Bowel Obstruction Surgery: Everything You Need to Know

Bowel obstruction surgery is performed when there is a partial or complete blockage of the bowels, which include the small intestine and the large intestine. Procedures to treat bowel obstruction range from minimally invasive laparoscopic surgery to more complicated open surgical procedures. This may include the removal of damaged intestines, surgical resection, stenting, colostomy, removal of adhesions, or revascularization. 

An x-ray showing a small bowel obstruction
 

What Is Bowel Obstruction Surgery?

Bowel obstruction surgery is an interventional procedure that involves both:

  • Removal of any material that's blocking the intestines (such as feces, cancer, a polyp, an infectious abscess, or a twist in the bowel)
  • Repair of regions of the intestine that may have been damaged due to the obstruction

This surgery is performed in a hospital under general anesthesia. It can be planned in advance, but sometimes bowel obstruction surgery has to be done as an emergency procedure due to rapidly worsening and life-threatening complications.

You might have a laparoscopic procedure, which is performed with a few small incisions, or you might need an open laparotomy with a large incision. The extent of the blockage isn't necessarily the primary factor when it comes to whether you will have a major procedure or a minimally invasive one.

There is a range of techniques used in bowel obstruction surgery, and your procedure might involve steps like:

  • Removal of an obstructive lesion
  • Blood vessel repair
  • Resection of severely damaged areas of the intestines
  • Creation of an ostomy (creation of hole in your abdomen through which waste can exit the body)

When deciding on an approach, your surgeons will consider several things, including the number and location of the blockages, the cause of the bowel obstruction, your risk of infection, and any previous surgeries.

Contraindications

Bowel obstruction surgery is a major procedure. But given that it is often a critically needed one, the pros often outweigh the cons in many patients.

However, in certain individuals, the cause of the obstruction considered alongside their age and overall health profile may lead a doctor to conclude that surgery may not be the best option for the patient, all things considered.

This is particularly true for older patients. A review of research published in the World Journal of Emergency Surgery notes that "frail" patients with small bowel obstruction who are over age 70 have a greater risk of poor outcomes after bowel obstruction surgery than peers who are in better overall health—so much so that the impact on quality of life and mortality may outweigh benefits of the procedure (depending on the cause of the obstruction).

Chronic bowel obstructions that cannot be removed with surgery may occur in some patients, particularly those with advanced cancer. This may be due to narrowed structures and/or large tumor size.

Potential Risks

In addition to the standard risks of surgery and anesthesia, possible complications following bowel obstruction surgery include:

  • Edema (accumulation of fluid and inflammation)
  • Infection
  • New, persistent, or worsened bowel obstruction after surgery
  • Damage to nearby organs in the body
  • Formation of scar tissue (adhesions) in your abdominal cavity that increases the risk of another intestinal blockage in the future
  • Incomplete healing of the regions of your intestines that are sewn together (anastomotic leak), which may cause urgent life-threatening problems
  • Post-surgical problems with your ostomy (colostomy, ileostomy, or J-pouch)
  • Temporary paralysis (freezing up) of the bowel, known as paralytic ileus

Purpose of Bowel Obstruction Surgery

A bowel obstruction can occur suddenly (acute) or may slowly worsen over time (chronic).

When certain causes are to blame, conservative measures may be tried prior to considering bowel obstruction surgery. In others, surgery is the main treatment option and, sometimes, is urgently needed.

Bowel obstruction can quickly become life-threatening. Surgery is done to save your small or large intestine and to prevent the dangerous complications that can happen when an obstruction isn't treated, including:

  • Chronic abdominal pain, nausea, and vomiting
  • Prevention of food and stool from passing through the bowels
  • Permanent intestinal damage
  • Problems with blood flow in the bowels
  • Necrosis (tissue death) of intestinal tissue
  • Bleeding or leaking from the intestines
  • Fluid and electrolyte disturbances

When severe, these issues can cause hypotension, multi-organ failure, or death. A complete intestinal obstruction is a serious medical emergency that requires surgery.

The sooner a significant intestinal blockage is removed, the better chances of survival. Surgery within the first 36 hours reduces the mortality rate to 8%, while delaying surgery past 36 hours has a 25% mortality rate.

Indications and Assessment

If you have symptoms of bowel obstruction—for example, severe pain, intermittent cramping, changes in bowel movements—your doctor will do a physical examination to check your abdomen and your bowel sounds.

Diagnostic testing can usually identify the number of obstructions, their locations, and the cause.

