Intestinal obstruction repair
Definition
An intestinal obstruction is a partial or complete blockage of the small or large intestine. Surgery is sometimes necessary to relieve the obstruction.
Purpose
The small intestine is composed of three major sections: the duodenum just below the stomach; the jejunum, or middle portion; and the ileum, which empties into the large intestine. The large intestine is composed of the colon, where stool is formed; and the rectum, which empties to the outside of the body through the anal canal. A blockage that occurs in the small intestine is called a small bowel obstruction, and one that occurs in the colon is a colonic obstruction.
There are numerous conditions that may lead to an intestinal obstruction. The three most common causes of small bowel obstruction are adhesions, which are bands of scar tissue that form in the abdomen following injury or surgery; hernias, which develop when a portion of the intestine protrudes through a weak spot in the abdominal wall; and cancerous tumors. Adhesions account for approximately 50% of all small bowel obstructions, hernias for 15%, and tumors for 15%. Other causes include volvulus, or formation of kinks or knots in the bowel; the presence of foreign bodies in the digestive tract; intussusception, which occurs when a portion of the intestine telescopes or pulls over another portion; infection; and congenital defects. While most small bowel blockages can be treated with the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube, surgical intervention is necessary in approximately 25% of patients with a partial obstruction, and 50%–65% of patients with a complete obstruction.
An obstruction of the large intestine is less common than blockages of the small intestine. Blockages of the large bowel are usually caused by colon cancer; volvulus; diverticulitis (inflammation of sac-like structures called diverticula that form in the intestines); ischemic colitis (inflammation of the colon resulting from insufficient blood flow); Crohn's disease (a disease that causes chronic inflammation of the intestines); inflammation due to radiation therapy; and the presence of foreign bodies. As in the case of small bowel obstruction, most patients with a blockage of the large intestine can be treated with IV fluids and bowel decompression.
Demographics
Approximately 300,000 intestinal obstruction repairs are performed in the United States each year. Among patients who are admitted to the hospital for severe abdominal pain, 20% have an intestinal obstruction. While bowel obstruction can affect individuals of any age, different conditions occur at higher rates in certain age groups. Children under the age of two, for example, are more likely to present with intussusceptions or congenital defects. Elderly patients, on the other hand, have a higher rate of colon cancer.
Description
After the patient has been prepared for surgery and given general anesthesia, the surgeon usually enters the abdominal cavity by way of a laparotomy, which is a large incision made through the patient's abdominal wall. This type of surgery is sometimes referred to as open surgery. An alternative to laparotomy is laparoscopy , a surgical procedure in which a laparoscope (a thin tube with a built-in light source) and other instruments are inserted into the abdomen through small incisions. The internal operating field is then visualized on a video monitor that is connected to the scope. In some patients, the technique may be used for abdominal exploration in place of a laparotomy. Laparoscopy is associated with faster recovery times, shorter hospital stays, and smaller surgical scars, but requires advanced training on the part of the surgeon as well as costly equipment. Moreover, it offers a more limited view of the operating field.
Treating an intestinal obstruction depends on the condition causing the blockage. Some of the more common surgical procedures used to treat bowel obstructions include:
- Lysis of adhesions. The process of removing these bands of scar tissue is called lysis. After the abdominal cavity has been opened, the surgeon locates the obstructed area and delicately dissects the adhesions from the intestine using surgical scissors and forceps.
- Hernia repair. This procedure involves an incision placed near the location of the hernia through which the hernia sac is opened. The herniated intestine is placed back in the abdominal cavity and the muscle wall is repaired.
- Resection with end-to-end anastomosis. "Resection" means to remove part or all of a tissue or structure. Resection of the small or large intestine, therefore, involves the removal of the obstructed or diseased section. Anastomosis is the connection of two cut ends of a tubular structure to form a continuous channel; the anastomosis of the intestine is most often accomplished with sutures or surgical staples.
