Small Bowel Obstruction
Small bowel obstruction or blockage of the small intestine can occur at any time especially once a patient has had an abdominal operation. These blockages are most often due to scarring from previous operations. Patients usually complain of severe cramping abdominal pain followed by nausea and vomiting. Patients are usually not able to pass gas or have bowel movements although some may have a bout of diarrhea at the beginning of the episode.
If you suspect you have an intestinal blockage, you should seek medical attention immediately. The history (symptoms), abdominal exam, x-rays, and sometimes a CT scan diagnose small bowel obstructions. Initial treatment will include pain control, withholding diet, IV fluids, and possibly a nasogastric tube. A nasogastric tube is a tube placed in the nose and down into the stomach. This tube, although unpleasant, can decrease distension and nausea. These measures can sometimes allow a partial blockage to relieve itself, as the intestine is able to decompress and untwist.
Significant blockages or obstruction felt to be causing bowel suffering will need surgery. Surgery may also be recommended after several episodes of partial blockage that relieve themselves.
Most small bowel obstructions can be relieved by releasing the scarring that may be present from a previous surgery and pinching the bowel. These surgeries may be done either open or laparoscopically.
An open procedure is performed through an incision along the middle of the abdomen. The scarring is released therefore relieving the obstruction. Sometimes, the bowel that was blocked may have suffered and need removal. This is accomplished by removing that segment of bowel and putting the two ends back together known as a small bowel resection.
A laparoscopic surgery is accomplished through small incisions with the assistance of a special camera known as a laparoscope. Advantages of the laparoscopic approach are smaller incisions with an earlier return of bowel function and ability to eat. The scarring may sometimes be too dense to perform the surgery safely from a laparoscopic procedure and the procedure may be converted to an open procedure.
- Diet should be resumed as tolerated. Multiple small meals may be easier to digest than 3 large ones.
- No heavy lifting for at least 2 weeks with a laparoscopic procedure and 4 weeks with an open procedure.
- Constipation can be common following this procedure and can be treated with Milk of Magnesia available over the counter.
- Persistent bloating, nausea, and vomiting are reasons to contact the office or seek medical attention.
- Patients may have either sutures or staples. Sutures are located underneath the skin and will dissolve on their own. Patients occasionally notice a thread or knot outside the skin. These will dissolve after a couple of weeks or can be removed in the office.
- Patients with staples should schedule their follow-up one week after surgery so that their staples can be removed. Dressings can be removed the day after surgery and patients may shower at that time.
- Patients with sutures should schedule a follow-up appointment 2 weeks after surgery. These patients will have both an outer and an inner dressing. The outer dressing may be removed the day after surgery and the patient may shower at that time. Inner dressings will resemble band aids are known as steri-strips. These should be left in place and they will fall off in a few days.
- Fevers, drainage or redness around incisions, and severe pain is reasons to contact the office, as they may be signs of infection.