You are likely to have an abdominal X-ray, computed tomography (CT) scan, or ultrasound. These tests generally involve intravenous (IV, in a vein) injection of contrast material. A barium enema is a more invasive imaging test in which a small amount of contrast material is inserted into the rectum to help visualize intestinal structures.

In addition, you will have blood drawn so your complete blood count and electrolyte levels can be checked. And you will have a urinalysis, which reflects your electrolyte levels and can show signs of an infection.

A sigmoidoscopy or a colonoscopy might also be part of your diagnostic evaluation. These are invasive diagnostic procedures that use a camera threaded through the colon to visualize the structure on the inside of the bowels.

You might need bowel obstruction surgery if it's determined that you have any of the following issues:

  • Mechanical obstruction: A blockage inside the lumen (passageway) of the small or large intestine can result from cancer, inflammatory bowel disease IBD), swelling, or infection.
  • Constriction: Pressure from outside the intestines can create pressure. This can occur due to cancer or scar tissue that often develops after abdominal surgery or radiation therapy.
  • Rotation: Twisting of the intestine can be a consequence of scar tissue, muscle disease, or nerve disease.
  • Hernia: A weakening of the abdominal muscle wall can form a pocket, which may squeeze the intestine.
  • Myopathy or neuropathy: Congenital or acquired conditions that prevent the intestinal muscles from moving properly may cause the intestines to collapse, compressing the lumen, or may lead to distorted movements.
  • Ischemic colitis: A loss of blood flow to a section of the intestines can result from a blood-clotting disorder.

Surgery As a Second-Line Treatment

If bowel obstruction is caused by edema, inflammation, or hardened feces, your doctor may try conservative treatments before bowel obstruction surgery.

These options are used when a person is medically stable and the bowel isn't in immediate danger or necrosis, or when the risk of surgery is very high (such as due to underlying disease, like heart disease).

Conservative therapies include:

  • IV fluids and medication: Electrolytes and fluid are given intravenously to treat or prevent dehydration and restore electrolyte balance. Medications are given to soften stool, induce intestinal motility (peristalsis), and relieve nausea and vomiting.
  • Enema: A nozzle is inserted into your anus and liquid is injected into the rectum. You are asked to hold the liquid for a period of time, then sit on the toilet to evacuate your bowels. 
  • Nasogastric tube: A long, thin tube is passed through the nose into the stomach and down to the intestine. This can be used to suction out waste material above the blockage, relieve gas build-up, and decrease swelling.
  • Colorectal tube: A long, thin tube is inserted through the rectum into the colon and used to remove fluid, gas, and inflammation.

If these treatments do not relieve the blockage, surgery might be the next step.

Of note and according to a study published in the journal Medicine, recurrent bowel obstruction—especially after abdominal surgery (such as for cancer)—tends to persist when repeatedly treated with conservative therapies and may have a higher chance of resolution with surgery instead.

How to Prepare

An acute bowel obstruction can be extremely painful and often results in a visit to the emergency room. For acute and chronic bowel obstruction, surgery may occur within a few hours to up to three days after the diagnosis.

Location

Bowel obstruction surgery is performed in the hospital in an operating room.

What to Wear

For the surgery and remaining hospital stay, you will wear a hospital gown. It is recommended that you arrive for your surgery wearing loose-fitting clothes that are easy to change out of.

Don't wear any jewelry during the surgery and leave anything of value at home.

Food and Drink

Surgery for bowel obstruction is typically done under general anesthesia. Ideally, you should not eat or drink for about eight hours prior to general anesthesia. However, when the procedure is done as an emergency, pre-surgical fasting is not always possible.

Medications

It is important to notify your surgical team of any prescription and over-the-counter medications and supplements you are currently taking. Certain medications may be problematic during surgery. In particular, blood thinners can cause excessive bleeding.

What to Bring

In addition to personal care and comfort items like toiletries and a change of clothes, make sure you have health insurance documents and personal identification with you.

If you take any prescription or over-the-counter medications, be sure to bring a list of them with you. Some of these medications may need to be changed, or your doctor might prescribe new ones after your procedure.

Upon discharge, you will likely not be allowed to drive, so arrange transportation in advance.

What to Expect on the Day of Surgery 

Before the surgery, your doctor will explain the procedure in detail, including a step-by-step description, the risks of surgery, and what a typical recovery looks like. You will likely be asked to sign consent forms at this time as well.