- Resection with ileostomy or colostomy . In some patients, an anastomosis is not possible because of the extent of the diseased tissue. After the obstruction and diseased tissue is removed, an ileostomy or colostomy is created. Ileostomy is a surgical procedure in which the small intestine is attached to the abdominal wall; waste then exits the body through an artificial opening called a stoma and collects in a bag attached to the skin with adhesive. Colostomy is a similar procedure with the exception that the colon is the part of the digestive tract that is attached to the abdominal wall.
Diagnosis/Preparation
To diagnose an intestinal obstruction, the physician first gives a physical examination to determine the severity of the patient's condition. The abdomen is examined for evidence of scars, hernias, distension, or pain. The patient's medical history is also taken, as certain factors increase a person's risk of developing a bowel obstruction (including previous surgery, older age, and a history of constipation). A series of x rays may be taken of the abdomen, as a definitive diagnosis of obstruction can be made by x ray in 50–60% of patients. Computed tomography (CT; an imaging technique that uses x rays to produce two-dimensional cross-sections on a viewing screen) or ultrasonography (an imaging technique that uses high-frequency sounds waves to visualize structures inside the body) may also be used to diagnosis intestinal obstruction.
Unless a patient presents with symptoms that indicate immediate surgery may be necessary (high fever, severe pain, a rapid heart beat, etc.), a course of IV fluids, NG decompression, and antibiotic therapy is usually prescribed in an effort to avoid surgery.
Aftercare
After surgery, the patient's NG tube remains until bowel function returns. The patient is closely monitored for signs of infection, leakage from an anastomosis, or other complications.
Risks
Complications associated with intestinal obstruction repair include excessive bleeding; infection; formation of abscesses (pockets of pus); leakage of stool from an anastomosis; adhesion formation; paralytic ileus (temporary paralysis of the intestines); and reoccurrence of the obstruction.
Normal results
Most patients who undergo surgical repair of an intestinal obstruction have an uneventful recovery and do not experience a recurrence of the obstruction.
Morbidity and mortality rates
The mortality rate of small bowel obstruction ranges from 2% for a simple obstruction to 25% for a strangulation obstruction that compromises the blood supply and is treated after a lapse of 36 hours. Large bowel obstruction carries a mortality rate of 2% for volvulus to 40% if part of the bowel is gangrenous.
Alternatives
Such nonsurgical techniques as the administration of IV fluids and bowel decompression with a NG tube are often successful in relieving an intestinal obstruction. Patients who present with more severe symptoms that are indicative of a bowel perforation or strangulation, however, require immediate surgery.
Resources
BOOKS
Bitterman, Robert A., and Michael A. Peterson. "Large Intestine." In Rosen's Emergency Medicine . 5th ed. St. Louis, MO: Mosby, Inc., 2002.
Evers, B. Mark. "Small Bowel." In Sabiston Textbook of Surgery . Philadelphia, PA: W. B. Saunders Company, 2001.
"Mechanical Intestinal Obstruction." In The Merck Manual of Diagnosis and Therapy , edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Torrey, Susan P., and Philip L. Henneman. "Small Intestine." In Rosen's Emergency Medicine . 5th ed. St. Louis, MO: Mosby, Inc., 2002.
PERIODICALS
Basson, Marc D. "Colonic Obstruction." eMedicine , September 26, 2001 [cited May 2, 2003]. http://www.emedicine.com/med/topic415.htm .
Khan, Ali Nawaz, and John Howat. "Small-Bowel Obstruction." eMedicine , April 18, 2003 [cited May 2, 2003]. http://www.emedicine.com/radio/topic781.htm .
ORGANIZATIONS
American Society of Colon and Rectal Surgeons. 85 W. Algonquin Rd., Suite 550, Arlington Heights, IL 60005. (847) 290-9184. http://www.fascrs.org .
United Ostomy Association, Inc. 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. (800) 826-0826. http://www.uoa.org .
