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Small bowel obstruction advice

dmdwins
Posts: 453
Joined: Aug 2008

Hi everyone.

Wondering if anyone could share experiences or offer any advice to me.

Six weeks ago I had emergent surgery for an intestinal volulus.(no adhesions were present) I was really sick ....finally after a heart rate of 176 and BP of 50/20 they took me to the OR...but that is a whole nother story. I was recovering and ready to go back to work in a few weeks then I started experiencing the same severe pain with nausea and vomiting this time. They diagnosed partial small bowel obstruction. I had an NG tube and was NPO for bowel rest. I was hospitalized for 3 days and was started on liquids then soft food. Since I could tolerate soft food and was passing gas I was released to home. I am still having pain(not nearly as much)and gi upset....so for those of you have experienced this..... did your symptoms still exist once you got home, what foods did you eat(Im afraid to eat anything), please tell me you eventually felt better, did you have recurrent obstructions? Honestly, these two episodes were worse than my colon surgery .....would appreciate any thoughts you would like to share.

:) Dawn

steved
Posts: 835
Joined: Apr 2004

After my initial resection I had intermittent ileus (functional owel obstructions) that would come on over a couple of hours of increasing cramping until I vomited a couple of times and then eased off. Never quite made it to needing to be back in hospital but it went on for a couple of months but gradually faded in frequency and stopped.
I spent a long time trying to figure out what upset my bowels and what was good and even now, eight year on, I still am not totally sure as it still can be unpredicatble and sensitive. Found regualr small meals of fairly inoffensive food- pasta, rice etc- with low fat and low fibre initally the best then slowly introduced other foods as experiments. However, in truth some days are simply better bowel days than others.
Do mae sure you are talking to your docs regularly about it but there is a good chance it will simply settle in time.
steve

steved
Posts: 835
Joined: Apr 2004

After my initial resection I had intermittent ileus (functional bowel obstructions) that would come on over a couple of hours of increasing cramping until I vomited a couple of times and then eased off. Never quite made it to needing to be back in hospital but it went on for a couple of months but gradually faded in frequency and stopped.
I spent a long time trying to figure out what upset my bowels and what was good and even now, eight year on, I still am not totally sure as it still can be unpredicatble and sensitive. Found regualr small meals of fairly inoffensive food- pasta, rice etc- with low fat and low fibre initally the best then slowly introduced other foods as experiments. However, in truth some days are simply better bowel days than others.
Do mae sure you are talking to your docs regularly about it but there is a good chance it will simply settle in time.
steve

maglets's picture
maglets
Posts: 2589
Joined: Jun 2006

oh Dawn that all sounds so painful.....i wish i had some advice for you but I have never had an obstruction. Just thought I would tag into a general eating thread here and echo what Steve said....After liver resection and gall bladder removal it took me a long time to realize that fat was not easy for me to digest.....this may in fact be from the bowel that was also resected. So I would have to say heavy doses of fat are not a good thing and really seem to cause upset. Sometimes an ice cream cone will cause upset and cramping.

hoping your concerns will resolve themselves soon

very best wishes,

maggie

Cathleen Mary
Posts: 827
Joined: May 2011

Dawn,

I am really sorry that you are having such a hard time. I have had 3 bowel obstructions, requiring two surgeries. Diet does help but doesn't seem to be the total answer. It's tricky. Time and experimentation has helped me to figure out with reasonable success what works for me and what doesn't. Smaller, more frequent meals helps me. Resting after a meal before becoming active helps. I have noticed that when I go off of probiotics I have more cramping. Working with a GI nutritionist was initially beneficial for me. I agree the obstructions were harder to deal with than the colon resection.
Good luck....

Cathleen Mary

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Re:
"Six weeks ago I had emergent surgery for an intestinal volulus.
(no adhesions were present)"

Intestinal volvulus

Intestinal volvulus is defined as a complete twisting of a loop
of intestine around its mesenteric attachment site. It is related
to but not precisely synonymous with malrotation, a more general
term used when the normal process of rotation and fixation of the
midgut goes awry. Malrotation may lead to 2 critical
complications: mechanical obstruction of the proximal intestine
and ischemia of part or all of the midgut.

