In our most recent blog, The Digestive Disease Consultants told the story of the signs and symptoms of bowel obstruction.  This is also called “intestinal” obstruction.  In this article we will define some different aspects, treatments and types of intestinal obstructions .

Intestinal obstruction whould not make as pretty a picture!

A Normal barium enema makes a pretty picture without intestinal obstruction.

We invite you to read or review the previous article.  It contains the proper signs and symptoms of bowel obstruction.

In our last blog, we introduced you to a sample patient in a mini-case-study story.  You met Ms. Lila Oberon, who had undergone recent emergency surgery for bowel obstruction.

As we often do on this blog, we presented that story to define some of the human reactions and aspects of the condition.  In this week’s blog, read below to discover variations on this condition.  And we will discover facts about treatments.

(Once again, Digestive Disease Consultants cautions you.  Please do not diagnose yourself by reading Internet information Blogs.  This information, although helpful, is not meant to replace your visit to the doctor.  Blogs are useful to illuminate some of the details you might discuss with him or her.)

Obstructions:  More than One Kind!

As we informed you in our last blog, if you have the symptoms of bowel obstructions, you must see a   doctor immediately.  Let’s look at diagnostic tests in more detail:

  • As you might have noticed, many of the bowel obstruction symptoms overlap with other digestive disease symptoms.  In order to diagnose you definitively with a bowel obstruction, doctors might order a CT scan.  This will create cross-section images of your body and doctors can find the obstruction.
    X-ray will reveal trapped gas and fluid in the form of “air-fluid levels” in the intestinal loops above the obstruction.
    A Contrast X-ray, given after you ingest barium, can show the doctors exactly where the obstruction is.
  • A CT scan is particularly effective in showing an abdominal mass or adhesions.
  • Some tests will show you do not have an obstruction, so it can be eliminated as the cause of your pain.  Just such a test is an abdominal ultrasound.

Type I:  When Intestinal Obstruction is Critical: The Complete Intestinal Obstruction

In a “Complete Obstruction, the colon will be completely kinked, twisted or blocked off from blood supply.  This condition mandates immediate surgery.

Meanwhile:  Meet the Cadillacs of Gastro-intestinal Tests– The Colonoscopy:   A Test and a Treatment for Intestinal Obstruction!

More than a test, the colonoscopy procedure might actually help a Partial Intestinal Obstruction

Test and Treatment for Intestinal Obstruction!

It might be said that the colonoscopy is the Cadillac of tests for a digestive difficulties.  It certainly can detect any type of bowel obstruction.

For example if a partial bowel obstruction is caused by polyps from diverticulitis, they might be removed during the course of the colonoscopy, thereby eliminating the cause.

Please remember that Digestive Disease Consultants, presents extensive colonoscopy services at our state-of-the-art Ambulatory Surgical Center, conveniently located in our main office building in Altamonte Springs…. Please check our home page link for more information about our Inpatient GI consultations.

Type II:  Partial Intestinal Obstruction:

A bowel obstruction may also be “partial,” in which case the bowel is not completely blocked off, but only partially obstructed.  This condition might also be treated with a few days of “bowel rest.”

Re-booting the Bowel With Bowel Rest

In the hospital, the technique of bowel rest requires that any food in the stomach is drained.  The patient is NPO, which means he or she does not eat.  Intravenous fluids are given to stay hydrated.

Dr. Desi stated, “Sometimes, within a few days things can open up and start moving along.”  Thus, no surgery is needed.  He added, “Patients can respond and do very well.”

For Bowel Rest, your doctor might thread a tiny tube, the nasogastric tube, through your nose and down into your stomach.  “The tube removes fluids and gas and helps relieve pain and pressure.”

Likewise, your physician might open up the blockage with enemas or small mesh tubes, termed stents.

Intestinal Obstruction:  When “Bowel Rest” Fails

However if the “bowel rest” is ineffective or bowel tissue starts to die because of the blockage, then surgery to untwist kinked bowel or remove blockage is the only recourse.  During surgery the surgeon will remove the affected part of the bowel. depending upon your disease or condition, you might need to have a colostomy or an ileostomy.  In bowel surgery, after the obstructed, diseased or “dead” part of the intestine is removed, sometimes the ends are sewn together, and the bowel “pinks up” nicely.

More Severe Cases

In other more severe cases, the surgeon sews the remaining part of the intestine to an opening in the skin. Thus, the surgeon allows the working part of the bowel to function and the rest of the bowel to rest.  Stool travels out of the body through the opening in the skin, where it accumulates in a disposable ostomy bag.

After Severe Intestinal Blockage: When a section of tumorous intestine is removed, this bag becomes a patient's best friend, for a while or forever.l

Accessory bag and disk for colostomy

Depending on what has caused the blockage and other medical conditions, the colostomy or ileostomy might be permanent or temporary.  “Colostomies are performed because of problems with the lower bowel.

Some problems can be corrected by temporarily diverting stool away from the bowel. This is when temporary colostomies are used to keep stool out of the colon.  “If the colon is badly diseased, as sometimes is the case in colon cancer, permanent colostomies are performed and the colon may be removed completely.”

Lila Oberon, our “example story” or case-study from last week smiles softly.  “You know, she says, I was a member of the plastic bag society several months.  I was horrified at first, but then I decided it was amazing they could save my life like that!  It just gave me time to heal.  The doctor stitched everything back together in a quick operation.  Later, and now I’m as good as new.”

If it the colostomy is temporary, then when the bowel has recovered, the surgeon will re-sew the ends of the intestine to each other, and repair the ostomy, as he did in the case of Lila Oberon.

Intestinal Obstructions:  More about Causes and Kinds

As we wrote previously, blockages can be caused by a twisting or narrowing of the intestine.  This is often true in hernias or as a result of Crohn’s disease.

Another cause can be a fold in the intestine, much like the tube-within-a-tube fold of a telescope.  This can cause a blockage. Doctors term this type of intestinal obstruction intussusception.  “Intussusception is the most common cause of intestinal obstruction in children between 3 months and five years of age.  It is extremely rare in children under 3 months of age or in older children and adults.”

3.  Pseudo-obstruction:  A Wolf in Sheep’s Clothing!

At times a patient will exhibit bowel obstruction symptoms but x-rays reveal no true blockages.  This is called intestinal pseudo-obstruction.

Healthy diet and an active lifestyle makes a happy bowel.

Even after Intestinal obstruction, a happy bowel is an active bowel.

In such cases, nerves or muscles fail to move food properly.  “Treatment may involve ingesting liquid food through a feeding tube or intravenously.”

This blog as well as our previous one have a serious underlying theme:

Be your own medical advocate:

If the onslaught of cramping and severe intestinal pain  is sudden and terrible—

-Suppose your abdomen is bloated, and your bowels will not move, and haven’t moved in several days,

–if you also have vomiting or diarrhea with the pain,   

–listen to your body.  Terrible pain is a message that something terrible could be wrong.

The Digestive Disease Consultants caution you that intestinal obstructions can quickly become a critical situation.  Know the symptoms and realize you require serious and immediate medical attention.  Do not ignore your body’s signals. Do not ignore the pain.  We hope you will be  a proactive patient, and let caregivers know at the ER that you believe this could be an intestinal obstruction.