Depending on the scope of the procedure, bowel obstruction surgery can take from an hour up to three and a half hours.

Before the Surgery

Prior to surgery, you will change into a hospital gown and have an IV inserted into your vein so you can receive the fluids and medications that you need. You will be transported to the operating room and moved to the operating table.

Your anesthesia provider will first give you an IV sedative to help you relax. Then an endotracheal tube (breathing tube) will be inserted through your mouth and into your windpipe before it's connected to the ventilator to help you breathe during the procedure. The anesthesia medication will ensure that you can't move or feel pain during your procedure.

A foley catheter is placed in the urethra to collect urine. You may also have a nasogastric tube placed into your nose and down to your mouth to collect blood and fluid from your stomach during surgery.

The surgical staff will swab your abdomen with a solution that kills germs and put a drape around the surgical area to prevent infections.

After it is confirmed that you are fully under anesthesia, your surgery will begin.

During the Surgery

Your surgeon will determine the proper technique to clear the obstruction based on its location, size, and cause. Much of this planning will occur prior to your surgery, but some decisions may be made during surgery as well. For instance, you may have cancer invasion into the intestine that requires a more extensive resection than initially planned. Or your doctor may see additional adhesions in multiple locations that need to be removed during your surgery.

Laparoscopic Bowel Obstruction Surgery Steps

Minimally invasive surgery may utilize thin scopes, which are tubes inserted through one or more tiny incisions in the abdomen. Alternatively, endoscopy, in which a tube is placed into the mouth, or sigmoidoscopy, in which a tube is placed into rectum, may be used to treat the blockage.

With minimally invasive laparoscopic procedures, the surgeon uses a computer monitor to view the intestines and the obstruction. Sometimes trapped stool is broken apart and suctioned out through the tube. Or a polyp or tumor might be removed, followed by repair of the adherent intestinal tissue. A stent might be placed if the obstructed area is prone to recurrent obstruction, such as due to nerve or muscle impairment.

Any abdominal incisions will be closed with stitches or steri-tape. And your wound will be covered with sterile gauze and tape to protect it.

Open Bowel Obstruction Surgery Steps

Open surgery is required when the intestines are strangulated due to rotation or compression, or if the obstruction is caused by loss of intestinal blood flow. With an open laparotomy, the surgeon might make up to a 6- to 8-inch abdominal incision to access the bowel obstruction for decompression and repair.

Depending on the cause of the obstruction and associated intestinal damage, your surgeon may also need to perform one or more of the following:

  • Surgical resection: Removal of a portion of the colon might be necessary when there is an invasive mass, such as cancer.
  • 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 for the 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 temporarily placed to prevent a severe gastrointestinal infection from spreading throughout the body. However, it is possible that the ends of the intestines cannot be reconnected, in which case these openings may be needed for the long term.
  • Revascularization: Ischemic colitis may require revascularization, which is the repair of the blocked blood vessels that supply blood to the intestines.

When the surgery is completed, the surgeon will use dissolvable sutures to close internal incisions. The external incision is sealed with stitches or surgical staples and the wound covered with sterile gauze and tape.

After the Surgery

Once the surgery is complete, the anesthesia is stopped or reversed and you will slowly begin to wake up. As your anesthesia wears off, your breathing tube will be removed and you will be moved to the recovery room for monitoring.

You will be groggy at first and slowly become more alert. Once you are awake and your blood pressure, pulse, and breathing are stable, you will be moved to a hospital room to begin recovering.

Your IV will stay in place so you can receive medications and fluids for the remainder of your hospital stay. Likewise, your urinary catheter will remain in place until you are physically able to get out of bed and walk to the bathroom.

Some people recovering from a laparoscopic procedure may be able to get out of bed several hours after surgery; it can take a few days to get back to walking and urinating on your own after open surgery.

Recovery

After surgery for a bowel obstruction, your stomach and intestines need time to regain normal function and heal. The amount of time that will take depends on the extent of your procedure and any co-occurring health conditions you may have, such as colon cancer.

Most patients stay in the hospital for between five and seven days following bowel obstruction surgery. It can take several weeks or months to fully return to normal activities.

Your medical team with work with you to manage post-surgical pain. Opioids, which are typically used to relieve pain, can lead to post-operative constipation and are used sparingly after bowel obstruction surgery. Nonsteroidal anti-inflammatory medications (NSAIDs) can also be risky as they may cause bleeding of the stomach or intestines.

