for someone with a chronic illness such as Crohn’s or Ulcerative Colitis to require surgery in order to relieve blocked or narrowed intestines. Some of the surgical procedures may require you to have a stoma in the form of a colostomy or ileostomy on a temporary basis.

Large Bowel Resection

The blocked or diseased part of your colon or large bowel may be removed surgically if you have a total blockage. The surgery can be performed laproscopically (via keyhole) or may be done as open surgery in an emergency. If the two pieces are bowel left are healthy then the ends will be stitched together or you may be given an colostomy where the colon is routed through an opening cut into your abdomen. You will then need to wear an ostomy bag over the top to collect the waste.

Small Bowel Resection

A small bowel resection is when the diseased or blocked part of the small bowel is surgically removed. The surgery can be performed laproscopically (via keyhole) or may be done as open surgery in an emergency. If the two pieces are bowel left are healthy then the ends will be stitched together or you may be given an ileostomy where the small bowel is routed through an opening cut into your abdomen. You will then need to wear an ostomy bag over the top to collect the waste.

Strictureplasty

This operation may be performed on patients with Crohn’s disease at this mostly affects the small bowel. Crohn’s disease can cause narrowing or strictures which can block the bowel and cause extreme pain. A strictureplasty is when the narrowed section is cut and sewn horizontally to widen the intestine.

Further information and downloads can be found in the RESOURCES section. Living with bowel condition or caring for someone with a bowel condition can affect you emotionally and socially; sometimes it can help to speak to others who understand your situation. The Bladder & Bowel Community Forum is available 24 hours today and will allow you to connect with those who share your condition. Start your own topic today or just follow one that interests you.

Hey everyone. My mom has stage 4 colon cancer with mets to liver, lungs, peritoneum. For the past few days she has been having intermittent vomiting and diarrhea. CT scan showed obstruction in ileum due to mets in omentum. Has anyone had small bowel obstruction? They are treating it conservatively now but there’s a high chance it won’t resolve. She can’t undergo surgery due to too much spread. What are we gona do??

Comments

Hello – I suffer partial bowel obstructions due to a scarred, narrowing in my small intestine. I follow a low residue diet – foods that digest and pass through easily. There are websites online that give info on this type of diet – foods that help to reduce the chances of having an obstruction and those foods that you should avoid to help prevent one – partial obstruction is extremely painful spasms that can go on for hrs. – an awful time. Wishing your Mom well – I also have supplements, like Ensure and Enlive.

Bowel obstruction –

Hello – I suffer partial bowel obstructions due to a scarred, narrowing in my small intestine. I follow a low residue diet – foods that digest and pass through easily. There are websites online that give info on this type of diet – foods that help to reduce the chances of having an obstruction and those foods that you should avoid to help prevent one – partial obstruction is extremely painful spasms that can go on for hrs. – an awful time. Wishing your Mom well – I also have supplements, like Ensure and Enlive.

Thank you! She’s currently npo cuz she vomits when she eats. I hope it resolves

How to prevent small bowel obstruction

What you need to know

Although the features of acute bowel obstruction are usually clinically obvious, the presentation of subacute small bowel obstruction and acute on chronic (large) bowel obstruction may be much more subtle

Consider bowel obstruction whenever a patient presents with colicky abdominal pain and recurrent vomiting (especially if prolonged for more than 24 hours), particularly if diarrhoea is minimal or absent

Abdominal distension is an important sign with bowel obstruction, but it may be absent if the obstruction is high and may be difficult to detect in obese patients. Vomiting may occur late and infrequently with low bowel obstruction

Neither normal bowel sounds nor stool in the rectum excludes the diagnosis

A 48 year old woman presented to her general practitioner with a seven day history of colicky lower abdominal pain and vomiting. The intermittent colicky abdominal pain started first when it woke her from sleep. The next day she vomited twice. Her colicky abdominal pain continued, and she noted that it tended to occur about half an hour after eating. She continued vomiting once or twice a day. She reported no diarrhoeaand had last opened her bowels six days earlier. On examination she was obese, had no abdominal scars, no abdominal hernias, had quiet bowel sounds, and non-specific generalised abdominal tenderness. There was no guarding or rebound tenderness. The rectum was empty. The general practitioner diagnosed constipation and prescribed a laxative. Three days later she was admitted to hospital with recurrent vomiting and dehydration. She was diagnosed with bowel obstruction due to a caecal carcinoma.

What is subacute bowel obstruction?

Sub-acute small bowel obstruction implies an incomplete obstruction of the bowel lumen. Whereas patients with complete bowel obstruction rapidly become extremely unwell, patients with subacute small bowel obstruction or chronic large bowel obstruction may have colicky pain, abdominal distension and vomiting that are less pronounced …

How to prevent small bowel obstruction

How to prevent small bowel obstruction

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Bowel Obstruction or Intestinal Blockage

A bowel obstruction is when a blockage stops food and liquids from moving through your digestive tract. It can also be called an intestinal obstruction, blocked intestine, or a gastrointestinal (GI) obstruction.

There are many possible causes of a bowel obstruction. It is more common in people with certain kinds of cancer and in people with advanced cancer.

A complete obstruction is a medical emergency and may require surgery. A partial obstruction is also a serious problem and needs to be treated right away. It is important to talk with your health care team if you experience any of the symptoms of a bowel obstruction.

Treatment for side effects is an important part of cancer care. This type of treatment is called palliative care or supportive care. Talk with your health care team about any symptoms you have, including new symptoms or changes. This helps them find side effects like a bowel obstruction as early as possible.

What is the gastrointestinal tract?

Your digestive tract or GI tract is made up of the esophagus, stomach, small intestine, and large intestine. It is part of your digestive system.

The small intestine digests nutrients from food and liquids and absorbs them into blood vessels. These nutrients include proteins, fats, and carbohydrates. Remaining food that cannot be digested moves from the small intestine to the large intestine. The colon absorbs water from the waste and stores waste until the next bowel movement, which removes the waste as stool (feces) from the body.

How to prevent small bowel obstruction

What are the signs of a bowel obstruction?

A bowel obstruction can happen in the small intestine (small bowel obstruction) or the large intestine (large bowel obstruction). During a bowel obstruction, some or all of the food and liquids that move through the digestive tract are unable to move past the blockage. Intestinal obstructions can be caused by something inside the GI tract blocking the intestine or by something outside the GI tract pressing on the intestine and causing it to collapse.

A bowel obstruction causes physical symptoms, including:

Severe pain in your abdomen (belly)

Cramping pain from peristalsis, the contractions that move food through your GI tract

Visible waves of movement across the belly from peristalsis contractions

Feeling food get stuck as it moves through the GI tract

Not being able to pass stool (constipation) or gas

What causes a bowel obstruction?

The common causes of a GI obstruction when you have cancer are:

Stool that is hard and difficult to pass

Twisting of the intestines

Scar tissue in the intestines

Inflammation of the intestines after radiation therapy

A tumor or tumors inside the GI tract

A tumor or tumors pressing on the outside of the GI tract

What types of cancer can cause a bowel obstruction?

GI obstructions can happen with many types of cancer. They are more common in people with:

How is a bowel obstruction diagnosed?

In order to diagnose a bowel obstruction, your doctor will do a physical exam. During this exam, they will feel your abdomen and use a stethoscope to listen to your belly.

A bowel obstruction can often be confirmed with an X-ray. But not all bowel obstructions will show on an X-ray, so you may need to have a CT scan or a barium enema.

How is a bowel obstruction treated?

Most people who have a bowel obstruction require hospitalization. The best treatment for a bowel obstruction depends on what caused it. Some ways to treat or manage a bowel obstruction are:

Getting fluids through an intravenous (IV) tube that goes into a vein in your arm. Not eating or drinking for a few days can help reset and reverse twisted bowels. If the blockage is not improving after a few days, you may also need IV nutrition.

Enemas or medication to loosen and/or soften a hard stool causing a blockage.

Using a tube to remove air and fluid in your stomach to prevent more pain. Called a nasogastric tube, this tube goes in through your nose and down into your stomach.

Taking medicine your doctor recommends to relieve nausea and vomiting, diarrhea, swelling, or pain.

If these options do not work, your doctor may suggest:

Surgery to fix the blockage and clear a path for food to go through your GI tract.

An expendable tube called a stent. This holds open the blocked area of the GI tract temporarily.

An ileostomy. This surgery can help your large intestine and rectum heal after a blockage. During an ileostomy, a temporary or permanent opening (stoma) is placed from the lowest part of the small intestine to the outside of your abdomen. Waste is collected in a pouch worn on the outside of your body and does not need to pass through the large intestine or the colon.

A colostomy. This surgery can help parts of your large intestine and rectum heal after a blockage. During a colostomy, a temporary or permanent opening (stoma) is placed from the large intestine to the outside of your abdomen. Waste is collected in a pouch worn on the outside of your body and does not pass through the rectum.

Questions to ask the health care team

Is a bowel obstruction a common side effect of the kind of cancer I have?

If I’m at risk for a blockage, what signs or symptoms should I watch out for?

Who should I contact if I have any signs or symptoms of a bowel obstruction? How soon?

What is causing my bowel obstruction? How can it be treated?