Stephanie Dionne Sherk
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Ileoanal anastomoses are usually performed in a hospital operating room . Surgery may be performed by a general surgeon or a colorectal surgeon, a medical doctor who focuses on the surgical treatment of diseases of the colon, rectum, and anus.
QUESTIONS TO ASK THE DOCTOR
- Why are you recommending intestinal obstruction repair?
- What diagnostic tests will be performed to determine if an obstruction is present?
- Will an ileostomy or colostomy be created? Will it be temporary or permanent?
- Are any nonsurgical treatments available?
- How soon after surgery may normal diet and activities be resumed?
Good day.I would like to know more new information about this topic (intestinal obstruction).Here,i'm worried possible of reoccurrence of the obstruction? I done Resection with end-to-end anastomosis since 2003, therefore, involves the removal of the obstructed or diseased section.
After the obstruction and diseased tissue is removed, an ileostomy or colostomy is created? on the other hand, have a higher rate of colon cancer??
How to avoid reoccurrence and aftercare guidelines?
Thank you.
Best Regards,
Emey Hoong
Over next 9 weeks I progressed extremely well; all indications were good that no bags were required and I was wearing no more bandages for any drainage.
7/29/08 I returned to clinic to complain of swelling around old stoma area and tenderness. It was announced that I had developed a hernia. A CT was prescribed. I am awaiting results of that scan.
Two days later I am seeing redness around the 'hernia' and the area above and below the stoma are very hard, not soft like I was told hernia would be.
note: I am 60 yr old female; 5' tall; 119 lbs in generally good health.
I would appreciate some feedback from here.
I have been under care of university physicians; I seldom get the same doctor to see me.
Thank you.
Mrs. Wilson is a 92 yr old female; 5'1"; 178 lbs. Patient has renal failure; she has been undergoing Peritoneal Dialysis for the past 2 years (with great success).
Recently she has been diagnosed with a small bowel obstruction. Treatment has consisted of the administration of intravenous (IV) fluids and decompression of the bowel by the insertion of a nasogastric (NG) tube. Also, a series of x rays have been taken of the abdomen, as well as a series of CT scans. However; no antibiotic therapy has been prescribed.
The patients surgical history includes:
**1946** total hysterectomy/appendectomy; **1983** gallbladder **2006** placement of Peg Tube (for feeding) inserted for one month then removed; **2006** placement of PD catheter (for dialysis)... still in place with no complications. Also, patient has no history of constipation issues.
The conclusion is possible adhesion's from previous surgeries.
The conclusion is possible adhesion's from previous surgeries.
I need answers to the following questions:
1) Is it possible for this surgery to be preformed through laparoscopy?
2) Is it necessary to remove the peritoneal catheter?
Thank you all
Brandi in Ca
Good day.I would like to know more new information about this topic (intestinal obstruction).Here,i'm worried possible of reoccurrence of the obstruction? I done Resection with end-to-end anastomosis since 2003, therefore, involves the removal of the obstructed or diseased section.
After the obstruction and diseased tissue is removed, an ileostomy or colostomy is created? on the other hand, have a higher rate of colon cancer??
How to avoid reoccurrence and aftercare guidelines?
My question is this: how long will it be before I am able to eat some what normally again? How long does this pain last? I just assumed that after four weeks I would be able to resume some sort or normal living again, however if I still do not take some kind of pain medication in the morning and afternoon the pain is pretty intense considering I have a really high tolerance for pain. My biggest concern is that there may be other issues there that maybe its not healing properly, or am I just being too impatient in the helaing process of this type of precedure? I am not very educated on this type is health issue so any advice that is offered would be greatly appreciated.
Thanks!
I asked the doctor if there where any life style/diet changes I could make to lessen the chance of another obstruction and he basically said, he can recomend a diet high in fibre and fluids but nothing really will prevent it from happening again.