Before Discharge

Your doctors will confirm that you can pass gas before you will be allowed to drink small amounts of fluid. Your diet will start with clear fluids and (when your body shows signs that it is ready) slowly advance to soft foods.

You'll be given instructions regarding wound care, medications, signs of infection, complications to look out for, and when you need to make a follow-up appointment. Follow all of your doctor's instructions and call the office with any questions or concerns.

If a colostomy or ileostomy was needed, you will have a tube with a bag attached to collect stool. Your nurse will instruct you on how to care for it before you go home.

Healing

Some patients may require a visiting nurse to check on the wound as it heals, oversee colostomy/ileostomy care, or administer tube feedings.

Once you are home and on the road to recovery, some things to keep in mind:

  • Wound care: Follow your doctor's instructions regarding how to care for your wound and any precautions you need to take when bathing. Watch for signs of infections, such as redness, swelling, bleeding, or drainage from the incision site.
  • Activity: Moving around throughout the day will help to prevent blood clots and promote healing. But avoid strenuous exercise or lifting heavy objects until your wound has healed completely (about four to six weeks). Do not exercise until your doctor gives you the go-ahead. 
  • Diet: Your doctor may prescribe a soft GI diet for up to six weeks after surgery, which is a diet low in bulk fiber. If so, avoid fresh fruit (other than bananas), nuts, meat with casings (such as sausage), raw vegetables, corn, peas, legumes, mushrooms, stewed tomatoes, popcorn, potato skins, stir-fry vegetables, sauerkraut, whole spices (such as peppercorn), seeds, and high-fiber cereals (like bran). Know, though, that it may take several weeks before you can tolerate regular food. Your nasogastric tube will remain in place until this occurs. Some patients continue to receive nutrition through a feeding tube after returning home.
  • Medications: Maintaining regular bowel movements is important for preventing future blockages. Your doctor may put you on a bowel regimen of stool softeners, such as Miralax (polyethylene glycol 3350), along with medications such as senna to promote bowel movement. Follow your doctor's instructions in terms of both what to take and avoid.

When to Call Your Doctor

Call your doctor for guidance if you experience any of the following:

  • Vomiting or nausea
  • Diarrhea that continues for 24 hours
  • Rectal bleeding or tar-colored stool
  • Pain that persists or worsens and is not controlled with medication
  • Bloated, swollen, or tender belly
  • Inability to pass gas or stools
  • Signs of infection, such as fever or chills
  • Redness, swelling, or bleeding or draining from the incision site
  • Stitches or staples that come out on their own

Coping and Long-Term Care

It is important to work closely with your gastroenterologist to restore regular bowel function and prevent another obstruction. This applies for the time soon after your surgery and, in many cases, beyond.

Treatment protocols are not one-size-fits-all and it may take several tries to find the right medication or combination of medications for you. If a particular medication fails to bring relief or if you experience uncomfortable side effects, notify your doctor, who can prescribe a different course of action.

You may be asked to keep a diary of bowel movements, including frequency, volume, and consistency based on the Bristol Stool Chart, which rates bowel movements on a scale of one (hard) to seven (runny).

Possible Future Surgeries

If you have had a colostomy or an ileostomy, you might have another procedure to get your bowels re-attached once inflammation goes down. Your doctor will discuss this plan at your follow up appointment.

Generally, bowel obstruction surgery provides sustained relief. However, there is a chance of having a recurrent bowel obstruction, especially when the initial condition that caused the bowel obstruction is chronic or incurable. Repeat surgery may be necessary.

Lifestyle Adjustments

Once you recover from a bowel obstruction, it is important to maintain bowel health and regularity. You may want to work with a dietitian to develop an eating plan that contains the right amount of fiber for your individual needs.

It is also important to drink at least eight 8-ounce glasses of water daily to ensure proper hydration and prevent a recurrence of constipation. Regular exercise can also help to keep stool moving through the intestinal tract. Be sure to have a doctor-approved plan for treating constipation in place in case it does occur.

If you have an ostomy, know that you can lead an active and healthy lifestyle but will also have to make some adjustments. This means timing your meals so you won't have to empty it at an inconvenient time, keeping it clean, and wearing clothes that are comfortable and convenient.

A Word From Verywell

Bowel obstruction surgery can take some time to recover from. Working with your doctors can help ensure proper healing and restoration of normal bowel functioning. It is important to maintain bowel regularity and treat potential constipation quickly to avoid another intestinal blockage, especially if you have risk factors that could predispose you to having another bowel obstruction.

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