Is there medication I can take to relieve the symptoms of a bowel obstruction?

If needed, what kind of surgery would you recommend to treat my bowel obstruction? What will my recovery be like?

Should I keep track of my bowel movements or cancer side effects during treatment? If so, what is a good way to track them?

You were in the hospital because you had a blockage in your bowel (intestine). This condition is called an intestinal obstruction. The blockage may be partial or total (complete).

This article describes what to expect after surgery and how to take care of yourself at home.

When You’re in the Hospital

While in the hospital, you received intravenous (IV) fluids. You also may have had a tube placed through your nose and into your stomach. You may have received antibiotics.

If you did not have surgery, your health care providers slowly began to give you liquids, and then food.

If you needed surgery, you may have had part of your large or small intestine removed. Your surgeon may have been able to sew the healthy ends of your intestines back together. You may also have had ileostomy or a colostomy.

If a tumor or cancer caused the blockage in your intestine, the surgeon may have removed it. Or, it may have been bypassed by routing your intestine around it.

What to Expect at Home

If you had surgery:

The outcome is usually good if the obstruction is treated before tissue damage or tissue death occurs in the bowel. Some people may have more bowel obstruction in the future.

If you did not have surgery:

Your symptoms may be completely gone. Or, you may still have some discomfort, and your stomach may still feel bloated. There is a chance your intestine may become blocked again.

Self-care

Follow instructions for how to take care of yourself at home.

Eat small amounts of food several times a day. Do not eat 3 large meals. You should:

  • Space out your small meals.
  • Add new foods back into your diet slowly.
  • Take sips of clear liquids throughout the day.

Some foods may cause gas, loose stools, or constipation as you recover. Avoid foods that cause these problems.

If you become sick to your stomach or have diarrhea, avoid solid foods for a while and try drinking only clear fluids.

Your surgeon may want you to limit exercise or strenuous activity for at least 4 to 6 weeks. Ask your surgeon what activities are OK for you to do.

If you have had an ileostomy or a colostomy, a nurse will tell you how to care for it.

When to Call the Doctor

Call your surgeon if you have:

  • Vomiting or nausea
  • Diarrhea that does not go away
  • Pain that does not go away or is getting worse
  • A swollen or tender belly
  • Little or no gas or stools to pass
  • Fever or chills
  • Blood in your stool

Alternative Names

Repair of volvulus – discharge; Reduction of intussusception – discharge; Release of adhesions – discharge; Hernia repair – discharge; Tumor resection – discharge

References

Mahmoud NN, Bleier JIS, Aarons CB, Paulson EC, Shanmugan S, Fry RD. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 51.

Mizell JS, Turnage RH. Intestinal obstruction. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 123.

I am not a medical expert. Always consult your doctor before making diet changes or if you feel you may have the start of a blockage. The following is what worked for my husband to prevent further bowel blockages based on his unique situation.

Our Story

My husband was diagnosed stage 4 colon cancer out of the blue 3 1/2 years ago. He had no previous symptoms and on his 42nd birthday, I took him to the ER with excruciating stomach pain. He had emergency colon resection surgery and removal of many lymph nodes. He was then diagnosed with stage 4 colon cancer.

After a successful 12 rounds of FOLFOX chemo, he was able to get a stoma reversal.

Due to these surgeries, the cancer coming back in the same area as the surgeries, and the side effects of his many treatments, he is VERY high risk for bowel obstructions. He was in the hospital twice this summer for a bowel blockage before we realized that we weren’t being given enough information from the hospital dietitians to really prevent this.

I did a ton of research and came up with a plan to help him avoid another hospital stay. I hope this helps someone else, because it is really hard to figure out what can be tolerated, what can’t and how to make it not a monotonous diet.

My goal: Ease of prep – Healthy – Yummy!

Tips to Avoid Bowel Obstruction

  • Instead of eating 3 large meals a day, eat smaller meals 5-6 times a day.
  • Pay attention to your fiber intake (some chemo treatments cause constipation, some loose stools – Your oncologist can tell you if you are getting enough or too much fiber based on your unique situation. If you are post-surgery, you are likely on a low-fiber diet.)
  • I highly recommend the app MyFitnessPal to track your nutrients and calories. Not only for yourself, but also to easily have a log for oncologist if the need ever arises. It is also handy to have a log of foods if you end up having a bad reaction or start to get stomach pain.
  • When you introduce new foods to your diet, do it SLOWLY so you can monitor how your digestive system handles it.
  • Chew food well and eat slowly.
  • Stay hydrated and drink LOTS of water.

Foods to Eat

  • Fruits without tough skins or seeds such as bananas, mangos, avocados & fruit juices (no or little pulp)
  • Vegetables without tough skins or seeds that are cooked well, such as cauliflower, broccoli, carrots, beans & peas.
  • Meats that are moist and easy chewed such as ground turkey, ground chicken, ground beef, eggs & fish. You do not want to eat any meat that is dry, chewy or stringy – for this reason we opt to buy ground meat with a little more fat than usual.
  • Grains that are easily chewed and digested such as oatmeal, bread without whole grains or seeds, pasta & rice.
  • Dairy products such as yogurt, milk & soft cheese (eat cheese in moderation)

Foods to Avoid

  • Nuts (unless smooth nut butter)
  • Raw vegetables
  • Anything with skin or seeds
  • Chewy or stringy foods such as steak, celery, overcooked chicken (you get the idea)
  • All fried foods
  • Crunchy foods such as chips, croutons
  • Raw or Cooked Lettuce (some people may be able to handle finely shredded iceberg lettuce on occasion)
  • If you are prone to constipation limit foods that are starchy such as pasta, rice and potatoes and include more anti-constipation foods such as split pea soup, fiber yogurt, prune juice and senna tea.
  • If you are prone to too loose of stools, eat more starchy foods such as pasta, rice, potatoes (no skins) and try to include bananas and oatmeal.

My Food Prep Routine

I spend the weekend food prepping for my husband so he has a variety of foods readily available for him.

I have 2 crockpots, a rice cooker and hand immersion blender which makes the prep SO MUCH easier and faster.

Saturday: I make crock pot chili, crock pot vegetable soup, and hardboiled eggs.
Sunday: I make crock pot split pea soup, asian ground beef and brown rice.

This gives him plenty to eat during the week in addition to his protein shakes, yogurt, bananas, avocados, bread and tuna.

The hardest part of all of this is finding VARIETY! I hope the following recipes help you change it up a little for yourself or your loved one!

Ideal Foods to Have on Hand for Easy Meals/Snacks

  • Eggs (including hardboiled eggs)
  • Fiber yogurt such as Activia
  • Avocados
  • Bread (not whole grain and no seeds)
  • Tuna or other cooked white fish
  • Lunch meat
  • Protein drinks
  • Fruit juices (including prune juice just in case)
  • Well cooked vegetables (cauliflower, carrots, sweet peas, mushrooms – just nothing that has seeds or skins and is easy to digest)
  • Soups or chowders (with only ingredients that you can have)
  • Oatmeal
  • Seedless jelly
  • Cooked brown rice
  • Senna tea (Smooth Move Tea is available on Amazon)

How to prevent small bowel obstruction

Crock Pot Cauliflower Soup

How to prevent small bowel obstruction

Crock Pot Asparagus Soup

More Recipes

No Seeds Spaghetti Sauce

  • 1 large onion, chopped
  • 3 garlic cloves, minced
  • 2 can (29oz) tomato sauce
  • 1 can (12 oz) tomato paste
  • 1 Tablespoon Worcestershire sace
  • 1 Tablespoon Italian seasonings
  • 1 teaspoon salt
  • 1 Tablespoons brown sugar

Place all ingredients in a crockpot and cook on low 6-8 hours or high 4 to 6 hours. Serve over cooked pasta.

Simple Split Pea Soup

  • 1 large onion, diced
  • 1 cup diced carrots
  • 1 bag (20oz) split peas
  • 2 garlic cloves, minced
  • ½ teaspoon salt
  • ½ teaspoon pepper
  • 6 ¼ cup hot water
  • 2 bay leaves
  • 1 cup heavy cream (or milk or dairy-free alternative)

Layer in crockpot onions and carrots, split peas, garlic, salt, pepper. Pour hot water over it, do not stir. Add 2 bay leaves on top. Cook on low for 8 to 10 hours or high 6 to 8 hours until peas are completely cooked. Remove bay leaves and stir in heavy cream.

Hearty Turkey Chili

  • 2lbs ground turkey
  • 2 Tablespoons Extra Virgin Olive Oil
  • Salt and pepper
  • 1 can (29oz) tomato sauce
  • 1 can (15.75oz) kidney beans, rinsed and drained
  • 1 can (15.75oz) black beans, rinsed and drained
  • I onion, chopped
  • 1 cup peeled and diced carrots
  • 2 carlic cloves, minced
  • 1 Tablespoon Worcestershire sauce
  • 1 Tablespoon smoked paprika
  • 2 Tablespoons Chili Powder
  • 1 Tablespoon Cumin
  • ! can (15.75oz) sweet peas

Heat oil in skillet, add turkey and cook until brown. Drain. All all ingredients to a crockpot except peas. Cook on high 4-6 hours or low 6-8 hours. Stir in peas and serve.