Volvulus can occur at various sites in the gastrointestinal (GI)
tract, including the stomach, small intestine, cecum, transverse
colon,[1] and sigmoid colon. Midgut volvulus refers to twisting
of the entire midgut around the axis of the superior mesenteric
artery (SMA). This article primarily focuses on midgut volvulus
because it is the most common type of volvulus and is very
serious in infants and children. Sigmoid volvulus is also briefly
discussed.

These conditions are extremely important, especially in the first
year of life, because they may result in numerous critical
clinical problems; the most feared complication is fatal ischemia
and necrosis of the entire midgut.

In 1832, Reid described a malpositioned cecum, found in the left
upper quadrant, in 2 autopsies.[2] Mall first described
intestinal rotation during the embryologic period in 1898.[3] The
first clear description of anomalies of intestinal rotation and
fixation (the clinical manifestations of which correlated with
the observations of the embryologist His) was published by Dott
in 1923.[4]

In 1932, Ladd published his landmark paper on congenital duodenal
obstruction and presented a surgical correction of
malrotation.[5] This technique has survived the past century with
only minor modifications to form the basis of surgical treatment
today. The understanding of GI embryology heavily contributed to
the development of a successful treatment and has remained vital
to the ability to recognize clinical presentations and
implications of this abnormality.

Laboratory findings are nonspecific. Imaging studies are an
integral part of the diagnostic process for a patient suspected
of having malrotation or other GI obstruction. Confirmation and
definitive diagnosis are accomplished more easily with an upper
GI contrast series.

The management of abnormalities of rotation and volvulus is well
established. Treatment is surgical; no other treatment is available.
The most important point is to recognize the diagnosis early
before complications develop. Some authors have reported
using laparoscopy to treat these conditions, but this has not
become standard practice.

Credit: www.medscape.com

Each and every event of abdominal surgery can (and usually does)
produce adhesions and hernias. Adhesions are part of the normal
process of healing. The damaged areas are from the handling
of organs that usually do not get "handled". It is akin to scar tissue,
and there to help heal what's appeared to have been wounded.

It would appear that the surgery for resection was the cause for
the intestine to become twisted when stitched back together, and
the result of your new pains.

But... it can also be due to adhesions that are constricting the
intestine; surgery does that... and you did just have surgery....
usually adhesions do not rear their ugly problems until two
or three years (or more) post-op.. your mileage will vary...

One day at a time!

My best wishes for you,

John

dmdwins
Posts: 453
Joined: Aug 2008

Thanks for your experiences and concerns. I do have a call in to my nutritionist. I did eat an egg this morning so we will see what that brings! Still having the shoulder, back and epigastric pain.....hoping it settles down in a few days.

Thanks again guys!

dmdwins
Posts: 453
Joined: Aug 2008

Thanks for the info on the volvulus haha....I am in the medical field so am well aware of the what and why's though I am sure it was good info for many.....more interested in management and experiences.

I spared the medical details as I thought it would be too much for most but obviously not for you so I'll give you the whole scoop!! :)

My initial resection was 4 1/2 years ago. Yes, believe it or not when I had my volvulus with emergent laparotomy surgery there were NO adhesions. One would typically think that was great, right? Well in my case since there were no adhesions to "hold" things in place and my small intestine found its way throught the "hole" in the mesentary and wrapped itself around the large intestine 3 times.Something that probably took a few years in the making per my surgeon. Obviously during this surgery my bowel was "handled" alot. I required a small resection because there was an area of bowel that did not have good blood supply return once they untwisted everything. My surgeon assured me that adhesions would happen this time. Great! or Not!! I dont think he or I thought that there would be an issue just 6 weeks out(if it is from newly formed adhesions). I hope and pray that is not an ongoing issue as these have been the roughest 9 weeks medically (certainly not emotionally)I have ever had including initial diagnosis and chemo.

The good news in all of this is that during the laparotomy he was able to get a great look around and saw no evidence of disease. I am Stage 4 so that was very reassuring to me. It brings hope to me and hopefully many others. It will be 5 years in October. I am grateful.

:)Dawn

John23's picture
John23
Posts: 2140
Joined: Jan 2007

There is a surgical technique that involves forming a suspension
device to keep the intestines from drifting too far downward,
did your surgeon mention that? Waiting for adhesions to form
(to do that job) seems a bit much to wait for... Of course,
you could bounce on your head for 5 minutes per day and try
to get them to slip in the other direction..?? (would that work?)