He also said he is not keen on doing surgery as often the post surgery results are not great for this problem, he said everytime they go in they can cause more scar tissue and make the condition worse. I'm really at a loss about what I can do about this am I just destined to have pain and reccuring episodes for the rest of my life? :(
I drink miralax everyday, I'm so afriad not to take it. I can't travel or enjoy life I'm so afraid of going further than a 20 mile radius of my hospital. I have had the adhiesions removed before about 3 years ago but they keep coming back. 9 days in the hospital-pain med-no food is a typical SBO episode for me. If anyboby knows anything different to do, please let me know.
i am 25 year old male, who underwent an appendectomy 28 days back. It was a complicated surgery because my appendix was suppurative and was ascended to liver. Doctors had to made a 6 inches incision to remove the appendix. I was discharged after 4 days. On second night after discharge I had multiple episodes of vomiting and abdominal pain. It took whole night to settle the pain through medicine. I was on normal diet by then. Then the seventh night at home, the same problem occurred of pain and vomits. This time it was unbearable and I was rushed to ER. It was found that I have developed small bowel obstruction. They inserted NG tube and kept me on IV fluids for 2 days. On the 3rd day i was feeling normal. I kept my hands on liquid and semi solid diet. I was discharged on the forth day. At home I just had lunch (semi-solid) and the pain took place again the following morning. I bear the pain but in the evening I had a vomiting. My family took me to ER again. I was dehydrated and the same problem of obstruction was diagnosed. The similar procedure of NG tube and IV was carried out. I took the first sip of water after 3 days.
In addition, I underwent a Liver Transplantation as a donor to my father in 2007. The doctors said that the internal wounds of Liver and appendix surgery has stuck to the intestines. It will be resolved via conservative treatment because according to doctors, to perform 3rd surgery was not viable.
I came home 3 days back. I am still on liquid and semi solid diet. Plus, I stay constipated on and off, so I take lactolose syrup every night.
I wanna ask, when will I be able to resume my normal diet and activities.
Thank you.
Kind regards,
Mourad M. Aly
Can you please help me, actually my daughter has undergone an intestine blockage Surgery, can you tell me how soon she may have her normal diet as she has just 6 months old.
I am not able to do anything on those days it is so bad. Thanks Mary
I had emergency surgery March 3 for a bowel obstruction. Scar tissue had cut off the blood supply to about 6 inches of my small intestine. After the adhesions were cut, the bowel regained blood supply and remained in tact. Since the surgery it was discovered that the ends of the bowel that were in a knot are now inflamed and narrowed. I am trying to reintroduce solids to my diet. I know that when I do this I take the risk of experiencing intense gas pain and pressure and pain in my abdomen. This sometimes last 3 or 4 hours.
I would appreciate any advice on how to reintroduce food into my diet. I am currently on a low residue diet, but can still eat only small amounts of solids. How long before I can expect to eat something and remain relatively pain free? Is there any reading you can recommend? I feel like I am the only person who has gone through this and am beginning to feel frustrated and helpless.
Thank you,
P Merritt
My father had a resection for bowel cancer, with a non reversable colostomy - initially after about two weeks he started to recover and eat and drink normally. His condition then started to deteriorate he could no longer tolerate food or liquids bringing everything back. He was admitted to hospital for 10 days where his bowel was decompressed with a NG tube and he was placed on IV. After this time, about 10 weeks after his initial operation his condition rapidly deteriorated and he was back in hospital, this time they found a partial blockage, not caused by cancer but by mucous/stools his bowel was cleaned out and he had an ileostomy bag fitted and the colostomy bag removed. He seemed to start recovering normally, until about 10 days after surgery he can no longer eat or drink and his condition has again started to deteriorate. The hospital staff don't let his family know his prognosis or how this can be resolved. If there is any advice you could give me please let me know.
Thankyou
Kind regards
Thank you
Ms. Victoria Henley