Bowel Obstruction RepairBy
What is bowel obstruction repair?
A bowel obstruction repair is surgery to remove or relieve a blockage in the bowel. The most common cause of a bowel obstruction is scarring from previous abdominal surgery. The bowels can twist or kink under the scarring and this can lead to the blockage.
The bowel is the part of the digestive tract that absorbs nutrients from food. A bowel obstruction stops the passage of stool and gas through your intestines. Symptoms include a distended abdomen, fullness, painful spasms, constipation, not passing gas, diarrhea, nausea with or without vomiting, and foul-smelling breath. It can be a serious, possibly life-threatening condition that may require prompt surgery. Bowel obstruction repair is also called intestinal obstruction repair.
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Bowel obstruction repair is a major surgery with risks and potential complications. You may have less invasive treatment options. Options vary depending on the location, extent or type of bowel obstruction. Consider getting a second opinion about all your treatment choices before having bowel obstruction repair.
Other surgical procedures that may be performed
A bowel obstruction can cut off the blood supply to part of the intestine. This can permanently damage the intestine. In this case, your surgeon may need to remove the damaged part of the intestine and reattach the healthy sections of the intestine.
It is not always possible to reconnect the healthy parts of intestine. If this occurs, your surgeon will bring the end of the intestine through the abdominal wall to the skin in this case. This creates an opening, called an ileostomy or a colostomy.
Stool will leave the body through the opening into a collection bag. This may be temporary. Your surgeon will remove the stoma and put the bowels back together again after they heal.
Why is bowel obstruction repair performed?
Your doctor may recommend a bowel obstruction repair to remove or relieve a blockage in the bowel. Your doctor may only consider surgical repair of the bowel if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a bowel obstruction repair.
A physical (mechanical) blockage in the intestine can cause a bowel obstruction. Causes of a mechanical blockage include:
Foreign bodies, which are more likely to be the cause of bowel obstruction in children than adults
Gallstones, which can wear away the gallbladder wall and travel into the small intestine
Hernia, which is when organ or other structure bulges through a weak part of tissue or muscle outside its normal place
Impacted stool, which can occur from chronic constipation
Scar tissue, which can occur from past abdominal surgeries. This is the most common reason for an intestinal blockage.
Tumors, which can block the passage of stool. A tumor can occur in any part of the intestine or other nearby structure.
Volvulus (twisting of the intestines), which is often due to a birth defect of the intestines
An ileus is another type of bowel obstruction. An ileus occurs when the bowels stop moving and pushing digested food through your intestine. Causes of ileus include:
Appendicitis, which is an inflammation or infection of the appendix
Certain drugs and medications, such as opioids and sedatives, can slow down peristalsis. Peristalsis is the series of contractions that propel food through the digestive tract.
Electrolyte imbalances, which can be caused by chronic vomiting or diarrhea
Gastroenteritis, which is an inflammation or infection of the stomach and intestines
Obstruction of the mesenteric artery, which is the blood vessel that supplies blood to the abdomen
Pancreatitis, which is an inflammation or infection of the pancreas
Surgical complications, which include ileus, a complication of bowel surgery. Bowel obstruction is usually temporary, but it can persist.
Who performs bowel obstruction repair?
The following specialists repair bowel obstructions:
General surgeons specialize in the surgical care of diseases, injuries and deformities affecting the abdomen, breasts, digestive tract, endocrine system and skin.
Pediatric surgeons specialize in the surgical care of diseases, injuries and deformities in premature and newborn infants, children, and adolescents.
Colon and rectal surgeons specialize in the surgical care of disorders of the colon, rectum and anus.
How is bowel obstruction repair performed?
Your bowel obstruction repair will be performed in a hospital. Your surgeon will make an incision to access the abdominal cavity and locate the blocked area of the intestine. Your surgeon then removes or corrects the blockage and sews the intestines back together.