Congrats on the "5 years"!! (If you're like me, you'll still be
waiting for the other shoe to drop for another umpteen years)

The ravages of cancer never seem to stop. Even after there's
no sign of cancer, we still go through the pains and repercussions
of the remnants of surgical procedures and/or the the lasting
effects of chemical or radiation therapies.

Oh well, at least we're here to complain about it, ehh?

By the way, using that technical term for the twisting/moving
and tangling of organs into regions they don't belong (volvulus),
forces people to "google" up a storm. A decent education
can be had practically for free here!

Be well !!

John

LivinginNH's picture
LivinginNH
Posts: 1458
Joined: Apr 2010

Dear Dawn, all all others that posted: Thank you!! -- Rick came home last night from visiting his kids over the weekend and told me that the pain in his side had been increasing in severity all day. He kept telling me that it was just gas and that it would go away, but he was in excruciating pain. Fortunately, I had just read this post!! To make a long story short, at 11:00pm I finally convinced him to go to the hospital since I told him that it might very well be an obstruction. The doctor ordered a CT scan and told us that he probably has a partial small bowel obstruction in its earliest stages. The doctor admitted him to a room at 6:00am this morning with IV fluids ordered for at least today - I don't know yet how long he'll be in there. So Dawn, if it wasn't for your post, I'm sure that he'd be in a lot worse shape right now. Thank you and everyone else who posted!

Hugs,

Cynthia

dmdwins
Posts: 453
Joined: Aug 2008

Cynthia,

I am so glad to hear that my post was beneficial to you and at the right time. How is Rick doing? It is a terrible thing to experience and I hope he can be treated without surgery and is doing well. Let us know.

Dawn

PhillieG's picture
PhillieG
Posts: 4884
Joined: May 2005

My advice is don't get one! Not fun at all. I had one about 2 months after my initial surgery. Had been feeling fine until something inside me felt wrong. Started to have stomach pains, thought it was gas. Wound up at the hospital the following day. It was a bowel obstruction for the previous surgery. Had the NFG tube in until they did surgery to correct the problem then it's been fine ever since.
I would often have problems with my bowels shutting down whenever I had surgery due to the pain meds (narcotics) which cause the slowdown.
I did feel better when I got home (but I did have the obstruction removed or repaired) and took it slow with what I ate.
Feel beter...
-phil

dmdwins
Posts: 453
Joined: Aug 2008

I hoped I would hear from you as I thought you had an obstruction but wasnt sure if it was treated surgically or not. Im still having pain and discomfort and hoping it will work itself out still. Its reassuring to me that you havent had issues since.

Also...was that a typo for the NG tube?...cuz it really is should have the "F" in there...its not pleasant haha.

Dawn

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Sundanceh's picture
Sundanceh
Posts: 4408
Joined: Jun 2009

Dawn, sorry you are having so much trouble and hope it resolves itself without too much intervention...I had my bowel twist when I got out of my original resection....had been in the hospital for ten days or so and was discharged home.

Less than a couple of days later, I had those huge pains of "gas" you talked about...I would belch but instead of being 'relieved', the cavity would just fill back up in the next breath....this went on and on until my wife got home from work.

I began throwing up bile etc. etc.

We ended up in the ER and CT revealed the twisting...their original plan was to go back in surgically to unkink it - but it finally resolved itself enough in a few days...went right back to NPO and worked my way up the food chain until I could come home.

I hope you will be okay.

And Rick/Cynthia, best of luck with your situation too - these posts are a wealth of information and it's wonderful to see folks getting helped, when they might otherwise be stumped.

-Craig

dmdwins
Posts: 453
Joined: Aug 2008

Trying to sloooowly work my way up the food chain too Craig..... as I am still having abdominal cramping and significant upper back pain....Its been almost a week since my initial attack....I hope it subsides soon. Thanks for your input as always!

Dawn

Disneynutt's picture
Disneynutt
Posts: 135
Joined: Aug 2009

So Dawn, did the cramping every stop? I'm in the hospital now with my first SBO. It is horrible and after day 3 the doctor wants to do more xrays because I still feel pain. That horrifies me since I was due in Cleveland for a clinical trial and then this happened.

I hope your abdominal cramping and am eager to hear how it has resolved. It could give me hope.

Thank you,
Kate

pepebcn's picture
pepebcn
Posts: 6352
Joined: Aug 2010

And it does not interfere with your trip! are you still on it?
Hugs.

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