A large bowel obstruction is when the large intestine, which is also known as the colon or large bowel, is partially or completely blocked. When this occurs, waste isn’t able to properly move through the bowels and exit the body. Immediate treatment becomes necessary to treat this blockage and relieve painful symptoms. It also works to prevent serious complications, like rupture of a person’s large bowel or tissue death. If it is not treated, a large bowel obstruction may be fatal. It is much more common for small bowel obstructions to occur, with obstructions of the large bowel only accounting for 20 percent of bowel obstructions. That being said, it is still useful to be aware of the symptoms and causes of the blockage so you can recognize them and receive prompt treatment.

What Are the Symptoms of Large Bowel Obstruction?

Some possible symptoms include the following:

  • Diarrhea from a liquid stool which is leaking around partial obstructions
  • Constipation during obstruction with possible bouts of constipation intermittently occurring for a few months before
  • Abdominal pain which is mild and vague or severe and sharp based on the obstruction cause
  • Bloated abdomen
  • In the case of a colon tumor causing the obstruction, there may be a history involvingrectal bleeding

What Causes Large Bowel Obstruction?

The underlying causes of a large bowel obstruction vary greatly by age, but among adults, the most common factor is colonic cancer, which accounts for 50 to 60 percent of cases and typically occurs in the sigmoid 1 to 4. Among adults, the second most common cause is acute diverticulitis which involves the sigmoid colon. These two causes together account for 90 percent of cases of obstruction.

Colorectal Cancer

Colorectal cancer accounts for around half of large bowel obstructions. When undiagnosed, this cancer may lead to the large intestine’s inner passageway gradually narrowing. In most cases, patients with an obstruction due to this cause will notice intermittent constipation before the obstruction occurs.

Volvulus

This is when a segment of the bowel twists abnormally around itself. In the typical case, this twisting will produce a closed bowel loop featuring a pinched base and this in turn leads to intestinal obstruction. Among Western countries, those over 65 are more likely to notice volvulus, particularly those with a history of chronic constipation.

Diverticular Disease

The diverticula are balloon-shaped, small pouches that extend from the intestinal wall in the large bowel. Diverticulitis refers to the infection of these diverticula. While healing from an infection, scars might begin to form along the colon wall. When a scar encircles the colon, it is known as a colon stricture. When these strictures age and tighten, they may gradually narrow the intestine, leading to a blocked colon.

Just some risk factors associated with a large bowel obstruction include:

  • Cancer of the colon, breast, lung, ovary, or stomach
  • Abdominal radiation
  • Abdominal surgery

Those at risk of an obstruction of the large bowel include people who:

  • Have or have had any type of cancer
  • Have had radiation therapy on their abdomen
  • Have had surgery on their abdomen
  • Although anyone can develop this issue, it is more common among those over 70
  • Keep in mind that less than a third of colorectal cancer patients will develop a large bowel obstruction.

How to Treat Large Bowel Obstruction

There are different treatments depending on the type of bowel obstruction you have. If you have a sudden and short-term bowel obstruction, the treatment including:

  • Fluid replacement therapy

This treatment involves providing intravenous fluids or various medications as a way to bring body fluid levels back to normal.

  • Electrolyte correction

This treatment aims to achieve the proper quantities of chemicals within the blood, specifically focusing on chloride, potassium, and sodium. The treatment may involve giving an infusion of fluids containing electrolytes.

  • Surgery

In cases where other treatment doesn’t relieve serious symptoms, surgery may be necessary. It may also take place in the case of a long-term bowel obstruction. The surgery will remove the obstruction as a way to improve the patient’s quality of life and relieve pain.

  • Stent

For long-term obstructions, your doctor may insert a metal tube into the bowel as a way to open up the blocked area.

  • Medications

Various medicines may be given to relieve various symptoms. They are typically designed to treat fullness of bowel, pain, nausea, or multiple symptoms.

Prognosis of Large Bowel Obstruction

The prognosis for someone with a large bowel obstruction depends on many factors, including the timing of treatment, the patient’s age, the cause of the obstruction, and the presence of other illnesses, particularly kidney, lung, or heart problems. In people who are otherwise healthy, an obstruction that is not linked to cancer tends to have a prognosis that is very good.

How to Prevent Large Bowel Obstruction

To prevent a large bowel obstruction, you should live a healthy lifestyle. This involves exercising every day and making sure that your diet is low in cholesterol and fat while containing a high amount of fiber. If your diet is currently low in fiber, then work to slowly increase your fiber intake to avoid negative side effects. You should also aim to drink lots of water as this ensures your intestines will work smoothly.

Those who are 50 years old or older should talk to the healthcare provider about how frequent they will need colorectal cancer screenings as this is an excellent preventative measure.

You should also be aware of when you will need to talk to your doctor about troublesome symptoms. Let your healthcare provider know if you notice a change to your bowel habits or see blood in any movements. If you have already experienced a blockage in the past and it was due to a health problem, take the time to make sure you have that health concern under control and know how to manage it. Doing so will reduce your risk of a repeat blockage.

Small bowel obstruction (SBO) is a common condition, usually the result of adhesions (scar tissue from prior abdominal surgery) that constrict the bowel lumen.

Related terms:

  • Enema
  • Bowel Obstruction
  • Intussusception
  • Hernia
  • Computer Assisted Tomography
  • Abdominal Pain

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About this page

Small Bowel Obstruction

Abstract

Small bowel obstruction is a common surgical problem and accounts for as many as 400,000 hospital admissions annually, and 30% to 40% of these patients will require operative exploration. Clinical acuity at the time of presentation varies widely, as does the etiology of obstruction or pseudoobstruction, and both play a major role in determining the next best step in management. The presence of a closed loop or complete obstruction and a patient manifesting signs of sepsis without alternative explanation are both indications for urgent to emergent operative intervention. A dual-contrast CT scan is recommended as the radiographic investigation of choice in those patients suspected to have small bowel obstruction (SBO); orally administered contrast alone may be used in those patients with insufficient renal function to tolerate intravenous contrast. In patients who fail to improve with nonoperative management, a CT scan should be repeated 48 hours from presentation. Laparoscopy is emerging as a reasonable alternative to laparotomy in exploring patients with SBO, but it should alter neither the decision to operate nor the necessary steps of the operation, including safe entry, identification and resolution of the obstruction, and inspection to identify any additional acute pathology in the abdomen.

Small Bowel Obstruction

Terms Used in Describing Small Bowel Obstruction and Adynamic Ileus

Small bowel obstruction is a condition, not a disease. The term small bowel obstruction does not indicate the cause, severity, or prognosis of the obstruction. The term ileus comes from the Greek variably meaning “to twist up,” “to wrap,” or “to roll up,” 1 implying that a patient is rolled up in discomfort. The term ileus means that the bowel lumen is dilated, but must have a qualifier before it that indicates neuromuscular-based dilation or mechanical obstruction. Functional ileus, paralytic ileus, functional obstruction, and adynamic ileus are equivalent terms indicating that the bowel is dilated because there is abnormal intestinal motility that prevents succus entericus from progressing down the gastrointestinal (GI) tract. Common causes of adynamic ileus include drugs that alter bowel motility (e.g., narcotics), recent abdominal surgery, intestinal ischemia, peritonitis, neuromuscular disorders (e.g., scleroderma), and endocrine disturbances (e.g., diabetes, hypothyroidism). If succus entericus cannot progress down the small bowel because the lumen is mechanically obstructed, the terms small bowel obstruction, mechanical ileus, or mechanical obstruction can be used. To avoid confusion, we will only use two distinct terms—adynamic ileus and small bowel obstruction.

Simple obstruction implies that the lumen is partially or completely occluded, but that blood flow is preserved. Strangulation or strangulated obstruction means that blood flow is compromised, leading to bowel wall edema, intestinal ischemia and, eventually, necrosis to perforation. A simple obstruction can be complete (i.e., no fluid or gas passes beyond the site of obstruction) or incomplete (i.e., some fluid and gas does pass beyond the site of obstruction). In open loop obstruction, intestinal flow is blocked distally, but the proximal loops are open and can be decompressed by vomiting or nasogastric intubation. In closed loop obstruction, both flow into and flow out of the closed loop are blocked, resulting in progressive accumulation of fluid in the closed loop (see Fig. 46-1 ).

SMALL BOWEL OBSTRUCTION

Malignancy

Small bowel obstruction secondary to malignant disease usually results from metastases or involvement of the small intestine by advanced cancer in a nearby organ. Primary small bowel cancers, usually adenocarcinomas or gastrointestinal stromal cell tumors, are less common causes. The surgical mortality rate in this group of patients ranges from 10 to 40%, with median survival time after the perioperative period measured only in months. Although the prognosis in these patients is grim, a limited palliative procedure in cases of obstruction secondary to advanced systemic malignancy can improve quality of life. Resection may offer better palliation than bypass, but the findings at the time of operation should dictate the procedure performed. In cases of a frozen abdomen from carcinomatosis, creation of a loop stoma in the bowel proximal to the obstruction is adequate palliation. If no amount of small bowel can be mobilized, then a gastrostomy tube is placed for decompression. If this situation is recognized preoperatively, then placement of a percutaneous gastrostomy tube and institution of hyperalimentation may allow the patient to return to home for the remainder of their life. Involvement of a palliative care specialist in these cases is important, as the administration of narcotic pain medication, antiemetics, anticholinergics, and somatostatin analogs will be the mainstay of treatment.