Surgical approaches to a bowel obstruction repair
Your surgeon will perform a bowel obstruction repair using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and a laparoscope through a few small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera. It sends pictures of the inside of your body to a video screen. Your surgeon watches the screen as a guide while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Open surgery involves making a large incision in the abdomen. An open surgery incision allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your surgeon may combine a minimally invasive procedure with open surgery. Your surgeon may also decide after starting minimally invasive surgery that you need open surgery to safely and effectively complete the surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different bowel obstruction repair procedures and ask why your doctor will use a certain type for you.
Types of anesthesia that may be used
Your surgeon will perform your bowel obstruction repair using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
What to expect the day of your bowel obstruction repair
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have
A tube is placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A surgical team member will start an IV and insert a urinary catheter into your bladder. The catheter collects urine during surgery. A tube is also inserted through your nose and into your stomach to collect fluids that your stomach produces and to protect you from vomiting. This tube is usually removed in one to three days once you are passing gas.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout your surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of bowel obstruction repair?
As with all surgeries, a bowel obstruction repair involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgical procedures include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain. This can cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of bowel obstruction repair
Complications of a bowel obstruction repair include:
Complications specific to colostomy or ileostomy if they need to be performed during bowel obstruction repair
Damage to other abdominal organs
Development of scar tissue on the intestine, which could cause another bowel obstruction
Intestinal leakage through damaged or sewn sections of the intestine
Opening of the surgical incision
Paralysis of the intestine (also known as paralytic ileus, which is usually a temporary condition)
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my bowel obstruction repair?
You are a very important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for bowel obstruction repair by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Not eating or drinking just prior to surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need bowel obstruction repair? Are there any other options for treating my condition?
What type of bowel obstruction repair procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my bowel obstruction repair?
Knowing what to expect can help make your road to recovery after bowel obstruction repair as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You will have a tube in your nose that runs down your throat into your stomach. This tube releases air and drains fluid from your stomach. It is removed when your body can process these substances by itself again.
You may have a sore throat from the tube placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
Your care team will move you to a regular hospital room or possibly an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care. A bowel obstruction repair generally requires a hospital stay of seven days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors. Full recovery takes six to eight weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be some discomfort after your surgery, including soreness at the incision. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after bowel obstruction repair. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate, have a bowel movement, or pass gas
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in the affected extremity
Pain that is not controlled by your pain medication
Severe abdominal pain or abdominal discomfort that is new or getting worse
Sudden and new abdominal swelling
Unexpected drainage, pus, redness or swelling of your incision
How might bowel obstruction repair affect my everyday life?
Bowel obstruction repair can return you to an active, normal life. Bowel obstruction repair usually results in very few limitations or restrictions to everyday activities.
Bowel obstruction repair that includes a colostomy or ileostomy causes major changes to the body and the way you have a bowel movement. You will wear a collection bag on the outside of your body. The collection bag requires regular emptying and cleaning.
Your care team will teach you how to use your colostomy/ileostomy supplies. The team will also help you adjust to new bowel and dietary habits and other changes. Changes include:
Change in some styles of clothing such as bathing suits
Dietary changes, including exclusion of certain types of foods and beverages
Significant change in body image
Significant change in elimination habits
You will need some time to adjust to and learn to manage these changes. Most people who have a colostomy or ileostomy eventually enjoy many of their favorite activities, including sports, outdoor activities, and many types of work.
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- Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy. National Digestive diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/ileostomy/
- Bowel Obstruction. Better Medicine. http://www.bettermedicine.com/article/bowel-obstruction-1
- Evaluation and Management of Intestinal Obstruction. American Family Physician. http://www.aafp.org/afp/2011/0115/p159.html
- Gallstone Ileus. Diagnostic Imaging. http://www.diagnosticimaging.com/case-studies/content/article/113619/1876150
- Ileus and Bowel Obstruction. Bookshelf, a service of the National Library of Medicine National Institutes of Health. http://www.ncbi.nlm.nih.gov/books/NBK13786/