Intestinal Obstruction

WHAT YOU SHOULD KNOW

Causes

A variety of culprits can trigger this problem. Among them are tumors, hernias, scar tissue, hardened feces, gallstones, and foreign bodies. An obstruction can develop if the bowel becomes twisted, or if the bowel wall slides over itself in a fold. Obstruction is also a possibility if infection takes hold inside a pocket in the wall of the bowel (diverticulitis).

Some types of obstruction---such as those caused by a hernia, a twist, or a fold in the intestinal wall---may be accompanied by a disruption in the blood supply to the area, a condition called strangulation. If this happens, gangrene can set in within as little as 6 hours.

Signs/Symptoms

An obstruction in the small intestine is usually signaled by cramps in the area of the belly button, vomiting, severe constipation if the obstruction is total, or diarrhea if the obstruction is partial. As time passes, the abdomen becomes distended and tender. Symptoms of a blockage in the large intestine are similar, but develop more gradually and may not include vomiting.

Care

Surgery is typically required to treat an intestinal obstruction, so you'll be hospitalized immediately if the doctor suspects this problem. The first step in treatment is usually insertion of a nasogastric tube through the nose and into the stomach or intestine. This tube is used to draw off material that has accumulated above the blockage, thus relieving abdominal distention and vomiting.

If the obstruction is due to postoperative scarring, treatment with the tube is occasionally all that's necessary. In some cases, an endoscope, a thin tube with a light on one end for viewing, may be advanced through the anus to correct a twisted intestinal segment responsible for the blockage. In most situations, however, surgery is performed immediately to remove the blocked segment of the intestine.

Risks

Whether or not there's a loss of blood supply to the area, distention of the bowel is likely to get progressively worse until it ruptures, leading to peritonitis and death.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may encounter the following procedures and equipment during your stay.

• Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respiration (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• X-ray: A picture showing the organs inside the abdomen usually will reveal the location of the obstruction.
• IV: A tube placed in your vein for giving liquids to replace water and salts lost from vomiting and diarrhea. The IV will either be capped or have tubing connected to it.
• Nasogastric (NG) Tube: This clear plastic tube is inserted through the nose, down the back of the throat, through the esophagus, and into the stomach to remove material that has accumulated above the blockage. The tube is uncomfortable but not painful.
• Pulse Oximeter: This is a device that is placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• Surgery: Surgery to remove the obstruction is performed immediately.
• Medicines:
• • Before surgery, you will be given medicine to make you sleepy before you are taken to the operating room.
  • Antibiotics: May be given to prevent you from getting an infection from the surgery. They may be given by IV, in a shot, or by mouth.
  • Pain Medicine: May be given in your IV, as a shot, or by mouth. If the pain doesn't go away or comes back, tell your nurse right away.

After You Leave...

• Get plenty of bed rest for the next several days. Do not resume normal activities until you feel up to them.
• Always take your medicine as directed. If you feel it is not helping, call your doctor. Do not quit taking it on your own.
• If you are taking antibiotics, take them until they are all gone---even if you feel better. If you stop too soon, infection could take hold.
• If you are taking medicine that makes you feel drowsy, do not drive or use dangerous equipment.

Call Your Doctor If...

• You have fever, swelling, or redness at your surgery site.

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