Surgery for a Bowel Obstruction

Treatment for Intestinal Blockage

Surgeon Beginning Procedure With Scalpel In Hand, Close-up
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There are several types of surgical procedures used to relieve a bowel obstruction, which is a partial or complete blockage of the intestines. A bowel obstruction can be treated with a surgical resection, stenting, colostomy, removal of adhesions, or revascularization. 

A bowel obstruction may be acute (sudden and rapid) or chronic (slowly worsening), and requires prompt medical attention because it may rapidly become life-threatening.

Indications

A bowel obstruction occurs in the small or large intestine, preventing undigested food and stool from passing through. This can cause a number of serious complications, including permanent damage to the intestines, severe fluid and electrolyte disturbances, and bleeding or leaking from the intestines. If untreated, blood pressure may drop, resulting in multi-organ failure and death.

Bowel obstruction may result from any of the following:

  • Mechanical obstruction, which is blockage inside the lumen (passageway) of the small or large intestine, typically due to cancer, inflammatory bowel disease, swelling, or infection
  • Constricting pressure from outside the intestines, usually due to cancer or scar tissue (which often results from prior abdominal surgery or radiation therapy)
  • Twisting of the intestine itself, which can result from scar tissue, muscle disease, or nerve disease
  • Myopathy (muscle disease) or neuropathy, which can be congenital or acquired: These conditions may prevent the intestinal muscles from moving properly, may cause the intestines to collapse, compressing the lumen, or may lead to distorted movements (resulting in twisting).
  • Ischemic colitis (loss of blood flow to a section of the intestines), usually as a result of a blood clotting defect

The most common cancers responsible for bowel obstructions include colon cancer, stomach cancer, and ovarian cancer, although any type of metastatic cancer can cause a bowel obstruction in the small or large intestine. Bowel obstructions from colon cancer tend to occur in the large intestine (the colon).

Recognizing Bowel Obstruction

Severe pain and abdominal discomfort are the most recognizable symptoms of bowel obstruction, although subtler signs and symptoms can occur as well.

Other symptoms that may occur with a bowel obstruction include:

  • Intermittent cramping, colicky pain in your abdomen
  • Decreasing appetite, nausea, vomiting
  • Bad breath
  • Changes in bowel movements 
  • Chronic constipation or lack of a bowel movement
  • Abdominal distention (unusually widening appearance)
  • Fluid in your abdomen

Pre-Surgical Testing

If you have symptoms of bowel obstruction, your doctor will do a physical examination to check your abdomen and your bowel sounds.

Your diagnostic evaluation may include an abdominal X-ray, computed tomography (CT) scan, or ultrasound. These tests may or may not include a barium enema, which involves inserting a small amount of contrast material into your rectum to help better visualize the structures.

If you have a blockage, you may also need a sigmoidoscopy or a colonoscopy, which are invasive diagnostic procedures in which a camera is inserted into the colon to visualize the blockage.

Procedure Options

There are several surgical options for treatment of bowel obstruction. Surgery is typically urgent, meaning that you may have your surgery within a few hours to a few days after being diagnosed with a bowel obstruction. Some medications may help with nausea, but they do not prevent the bowel obstruction from worsening or improve it.

Ideally, you should not eat or drink for about eight to 10 hours prior to this type of surgery, but, because of the urgency, pre-surgical fasting is not always possible. Surgery for bowel obstruction is typically done under general anesthesia in the operating room.

You may have an open surgery, with a large incision, or a minimally invasive surgery with a few small incisions and a camera for visualization. This depends on the location, size, and cause of your bowel obstruction. Large tumors or widespread adhesions may require an open procedure, while a small tumor or infection may be treated with minimally invasive surgery.

Types of surgery for bowel obstruction include:

  • Surgical resection: Removal of the obstruction is necessary when there is a mass, such as a tumor.
  • Removal of adhesions: If you have scar tissue squeezing your intestines from the outside, this often requires careful incisions to cut them away, although scar tissue can return again.
  • Stent placement: A stent, which is a tube that holds the intestine open, may be placed inside the intestine to allow passage of food and stool and to prevent another blockage. This may be necessary when a bowel obstruction is recurrent or when the intestines are severely damaged.
  • Colostomy/ ileostomy: If your intestines are damaged or inflamed, a permanent or temporary ileostomy or colostomy, which is an artificial opening in your abdomen for waste or stool evacuation, may be needed. Sometimes, these are temporary structures needed to prevent a severe gastrointestinal infection from spreading throughout the body. However, it is possible that the ends of the intestines cannot be reconnected, and these openings may be needed for the long term.
  • Revascularization: Ischemic colitis may require revascularization, which is repair of the blocked blood vessels that supply blood to the intestines.

Recovery

After surgery for a bowel obstruction, your stomach and intestines will need time to regain normal activity and to heal. You may not be permitted to eat right away, and your doctors will confirm that you can pass gas before allowing you to drink small amounts of fluid. Your diet will advance slowly, from fluids to soft foods to bulkier foods.

You may need pain medication for the first week after your procedure. Some medications, such as opioids, can interfere with healing by causing severe constipation and are, thus, used sparingly. Nonsteroidal anti-inflammatory medications (NSAIDS) may cause bleeding of the stomach or intestines. In general, pain medication is carefully administered and monitored after bowel obstruction surgery, and intravenous fentanyl, panadol, or methadone are some of the common pain treatments.

As you are advancing your diet, you may also need an X-ray of your abdomen to confirm that you are healing and that there is no remaining (or new) blockage. Throughout this time, you will need IV fluids to maintain your hydration and nutrition. You should begin to have small bowel movements as you advance your diet, and you can expect to have normal bowel movements once you start eating solids.

Full recovery can take several weeks and may take as long as several months. It is not easy to predict how long it will take you to recover, as this is dependent on how well you tolerate liquids and solids, not on the type of surgery. As a general guide, however, surgery that involves removal of a large section of the colon can take longer to recover from.

Complications

Complications of surgery for bowel obstruction can include an infection, bleeding, perforation (a hole in the bowel), and movement of the stent. In advanced colon cancer or in inflammatory bowel disease, bowel obstructions can recur, even after treatment.

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