Bowel obstruction, also known as intestinal obstruction, occurs when there is a blockage somewhere in your small or large intestines that prevent the passage of food, fluids, and gas during the process of digestion.

Ordinarily, after leaving the stomach, food particles must pass through the whole span of the intestines as part of normal digestion. These particles are constantly moving through the intestines. However, a bowel obstruction stops this movement, leading to a build-up of food particles, digestive fluids, and gas behind the point of the blockage.

If this blockage persists, the increasing pressure can rupture the intestines, causing harmful intestinal contents and bacteria to leak into the abdominal cavity. The blockage can also prevent blood from reaching a segment of the affected intestine, leading to tissue death and infection. These complications are life-threatening.

Common causes of bowel obstruction include intestinal adhesions, hernias, fecal impaction, ingestion of a solid indigestible object, inflammatory bowel disease, twisting of the intestine (volvulus), diverticulitis, cancer, and others. In older adults, cancer as a cause becomes more likely.

How to prevent small bowel obstruction

Symptoms of Bowel Obstruction

Bowel obstruction causes a number of uncomfortable symptoms, which include:

  • Severe bloating
  • Abdominal pain (cramps, comes and goes)
  • Inability to pass stool or gas
  • Nausea
  • Loss of appetite
  • Vomiting
  • Constipation
  • Abdominal swelling
  • Diarrhea

The presence or absence and the severity of each of these symptoms depend on a number of factors, such as the location, cause, and extent (partial or complete) of the obstruction.

Due to the serious complications that can result from bowel obstruction, contact your doctor when you notice any of the symptoms listed above.

Signs a Bowel Obstruction is Clearing

Most cases of bowel obstruction are treatable. However, do not ignore the symptoms or attempt to treat yourself at home. Rather, see a doctor who would decide on the best treatment option to adopt for you.

Whether your bowel obstruction is corrected surgically or treated through other options, it is expected that the blockage would clear — either gradually or at once, depending on the treatment option adopted.

Here are the signs that your bowel obstruction is clearing:

1. Feeling generally better

The symptoms of bowel obstructions are quite discomforting. So, with the blockage still intact, you will not feel well. However, once the blockage starts to clear or is removed, you start to feel much better again. And the overall discomfort caused by the symptoms starts to subside.

2. Passing gas

In cases of complete bowel obstruction, the resulting blockage makes it impossible to pass gas. This causes severe bloating and contributes to abdominal pain and swelling. However, once the obstruction starts to give way, you will be able to pass gas again, as there would be a passage for gas to pass to your anus.

3. Passing stool

Since the inability to pass stool is one of the major symptoms of bowel obstruction, it is quite expectable that reduction or removal of the blockage would allow for the passage of stools. So, once you are able to pass stools after a bowel obstruction, it is a sign that the obstruction is giving way or has been totally removed.

4. Relief from abdominal pain

The build-up of food particles, gas, and other digestive substances in your intestines during a bowel obstruction is the cause of abdominal pain. Once the blockage starts to give way or is surgically removed at once, the abdominal pain would subside as the intestine is able to expel its contents again.

5. Relief from other symptoms

As the bowel obstruction clears or is removed, you begin to observe relief from all other symptoms that resulted from the blockage in the first place. You would regain your appetite and would no longer feel like vomiting at the thought or sight of food. And you would no longer vomit after eating. If you have diarrhea, this would stop as well.

Note, however, that the signs discussed above are those that you can feel yourself. While they indicate a positive development, your doctor might want to run a number of tests to confirm that the blockage is truly giving way or totally removed from your bowel.

Wrap-up

Bowel obstruction by whatever cause prevents forward the passage of food through the gastrointestinal tract. This leads to a build-up of food particles, gas, and other digestive substances in the intestines, and this, in turn, leads to a number of discomforting symptoms.

However, these symptoms begin to disappear as soon as the bowel obstruction is treated by your doctor. We have mentioned some of the things you would feel when bowel obstruction is clearing.

WARNING: Once you observe the symptoms of bowel obstruction, seek medical help immediately. Do not wait to see if it would “clear” or attempt to treat it on your own, as these might lead to serious complications.

This article was co-authored by Dale Prokupek, MD and by wikiHow staff writer, Jessica Gibson. Dale Prokupek, MD is a board-certified Internist and Gastroenterologist who runs a private practice based in Los Angeles, California. Dr. Prokupek is also a staff physician at Cedars-Sinai Medical Center and an associate clinical professor of medicine at the Geffen School of Medicine at the University of California, Los Angeles (UCLA). Dr. Prokupek has over 30 years of medical experience and specializes in the diagnosis and treatment of diseases of the liver, stomach, and colon, including chronic hepatitis C, colon cancer, hemorrhoids, anal condyloma, and digestive diseases related to chronic immune deficiency. He holds a BS in Zoology from the University of Wisconsin – Madison and an MD from the Medical College of Wisconsin. He completed an internal medicine residency at Cedars-Sinai Medical Center and a gastroenterology fellowship at the UCLA Geffen School of Medicine.

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If you’re suffering from a bowel obstruction, which is a blockage of your small or large intestine, it’s important to get emergency medical attention. Bowel obstruction symptoms, which include nausea, vomiting, abdominal distension, severe abdominal pain, and inability to pass gas or a bowel movement, usually come on fast and require immediate treatment. Visit your doctor, an urgent care center, or an emergency room for proper diagnosis and treatment. With medical care, rest, and a low-fiber diet, you’ll begin to feel better within a few weeks. [1] X Research source

A bowel obstruction means there is a blockage in the bowel. It is a serious complication, which is much more common with advanced cancer.

About bowel obstruction

Your bowel might become completely or partly blocked. This means that the waste from digested food can’t get past the blockage. The diagram shows the bowel and the rest of the digestive system.

How to prevent small bowel obstruction

Bowel obstruction can happen when:

  • cancer in the abdominal area (such as ovarian, bowel or stomach cancer) presses on the bowel
  • other cancers (such as lung or breast cancer) spread to the abdomen and press on the bowel
  • cancer grows into the nerve supply of the bowel and damages it – this can stop the muscles working
  • a solid mass of indigestible material collects in the bowel (called a bezoar)

Bowel obstruction is much more common with advanced cancer. People who have had surgery or radiotherapy to the tummy (abdomen) are more at risk of developing a bowel obstruction.

Symptoms of bowel obstruction

The symptoms include:

  • feeling bloated and full
  • pain (usually colicky tummy pain)
  • feeling sick
  • vomiting large amounts (including undigested food or bowel fluid)
  • constipation (shown by not passing wind and no bowel sounds)

Diagnosing a bowel obstruction

Your doctor will examine you and ask you questions. They will then arrange some tests and investigations. These might include blood and urine tests.

You may also have an abdominal x-ray. Or you might have a barium enema to find out exactly where the obstruction is in your bowel.

Treating a bowel obstruction

It’s important to understand what your doctors are trying to achieve with any treatments they recommend. So talk it through with them or with your specialist nurse.

Treatments for a blocked bowel can include:

Drips and drains

Your doctor might suggest treatment to give your bowel time to rest. You need to stop eating and drinking until your bowel is working normally again. You may need fluids through a drip so you don’t get dehydrated. This is called an intravenous infusion.

Sometimes you can have an infusion of fluids at home. You have this through a fine needle put just under the skin, instead of into a vein.

This may fix the blockage. But if it isn’t successful, you may need other treatments.

You might have a tube that goes up your nose and down into your stomach (called a nasogastric tube). This drains fluid from your stomach and stops you feeling sick.

Or your doctor might suggest that you have a venting gastrostomy to help relieve nausea and vomiting. This is when they put a special tube called a percutaneous endoscopic gastrostomy tube (PEG tube) into your stomach through an opening made on the outside of your abdomen. You usually have this under sedation.

Surgery

If your cancer is advanced and cannot be cured your doctor might suggest surgery to offer you longer term relief from your symptoms. The surgeon removes enough of the cancer to unblock the bowel. They might remove part of the bowel as well.

After the operation your surgeon is most likely to repair the bowel by stitching the ends back together. But sometimes it isn’t possible to do this and you may need to have a colostomy or ileostomy (stoma). A stoma is an opening from the bowel onto the abdomen. Your poo comes out of this opening into a plastic bag that sticks over it.

Deciding whether to have an operation like this can be difficult.

The surgery won’t cure your cancer. But it can relieve the symptoms that you have. Unfortunately, no one can tell beforehand how much you will benefit from an operation to unblock your bowel.

The operation could be successful and the cancer might not grow back to block the bowel again. But it is quite a big operation to have when you are likely to be feeling very weak and ill.

You might want to talk through having this operation with your close family and friends as well as your doctor and nurse.

A stent

A stent is a tube that the surgeon puts into the bowel. It expands to keep the bowel open. This can relieve the symptoms caused by the obstruction.

Your surgeon may be able to put in a stent if you are not able to have a big operation.

Medicines

Instead of an operation, medicines can sometimes help to control symptoms of a blocked bowel. Unfortunately these types of treatment will usually only control your symptoms for a while.

