Intestinal Obstruction

What is an intestinal obstruction?

An intestinal obstruction is a blockage of the small or large intestine (also called the small or large bowel). The blockage makes it hard for the contents of the bowel to pass through and out of the body. If the obstruction is only partly blocking the intestine, you may feel some relief of crampy belly pain and fullness as you pass liquid stool or gas. Sometimes the blockage cuts off blood flow to part of the bowel. When this happens, the bowel is said to be strangulated (or ischemic). The lack of blood flow can cause death of some of the tissue and can be life threatening.

The most common cause of an intestinal obstruction is scar tissue (adhesions) from previous surgeries. These scars may grow between parts of your bowel and trap loops of bowel. Other causes of a blockage may include:

• Tumors that block the intestine
• A hernia, which is part of the intestine that bulges through a weak area or gap in the muscles in your belly and may get trapped
• Inflammation of the bowel from conditions such as Crohn’s disease or diverticulitis
• Twisting of the bowel
• A hard lump of stool (fecal impaction)
• Intussusception, which is the intestine folding into itself, cutting off the flow of partly digested food and eventually cutting off blood flow to the tissues
• Narrowing of the bowel that has been present since birth

What can I expect in the hospital?

Several things may be done while you are in the hospital to monitor, test, and treat your condition. They include:

Monitoring

• You will be checked often by the hospital staff.
• Your heart rate, blood pressure, and temperature will be checked regularly.
• Your blood oxygen level may be monitored by a sensor that is attached to your finger or earlobe.

Testing

Your healthcare provider will ask about your medical history and symptoms and perform a physical exam. The following tests may also be done:

• Blood tests to check for infection or blood loss
• Tests of bowel movements to check for blood or infection
• Tests to look for abnormalities in the intestine and abdomen, which may include:
  • X-rays: Pictures of the inside of the abdomen and the intestines to check for a blockage
  • Computed tomography (CT) scan: A series of X-rays is taken from different angles and arranged by a computer to show thin cross sections of the intestines.
  • Upper gastrointestinal (GI) endoscopy (EGD): A thin, flexible, lighted tube is put through your mouth, into your stomach and intestine to look for a blockage. Sometimes one or more pieces of tissue are removed to help make a diagnosis. This is called a biopsy.
  • Sigmoidoscopy or colonoscopy: A thin, flexible tube and tiny camera is put into the rectum and up into the colon to look for a blockage. Sometimes a biopsy will be done to help make a diagnosis.
  • Barium enema: An X-ray is taken of the belly after barium is inserted through your rectum to show the walls of the intestine and any possible problems.
  • Ultrasound scan: Sound waves and their echoes are passed through your body from a small device that is held against your skin to create pictures of the inside of your belly and intestines.
  • Laparoscopy: A small lighted tube put into the belly through a small cut to look at the organs and tissues inside your abdomen and pelvic cavity. Sometimes a biopsy may be done to help make a diagnosis.

Treatment

The treatment for an intestinal obstruction depends on its cause.

• You will have a small tube (IV catheter) inserted into a vein in your hand or arm. This will allow for medicine to be given directly into your blood and to give you fluids, if needed.
• You may not be allowed to eat a regular diet until after the cause of the intestinal obstruction is found and treated.
• You may have a tube put through your nose down into your stomach, called a nasogastric or NG tube. The tube may be used to give fluids or medicine, or with suction to help remove fluid and air and relieve pressure in your stomach and intestine.
• You may have a tube inserted into your rectum, called a rectal tube, to help fix an obstruction caused by a twisted bowel and relieve pressure in the intestine from bowel gas.
• If the blockage is a hard lump of stool near the anus, it may be possible to remove it with an enema or a gloved finger. This may require several enemas and may be very uncomfortable.
• Your provider may prescribe medicine to:
  • Treat pain
  • Treat or prevent an infection
  • Treat or prevent side effects, such as nausea or constipation, from other treatments
  • Soften stool and reduce straining with a bowel movement
• Your provider may recommend other types of therapy to help relieve pain, other symptoms, or side effects of treatment.
• You may need surgery to treat the intestinal obstruction. Surgery may include:
  • Ladd procedure: If the obstruction is caused by a twist in the intestine, the surgeon may straighten it out and tack it down so it cannot twist again. The appendix is usually removed during this surgery to prevent future problems. If the blood supply to part of the intestine was blocked by the twist, a section of intestine may need to be removed.
  • Colon resection: Surgery to remove the section of colon that was blocked or twisted. The ends of the intestine are then sewn back together
  • Colostomy: Surgery to remove a section of the colon. The healthy part of the remaining colon is attached to an opening in the wall of the abdomen. Bowel movements then pass through this opening instead of the rectum. They are collected in a bag outside the body. After the remaining colon heals, the colostomy can sometimes be reversed. This means that you will have a second surgery to rejoin the ends of the colon to each other and will no longer have a colostomy.
  • Lymphectomy: Surgery to remove lymph nodes in the abdomen if the blockage was caused by cancer to check if the cancer has already spread. It also allows the pathologist to determine the stage of the cancer accurately. This will allow your healthcare providers to determine if you need more treatment after you recover from surgery.

What can I do to help?

• You will need to tell your healthcare team if you have new or worsening:
  • Change in bowel habits, such as pain, mucus, diarrhea, constipation, or other intestinal problems
  • Bloating
  • Belly pain that goes away and then comes back worse than it was
  • Nausea or vomiting
  • Blood in your bowel movements
  • Blood in your vomit
  • Redness, swelling, pain, warmth, or drainage from your surgical wound
  • Fever, chills, or muscle aches
• Ask questions about any medicine or treatment or information that you do not understand.

How long will I be in the hospital?

How long you are in the hospital depends on many factors. The average amount of time to stay in the hospital with an intestinal obstruction is 6 days.