A drug called hyoscine butylbromide (Buscopan) stops muscle spasms and reduces pain. You can also have painkillers and anti sickness medicines.

You might also have a drug called octreotide. Octreotide reduces the amount of fluid that builds up in your stomach and digestive system. It can help to control sickness.

Or you might have steroids. Steroids can help to reduce the inflammation of your bowel. They can also help to control sickness.

A small bowel obstruction occurs when part or all of the small intestine (bowel) is blocked. As a result, digestive contents can’t move through the bowel properly and out of the body. Treatment is needed right away to remove the blockage. This can ease painful symptoms. It can also prevent serious problems, such as tissue death or bursting (rupture) of the small bowel. Without treatment, a small bowel obstruction can be fatal.

Causes of small bowel obstruction

A small bowel obstruction can be caused by:

Scar tissue (adhesions). These may form after belly (abdominal) surgery or an infection.

Hernia. A hernia is when an organ pushes through a weak spot or tear in the abdomen wall. Part of the small bowel can push out and be seen as a bulge under the belly. Hernias can also occur internally.

Certain health problems. These include when part of the bowel slides inside another part (intussusception). Other causes include irritable bowel disease such as Crohn’s disease, and inflammation and sores in the intestine (ulcerative colitis).

Abnormal tissue growths (tumors). These can form on the inside or outside of the small bowel. They are usually due to cancer.

Symptoms of small bowel obstruction

Common symptoms include:

Belly cramping and pain

Belly swelling and bloating

Upset stomach (nausea) and vomiting

Can’t pass stool (constipation)

Diagnosing small bowel obstruction

Your provider will ask about your symptoms and health history. You’ll also have a physical exam. Tests may also be done to confirm the problem. These can include:

Imaging tests. These provide pictures of the small bowel. Common tests include X-rays and a CT scan.

Blood tests. These check for infection and other problems, such as excess fluid loss (dehydration).

Upper GI (gastrointestinal) series with a small bowel follow-through. This test takes X-rays of the upper digestive tract from the mouth through the small bowel. An X-ray dye (contrast fluid) is used. The dye coats the inside of your upper digestive tract so it will show up clearly on X-rays.

Treating small bowel obstruction

Treatment takes place in a hospital. As part of your care, the following may be done:

No food or drink is given by mouth. This allows your bowels to rest.

An IV (intravenous) line is placed in a vein in your arm or hand. The IV line is used to give fluids. It may also be used to give medicines. These may be needed to ease pain, nausea, and other symptoms. They may also be needed to treat or prevent infections.

A soft, thin, flexible tube (nasogastric tube) is inserted through your nose and into your stomach. The tube is used to remove extra gas and fluid in your stomach and bowels. This helps to ease symptoms such as pain and swelling.

In severe cases, surgery is done. This may be needed if the small bowel is almost or totally blocked, or there is a hole in the bowel (bowel perforation). During surgery, the blockage is removed. Parts of the bowel may also be removed if there is tissue death. Other repair may be done as well, depending on what caused the blockage. Your healthcare provider will give you more information about surgery, if needed.

You’ll be watched closely in the hospital until your symptoms improve. Your provider will tell you when you can go home.

Long-term concerns

After treatment, most people recover with no lasting effects. If a long part of the bowel is removed, there is a greater chance for lifelong digestive problems. Bowel movements may become irregular. Work with your provider to learn the best ways to manage any symptoms you may have, and to protect your health.

When to call your healthcare provider

Call your provider right away if you have any of the following:

Severe pain (Call 911)

Belly swelling or cramping that won’t go away

Can’t pass stool or gas

Nausea or vomiting (especially if the vomit looks or smells like stool)

How to prevent small bowel obstructionThe small intestine is actually a very long and essential organ for daily function. Measuring around 20 ft in full-grown adults, the small intestine responsible for the majority of digestion. However, there are times that part of the small intestine must be removed. In these cases, a small intestine resection, or surgery, can be completed. But how much of a small intestine can really be removed? How essential is the small intestine? What does small intestine surgery entail? And what is recovery like for small intestine surgery?

What is the Small Intestine?

How to prevent small bowel obstruction

The small intestine is an essential organ in the process of digestion. When food enters the body, the digestive process begins as you chew your food. This breaks the food down from large chunks into smaller, more manageable chunks. Saliva is also involved, chemically breaking down the different parts of the food. Next, the food travels down the throat, through the esophagus, and to the stomach.

In the stomach, more aggressive enzymes continue to break down the food. Muscular contractions are also responsible for preparing the food for further digestion. The small intestine then receives the food from the stomach. Here, even more enzymes-those created by the pancreas and the liver- break down the food even more. small intestines where the majority of nutrient absorption is completed in the digestive tract. Finally, The food travels to the large intestine, or the colon. Once in the colon, leftover waste that could not be used in the digestive process is excreted. As we can see, the small intestine is essential for the proper breakdown of food and digestion.

Why Would you Need Small Intestine Surgery?

How to prevent small bowel obstructionThere are a few different reasons that small intestine surgery might be deemed necessary.one of the most common causes for small intestine surgery is a blockage within the organ. As food travels through the small intestines, it may block the passage of other foods through the intestines. This can cause major problems, including infection, disease, constipation, and even potentially death. In cases where there is a blockage within the intestines, surgery is one of the most effective techniques to remediate that.

Because the small intestine is so long, it is possible to remove only a small section of it. During the process of digestion within the small intestine, vitamins and nutrients are absorbed through the lining of the intestinal wall. Therefore, a top priority for surgeons is that of leaving as much intestinal wall intact as possible. In other cases, a section of the small intestine may become diseased or cancerous. Small intestines surgery may be completed in order to protect the rest of the small intestine. If this disease were to spread, the entire small intestine could be compromised.

What to Expect from Small Intestine Surgery Recovery

The small intestine is essential for our daily life. any changes that we make to the small intestine will have an immediate impact on our daily routine. Obviously, your diet will have to change. Just prior to and shortly after the surgery, you will not be able to eat or drink anything. A nasogastric tube movie placed to give you the nutrients you need. This is typically removed within the first week of recovery. Once you are at home, activity restrictions will help protect the incision site and small intestine. Any activity that causes stress to the abdominal region, such as heavy lifting, is to be avoided.

Do you need small intestine surgery? Contact the best surgeons in NYC and schedule an appointment today.

WHAT IS IT?

Small Bowel Obstruction (SBO): just as the name sounds, is a process in which the small intestines are obstructed (it is as simple as that!).

How to prevent small bowel obstructionIt is important not to overcomplicate the topic of an SBO! Its name is very self-descriptive (source)

WHAT CAUSES IT?

There can be many causes for this condition however common ones include:

  • Adhesions in the abdomen/bowel lumen: these most commonly occur after abdominal surgery post surgery.
  • Hernias: herniated bowels can become obstructed.
  • Volvulus: this process will cause a mechanical obstruction.
  • Intussusception: this telescoping can cause the SBO as well.
  • Polyposis: polyps within the intestinal lumen can also cause mechanical obstruction.
  • Ovarian neoplasms (female patients): can compress the bowels.
  • Ascaris lumbricoides: this roundworm can sometimes be responsible for cause an SBO.

In the end remember anything that can cause a mechanical obstruction in the lumen of the small bowel can cause an SBO!

How to prevent small bowel obstruction Adhesions in the small bowel can be caused by fibrotic processes post surgery. These adhesions are one of the most common causes of small bowel obstruction (source)

WHY IS IT A PROBLEM?

If the small bowel is obstructed this means that ingested food/liquids will not be able to pass by this obstruction. As a result, the patient have swelling of the bowels proximal to the obstruction and present with pain (and other symptoms that are explained more below).

WHAT MAKES US SUSPECT IT?

Risk factors:

History of abdominal surgery

Chief Complaints:

  • Abdominal pain
  • Obstipation
  • Nausea/vomiting

History Of Present Illness:

Deceased oral intake given that the patient will become nauseous/vomit if they continue to eat/drink. This is because the obstruction will cause a mechanical “back-up” of all ingested items (no place for it to go but back up!)

Nausea/vomiting especially with significant relief upon vomiting.

Decreased/lack of bowel movements or flatus: if the small bowel is persistently obstructed, then at a certain point the patient will no longer be able to pass gas/have bowel movements.

How to prevent small bowel obstructionConstipation is a very characteristic feature of SBO. While it is not specific to only this condition, it stands to reason that if there is an obstruction in the small bowel, eventually the patient will no longer be able to pass stool (source)

Physical exam:

Abdominal exam can reveal:

  • Abdominal distention
  • Abdominal tenderness
  • Hernias (vental/umbilical/other) may be present (and the cause of the SBO).

Genitourinary exam:

  • Inguinal hernias (direct/indirect) might be present (and the cause of the SBO)
WHAT IS THE CLINICAL WORKUP?

Abdominal X-ray (KUB): this study is fairly routine and often is ordered due to its convenience. Possible findings that can support a diagnosis of a SBO include: dilated loops of bowel, often with multiple air fluid levels. See more examples of how a SBO will appear radiologically here. Ultimately a CT scan will provide more insight into the etiology/location of the obstruction.

How to prevent small bowel obstructionThe presence of so many air fluid levels (marked by the arrows) is suspicious for an SBO (generally more then 3 is considered abnormal). These air fluid levels are seen most clearly in an upright abdominal X-ray like the one pictured above (source)

CT scan: further imaging can show a transition point at the site of the obstruction (the bowel will be dilated proximal to the obstruction, and compressed distal to the obstruction). The etiology of the SBO may also be discovered on the CT-scan. See more examples of how a SBO will appear radiologically here.

How to prevent small bowel obstructionEvaluation of an SBO on a CT scan (source)

WHAT ELSE ARE WE WORRIED ABOUT?

Bowel necrosis/perforation: some etiologies of SBO can lead to ischemia of the mesentery/bowel. This can result in necrosis and bowel perforation which can be dangerous to the patient!

HOW DO WE TREAT IT?

The fundamental first line treatment for SBO is manage the symptoms of the patient while decompressing the mechanical obstruction present in the small bowel. This involves a few elements:

  • Oral intake is stopped (patient made NPO) to prevent further compression
  • IV fluids are started to keep patients hydrated
  • Antiemetics (i.e. Ondansetron) can be used to make patients more comfortable and address persistent nausea.
  • Insertion of nasogastric tube can be conducted to remove contents from the proximal GI tract and decompress the patient. This can sometimes resolve the obstruction on its own.

Surgery for this condition may also be required if the above patients fail to reverse patient symptoms/resolve the. Generally one will wait a few days and monitor the progression of symptoms before pursuing the surgical treatment option.

  • Severe symptoms/bowel perforation may expedite the decision to operate on patients.
HOW WELL DO THE PATIENTS DO?

In many cases patients with SBO resolve without surgical intervention.

WAS THERE A WAY TO PREVENT IT?

Fundamentally many of the causes of this condition are difficulty to anticipate/prevent. With this in mind, there is some evidence to suggest that laparoscopic surgery might be associated with lower risk for adhesive small bowel obstruction compared to laparotomy (source).

OTHER HY FACTS?

Gastric motility agents (such as Metoclopramide) should NOT be used in patients with SBO as they will worsen the condition of the patient (and might even cause bowel perforation).

ARCHIVE OF STANDARDIZED EXAM QUESTIONS

This archive compiles standardized exam questions that relate to this topic.

Surgery for small bowel obstruction is a very common emergency operation done in many hospitals. Intestinal obstruction is a blockage of your small intestine or colon that can prevent food and liquid through it. Intestinal obstruction can occur due to a number of conditions, including attachments in the abdominal tissue (adhesions), hernias and tumours or fibrous belts.

Intestinal obstruction may cause unpleasant symptoms, including abdominal pain and swelling, nausea, and vomiting series. If left untreated, it can cause formation of toxins due to stagnant contents. This may result in the death of intestinal tissue, severe infection, shock, and perforation. However, due to institution of timely medical care the obstruction can often be successfully treated.
Cause of small bowel obstruction
Common causes of mechanical intestinal obstruction to small bowel are:

  • adhesions – bands of fibrous tissue in the abdomen, often abdominal or pelvic surgery,
  • hernias – intestines which in different parts of your body projection
  • in the small intestine cancer
  • inflammatory bowel disease such as Crohn’s disease
  • twisted bowel (volvulus)
  • intestines stretching (retraction)

Signs and symptoms of intestinal obstruction include:

  • crampy abdominal pain that comes and goes
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • no stool or fart
  • abdomen (stomach) swelling

The treatment of intestinal obstruction depends on the reason for your condition.
For the treatment of intestinal obstruction require hospitalization. When you arrive at the hospital, the doctor will first assess your condition and start certain emergency mesures. This may include:

  • Intravenous (IV) line placed in a vein in your arm, so that the liquid can be given
  • Nasogastric (NG) tube placed through the nose and into your abdomen, air and water suction to reduce abdominal swelling
  • Flexible urinary tube (catheter) placed into your bladder is thin, and the collection of urine test

Treatmet of local mechanical obstruction

If you have mechanical obstruction in the amount of food and liquid can still (partial blockage), came back and has been stable in hospital. You can not further treatment. Your doctor may also put forward a special low-fiber diet, this is your easy to deal with partially blocked intestine. If the obstruction is not clear itself, may need surgery to relieve obstruction.
Dealing with a complete mechanical obstruction

Complete obstruction, of which nothing can through your intestinal tract, usually require Surgery for small bowel obstruction to relieve congestion. Your program will depend on the cause of obstruction, which parts of your gut. Surgery for small bowel obstruction is usually to remove the obstruction and any of your part, which is dead bowel.

Treatment of intestinal obstruction caused by the blockage depends on the situation. For the treatment of intestinal obstruction some of the more common Surgery for small bowel obstruction include:

The elimination of these bands of scar tissue is called adhesiolysis. After the abdominal cavity is opened, the surgeon’s subtle analysis of intestinal obstruction by the surgical adhesions is relieved by using scissors and forceps.

This process involves opening incision through it near the place of the hernia sac.

Removal of end-to-end anastomosis.

“Resection” is a type of Surgery for small bowel obstruction which means to remove part or all of an organization or structure. the part of Small or large intestine removed, is therefore, hinder or to the normal passage. Anastomosis is connecting two cut end of a tubular structure, forming a continuous channel. His is a very common Surgery for small bowel obstruction.

Removal of ileostomy or colostomy.

In some patients, the anastomosis is not possible, because the severity of the obstruction. After blocking and diseased tissue is removed, an ileostomy or colostomy is created. Ileostomy is a Surgery for small bowel obstruction in which the small intestine connected to the abdominal wall, and the waste then exit the body through the artificial opening holes. Colostomy is a procedure in which the colon is the part of the digestive tract that is attached to the abdominal wall.

Paralytic Ileus

Postoperative ileus is transient impairment of bowel motility occurring after major surgery, generally due to a lack of coordinated bowel activity

Causes of Paralytic Ileus

  • The most common cause is abdominal surgery, including laparoscopic surgery. There is risk associated with cardiothoracic, gynecologic, genitourinary, and arthroscopic surgery
  • Electrolyte abnormalities (hyponatremia, hypokalemia, hypomagnesemia, hypermagnesemia)
  • Drugs (Opiates, anticholinergics, tricyclic antidepressants, calcium channel blockers)
  • Spine procedures
  • Uremia, mesenteric ischemia, myocardial infarction
  • Infections (peritonitis, intra-abdominal abscess, pneumonia)
  • Surgical factors correlated with a heightened chance of postoperative ileus
    • Duration of surgery
    • Amount of Blood Loss
    • The dose of opiate use
    • Tissue trauma in the gastrointestinal tract

Ileus vs Small Bowel obstruction

Diagnosis of Paralytic Ileus

Abdominal x-ray showing both small and large bowel loops dilatation till rectum is diagnostic of paralytic ileus. It can’t be always feasible to distinguish ileus from mechanical small bowel obstruction on frontal views. A lateral radiograph may help in this condition by showing air in rectum; however, ultrasound or contrast study may be required in equivocal cases. This is very helpful to distinguish ileus vs small bowel obstruction.

Management of Paralytic Ileus

Once ileus has occurred:

  • A nasogastric tube may decompress the stomach and relieve symptoms, and prevent aspiration in patients with nausea or vomiting
  • Administer IV fluids of isotonic dextrose-saline crystalloid or Ringer’s solution for postoperative maintenance
  • Wean opiate pain management and substitute sequentially with regular acetaminophen (paracetamol), regular NSAIDs (unless contraindicated), and regular or as-required tramadol and reserve opiates for breakthrough pain
  • Consider neostigmine IV infusion in some cases
  • Reserve surgery or invasive treatment for severe cases not responding to conservative therapies

How to prevent small bowel obstruction

What you need to know

Although the features of acute bowel obstruction are usually clinically obvious, the presentation of subacute small bowel obstruction and acute on chronic (large) bowel obstruction may be much more subtle

Consider bowel obstruction whenever a patient presents with colicky abdominal pain and recurrent vomiting (especially if prolonged for more than 24 hours), particularly if diarrhoea is minimal or absent

Abdominal distension is an important sign with bowel obstruction, but it may be absent if the obstruction is high and may be difficult to detect in obese patients. Vomiting may occur late and infrequently with low bowel obstruction

Neither normal bowel sounds nor stool in the rectum excludes the diagnosis

A 48 year old woman presented to her general practitioner with a seven day history of colicky lower abdominal pain and vomiting. The intermittent colicky abdominal pain started first when it woke her from sleep. The next day she vomited twice. Her colicky abdominal pain continued, and she noted that it tended to occur about half an hour after eating. She continued vomiting once or twice a day. She reported no diarrhoeaand had last opened her bowels six days earlier. On examination she was obese, had no abdominal scars, no abdominal hernias, had quiet bowel sounds, and non-specific generalised abdominal tenderness. There was no guarding or rebound tenderness. The rectum was empty. The general practitioner diagnosed constipation and prescribed a laxative. Three days later she was admitted to hospital with recurrent vomiting and dehydration. She was diagnosed with bowel obstruction due to a caecal carcinoma.

What is subacute bowel obstruction?

Sub-acute small bowel obstruction implies an incomplete obstruction of the bowel lumen. Whereas patients with complete bowel obstruction rapidly become extremely unwell, patients with subacute small bowel obstruction or chronic large bowel obstruction may have colicky pain, abdominal distension and vomiting that are less pronounced …

  • Medical Author: Divya Jacob, Pharm. D.
  • Medical Reviewer: Pallavi Suyog Uttekar, MD

How to prevent small bowel obstruction

Strictureplasty can be used to treat simple or short strictures. In this procedure, the damaged portion of the intestine is cut open and reshaped. For long and complicated strictures, surgical removal of the affected part of the bowel (resection) should be considered.

What are strictures?

Strictures are narrowed parts in the intestine that often leads to bowel obstruction.

Factors causing strictures are as follows:

  • Tuberculosis
  • Inflammatory bowel disease such as Crohn’s disease
  • Cancer
  • Infections
  • Previous surgery

What is strictureplasty?

Strictureplasty is a surgical procedure to repair strictures by enlarging the narrowed area without removing any portion of your intestine. Strictureplasty is a well-established treatment for Crohn’s disease.

Strictureplasty is generally a safe procedure and is most effective in treating lower sections of the small intestine called the ileum and jejunum.

Why is strictureplasty done?

Strictureplasty is performed under the following conditions:

  • Multiple strictures in the long segment of the bowel
  • A previous resection surgery (surgical removal of more than 100 cm of the small bowel)
  • Rapid reoccurrence of Crohn’s disease with obstructive symptoms
  • Obstructive small bowel strictures without associated sepsis formation

How is strictureplasty performed?

Strictureplasty depends on various factors:

  • Length of strictures
  • Positioning of strictures within the small intestine
  • Number of strictures present

Strictureplasty techniques depend on the length of strictures, which are as follows:

  • For short strictures (less than 10 cm in length), the Heineke Miulicz strictureplasty technique is used.
  • For medium strictures (10-20 cm in length), the Finney strictureplasty technique is used.
  • For long strictures (longer than 20 cm in length), the side-to-side isoperistaltic strictureplasty technique is used.

Heineke Miulicz technique:

  • Strictureplasty is performed under general anesthesia or local anesthesia.
  • An incision (surgical cut) is made along the bowel that is slightly longer than strictures.
  • The incision is transverse (perpendicular) to the stricture length.
  • Two stitches are placed at the ends of the opening of strictures.
  • The incision is closed using absorbable sutures.
  • This causes widening of strictures.

Finney strictureplasty technique:

  • The intestine is folded at the stricture site.
  • A U-shaped incision is made along strictures without disturbing the adjacent healthy tissues.
  • Strictures are sealed by stitching it side-to-side creating a widened passage in the intestine.

Jaboulay (side-to-side isoperistaltic) technique:

  • This is done where the opening is too narrow.
  • The intestine is folded at the stricture site.
  • Two short incisions are made along strictures without disturbing the adjacent healthy tissues.
  • In this, a bypass is created around strictures.

How do you treat strictures in Crohn’s disease?

Inflammatory bowel disease such as Crohn’s disease can lead to scarring within your intestines. Over time, this can lead to narrow sections in your bowels (strictures). Surgery is needed to widen strictures to remove an obstruction.

Strictureplasty does not involve the removal of any part of the intestine, and hence, it is a bowel-preserving surgery. Strictureplasty reduces the risk of short bowel syndrome, which is usually the complication of resection surgery.

How to prevent small bowel obstruction

QUESTION

What are the complications of strictureplasty?

As with any surgery, complications are inevitable with strictureplasty. Some uncommon possible complications caused due to strictureplasty are as follows:

  • Infection at the surgical incision
  • Bowel obstruction
  • Bleeding in your bowel
  • Fluid leaking from the stitches
  • Recurrence of strictures

When should strictureplasty be avoided?

Strictureplasty should be avoided in the following conditions:

  • Inflammation, swelling, or hole at the affected site
  • Strictures close to a planned surgical site
  • Multiple strictures in a short segment of the bowel
  • Any stricture with cancerous cells

Key points

  • Dilated small bowel >3cm is considered abnormal
  • Small bowel obstruction and ileus can have similar appearances

If a patient presents with clinical features of obstruction then radiological assessment can be very helpful in determining the level of obstruction, and occasionally the cause.

There are features visible on a plain abdominal X-ray that may help locate the level of obstruction. These are partly determined by a knowledge of small and large bowel anatomy. See the page on normal Bowel Gas Pattern.

Dilatation >3cm of the small bowel is considered abnormal, however the longer the segment of bowel that is dilated, the more likely bowel dilatation represents a genuine obstruction.

Small bowel obstruction – features

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Small bowel obstruction – features

  • Centrally located multiple dilated loops of gas filled bowel (arrowheads)
  • Valvulae conniventes (arrow) are visible – confirming this is small bowel
  • Evidence of previous surgery – note the anastomosis site (red ring) – this suggests adhesions is the likely cause of obstruction (confirmed at surgery)

Small bowel obstruction – causes

The most common causes of obstruction are adhesions secondary to intra-abdominal surgery, hernias, tumours and Crohn’s disease. Regardless of whether there is evidence of these causes on an abdominal radiograph, a full surgical history should be taken and examination of the hernial orifices should be performed.

Ileus

Ileus is a term used for aperistaltic bowel not caused by a mechanical obstruction. This phenomenon is common after abdominal surgery. The radiological features can be similar to those of obstruction.

Post operative ileus

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Post operative ileus

  • Appearances are similar to those of mechanical obstruction
  • There are multiple loops of gas filled bowel projected centrally over the abdomen
  • This patient had prolonged non-colicky abdominal pain following a Caesarian section – recovery was spontaneous

Sentinel loop

Intra-abdominal inflammation, such as with pancreatitis, can lead to a localized ileus. This may appear as a single loop of dilated bowel known as a ‘sentinel loop.’

Sentinel loop

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Sentinel loop

  • A localized loop of small bowel is dilated in this patient with acute pancreatitis
  • This appearance is not diagnostic of intra-abdominal inflammation, but rather an occasional associated feature

Page author: Dr Graham Lloyd-Jones BA MBBS MRCP FRCR – Consultant Radiologist – Salisbury NHS Foundation Trust UK ( Read bio )

Last reviewed: October 2019

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How to prevent small bowel obstruction

Bowel obstruction is also known as an intestinal obstruction or Paralytic ileus and also Intestinal volvulus and even Pseudo obstruction intestinal and in some circles it can be called Colonic ileus. The obstruction in the bowel is an involuntary affair and causes the usual movement of foods in the digestive tract to be stalled. The obstruction can happen in any place of the digestive track. Unfortunately it is classed as a medical emergency and you will need intervention.

The bowel sometimes does not work correctly and causes an obstruction which we call ileus. In some cases of obstruction it is called pseudo-obstruction-intestine which affects neonates and pediatric patients the cause of the obstruction in this case is when the bowel wall obliterates and can lead to other conditions such as jaundice and electrolyte imbalances. This type of obstruction in the bowel can be a threat to your life so look out for signs like abdominal distention, abdominal pain and absence of bowel sounds. The best way to treat an obstruction is with fiber. Fiber are non digestible and go along the digestive track taking on water and will inevitably relieve defecation. It is non-starch polysaccharides like cellulose and some other parts such as waxes, chitins, pectins, dextrins, inulin, lignin and beta-glucans.

Aloe Vera is a type of flowering tender plant. It is originally from Africa. They have huge leaves which are shaped like a lance with a spiky edge.Honey is made by honey bees and comes from the nectar of flowers. It is very sweet but sweeter than sugar in fact. It has vitamin B6 vitamin C thiamin, niacin, riboflavin, and pantothenic acid. Honey is also known to have parts that can be used as antioxidants. Some of the antioxidant in honey are vitamin C, catalase, chrysin, pinobanksin, and pinocembrin. There have been some studies done that have found honey to increase the amount of probiotic bacteria in the stomach which will in effect contribute to strengthening the immune system and progress the digestion it also helps to lower the cholesterol levels and also prevent any future colon cancer.

Prunes are a type of plum and are quite wrinkly in their shape, they have been used for cooking and are well known for their relief effects of constipation. They give off potassium and fiber. Plums have the same effect as prunes because they both have dietary fibers sorbitol and isatin so they can both be used as juice to assist in controlling the function of the digestive system.

How to prevent small bowel obstruction

In my mind, the use of NG tubes for bowel obstruction is an anachronism. I grew up hearing about literature that said NG tubes provide no benefit, but are routinely rated as among the most painful things we do to our patients. In my mind, this was a classic example of a medical myth that had been relegated to the history of medicine, side by side with things like leeches and trephination. However, every time I admit a patient with a bowel obstruction, the issue of NG tubes is raised, so I guess we need a quick blog post.

Like many historical medical practices, the NG was adopted well before the era of evidence based medicine. Its use was based on common sense, and some pathophysiology, but not evidence. Unfortunately, time and again in medicine common sense and physiology have led us astray.

There is no evidence that NG tubes help

The use of NG tubes to decompress the stomach in small bowel obstruction seems to have originated with Dr. Owen Wangensteen. Over the course of a couple of decades of research into bowel obstruction, the mortality rate at Massachusetts General Hospital fell from around 45% in 1920 to approximately 20% by the end of the 1930s. Although both the diagnosis and surgical management changed dramatically over the decades, this decrease in mortality, publicized through case series, was the evidence that promoted widespread use of NG tubes. (Edlich 1996) Obviously, by modern standards, a case series in which many changes were made over many decades, from an era in which CT was unavailable and mortality was dramatically higher, does not count as a very high standard of evidence. At best, this is hypothesis generating.

Unfortunately, as far as I can tell, this hypothesis has never actually been tested. There is not a single randomized trial of any size or quality that addresses this issue. All we have is observational data (and the observational data from the modern era appears to conflict with the Wangensteen case series).

There are some major limitations to observational data, because patients who receive NG tubes are likely different from those who are treated without, but the available observational data does not support a benefit from NG tube use. In one chart review of 290 patients admitted with small bowel obstructions, about 20% were managed without an NG tube. The use of an NG tube was associated with worse outcomes across the board: longer time to resolution, longer length of stay, and a higher complication rate. Non-operative management was successful in 2/3rds of the patients, and was the same whether or not an NG was placed. Of note, almost 2/3rds of the patients who had an NG placed had minimal drainage, indicating the procedure could not possibly help the majority of patients. (Fonseca 2013)

The Best Evidence Topic Reports (Best BETs) series covered this topic in 2014, and the only relevant paper that they identified was the Fonseca 2013 observational study. Their bottom line: “There is no scientific evidence for the routine use of nasogastric tubes in adults with small bowel occlusion.” (Paradis 2014)

Just like dogs, cats — especially young, curious cats — sometimes eat things that can get stuck in their intestinal system. If this happens, a painful and potentially life-threatening condition called cat intestinal blockage, or cat bowel obstruction, can occur. Here’s a closer look at why this condition occurs, how it is diagnosed and treated and how you can prevent it from happening to your cat.

Common Reasons For Cat Intestinal Blockages

If your cat has an intestinal blockage it’s most likely because they ate something they shouldn’t have. Most things pass through the digestive tract just fine, but sometimes an object is too big to get through the intestines. When this happens, it’s called foreign body obstruction. Another common cause of cat bowel obstruction is when a cat swallows string, thread or tinsel. When this happens it is called a linear foreign body obstruction. In either case, your pet may require surgical care to remove the material.

What Happens When It Occurs?

When a cat swallows, food goes first to the stomach then through the small intestines, the large intestine, the colon and finally out the anus as feces.

But when the intestines are blocked, nothing can get through. If the cat continues to eat and drink, then fluid and food will build up behind the obstruction, causing swelling, inflammation and distention of the intestines. If this occurs in the part of the intestine closer to the stomach, it can cause vomiting. If it happens closer to the tail, it can cause diarrhea. If the intestines are completely blocked, the condition is considered life threatening unless treated.

How to prevent small bowel obstruction

Signs & Symptoms of Cat Intestinal Blockages

Signs of a possible intestinal blockage may include:

  • Vomiting, either food or liquid
  • Diarrhea, which can be bloody
  • Pain in the belly
  • Loss of appetite
  • Loss of energy
  • Hiding
  • Straining in the litter box to defecate
  • Smaller amounts of feces in comparison to normal
  • Increased aggression
  • Pawing at the face (occurs when string is swallowed and has wrapped around the base of the tongue)

If you notice any of these signs, call your veterinarian immediately.

Diagnosing Cat Intestinal Blockages

Your veterinarian will use a combination of factors to diagnose your cat. They will rely on any history you have of your cat’s behavioral changes and any sick behaviors you notice (hiding, loss of energy, vomiting, etc.). The veterinarian will also conduct a complete physical exam and may recommend a combination of laboratory blood, urine testing and X-ray or abdominal ultrasound to check for any indications of obstruction.

Treatment Options

Partially blocked intestines may be treated without surgery. In these cases your cat will be hospitalized, given fluids and pain medications and checked in on to see if the blockage passes on its own. If the blockage does not pass, then surgical removal of the foreign body will be required.

After surgery, you will likely be discharged with medication. Medication can include pain medication, anti-nausea medication and possibly antibiotics. Give all medications as prescribed and follow all post-surgical instructions completely. Your cat will likely have to wear an Elizabethan collar to prevent them from opening their stitches back up. Your cat will need to rest following surgery, and you may need to restrict your cat’s activity.

It is also very important to feed your cat bland, easily digestible food that won’t overtax the digestive system. Your vet will most likely recommend therapeutic food to help support the digestive system while it heals.

Future Prevention

If you have a naturally curious and playful cat that likes to explore, or if your cat has a history of eating things that could block up the intestinal tract, try “cat proofing” your house. Put items that your cat might eat in a secured drawer or cabinet, especially rubber bands, paper, wool, hair ties or scrunchies — cats seem to have a particular affinity for hair accessories. Supervise your cat playing with small toys and then put them away when you aren’t able to observe. If your cat likes to eat plants, you may need to prevent access to houseplants as well.

With a little knowledge and planning, you can help prevent your cat from ingesting things they shouldn’t. And if it happens, now you know what to look for and when to seek help. If you are ever in doubt, consult with your local veterinarian who is ready and willing to help.

Bowel obstruction complications can lead to life-threatening situation if left untreated. Read on, to know the symptoms of health complications that may result from an obstruction of the small and large intestine.

How to prevent small bowel obstruction

Bowel obstruction complications can lead to life-threatening situation if left untreated. Read on, to know the symptoms of health complications that may result from an obstruction of the small and large intestine…

Bowel obstruction can be experienced by elderly as well as children. Obstruction of the small intestine is more common than obstruction of the large intestine. Small intestine helps digest the food while large intestine helps hold and throw away the waste material. The intestines thus play an important role in maintaining the health of an individual. Intestinal obstruction can be partial or complete, in any case, blockage of the intestinal contents can lead to serious health complications.

Small and Large Bowel Obstruction

Causes

  • Intussusception (telescoping) of the intestine can lead to obstruction.
  • Gallstones or growing tumors, especially cancerous tumors within your abdomen, can block the intestines.
  • Twisting of the intestine, known as volvulus, can lead to intestinal obstruction. You should read more on twisted bowel symptoms and causes.
  • Inflammatory bowel diseases like Crohn’s disease, leads to thickening of the intestine’s walls. This results in narrowing of the intestinal passageway.
  • Bowel obstruction is often noticed as a complication after abdominal or pelvic surgery. Surgeries often lead to scar tissues (bands of fibrous tissue) or adhesion which result in intestinal obstruction.
  • Hernia is one of the most common causes of intestinal obstructions. Portions of intestine, protruding into another part of the body are referred to as hernias. Obstruction due to tumors or hernias is termed as ‘mechanical obstruction’.
  • Dysfunction of the intestine itself (paralytic ileus) due to muscle or nerve problems, can lead to prevention of food and fluid from passing smoothly through the digestive tract. Certain muscle and nerve disorders, such as Parkinson’s disease, use of certain medications (narcotics), abdominal or pelvic surgery, an infection, can cause paralytic ileus.
  • In infants and children, paralytic ileus can be caused by ingestion of foreign bodies, or electrolyte deficiency, or mineral disturbances, for example, low potassium levels; or by decreased blood supply to abdominal area.
  • Impacted feces, colon cancer, twisting of the colon (volvulus), diverticulitis (inflammation of the bulging pouches in the colon due to infection) can cause obstruction in the colon. Inflammation and scarring can cause narrowing of the colon, leading to obstruction.

Symptoms

  • Abdominal distention, swollen stomach even without eating
  • Abdominal fullness, gas
  • Abdominal pain and cramping
  • Bad breath
  • Constipation
  • Inability to have a bowel movement or pass gas
  • Electrolyte imbalances
  • Jaundice
  • Diarrhea
  • Nausea
  • Vomiting
  • Backache
  • Shortness of breath
  • Some people may experience dizziness, intense sleepiness

The symptoms of intestinal obstruction may vary from person to person, depending on the affected portion and extent of severity. In mild conditions, symptoms may come and go. The condition at this stage may not be a severe health condition but neglecting such symptoms can worsen the situation.

Complications

Intestinal obstruction can seriously affect your digestive health and in turn your overall health. Moreover, due to the obstruction, the supply of oxygen, blood and nutrients to the intestinal portion and the remaining digestive tract can get cut off. If the condition is not treated promptly, the intestinal wall can die. Tissue death (necrosis) can cause a tear or perforation in the intestinal wall, increasing the chances of infection and gangrene. The infection in the abdominal cavity is termed as peritonitis. Proper medications and surgery may be required to correct the condition (depending upon the underlying cause). In infants, paralytic ileus can result in destruction of the bowel wall which can prove to be a life-threatening condition. It may even lead to blood and lung infections.

Intestinal obstruction is a serious condition that needs prompt medical attention. Complications after bowel obstruction surgery include formation of scar tissue again causing blockage in the future, bleeding inside the abdomen, bowel leakage, damage to nearby organs, infection, temporary paralytic ileus, opening of the wound, or the edges of your intestines that are sewn together, etc. Only an expert surgeon can handle the situation well.