Bowel obstruction surgery is performed with partial or complete bowel obstruction , including the small and large intestines. Treatments for intestinal obstruction range from minimally invasive laparoscopic surgery to the more complex open surgical procedures. This may include removal of the damaged bowel, surgical resection , stenting, colostomy , removal of adhesions, or revascularization.
What is bowel obstruction surgery?
Bowel obstruction surgery is an interventional procedure that includes:
- Removal of any material that blocks the intestines (such as feces, cancer, polyps, infectious abscesses, or intestinal vortices)
- Repair of areas of the intestine that may have been damaged by an obstruction.
This operation is performed in a hospital under general anesthesia . This can be planned in advance, but sometimes bowel obstruction surgery must be performed as an emergency due to the rapid worsening and life-threatening complications.
You may have a laparoscopic procedure with several small incisions, or you may need an open laparotomy with one large incision. The degree of blockage is not necessarily an important factor when it comes to whether you will have a major procedure or a minimally invasive procedure.
There are a number of techniques used in bowel obstruction surgery and your procedure may include steps such as:
- Elimination of impassable mass
- Blood vessel repair
- Resection of severely damaged areas of the intestine
- Creation of a stoma (creation of an opening in the abdomen through which waste can exit the body)
Your surgeons will consider several factors when deciding which approach to take, including the number and location of the blockage, the cause of the intestinal obstruction, your risk of infection, and any prior surgery.
Bowel obstruction surgery is a serious procedure. But since this is often very necessary, the advantages often outweigh the disadvantages for many patients.
However, in some people, the cause of the obstruction, when considered in conjunction with their age and general health profile, may lead the doctor to conclude that surgery may not be the best option for the patient, all things considered. .
This is especially true for older patients. A review of studies published in the World Journal of Emergency Surgery notes that "weakened" patients with small bowel obstruction older than 70 years are at higher risk of adverse outcomes after bowel obstruction surgery than their peers with better overall health. so that the impact on quality of life and mortality outweighs the benefits of the procedure (depending on the cause of the obstruction).
Chronic intestinal obstruction that cannot be removed with surgery can occur in some patients, especially those with advanced cancer. This may be due to narrow structures and / or the large size of the tumor.
In addition to the standard risks of surgery and anesthesia, possible complications after bowel obstruction surgery include:
- Swelling (fluid buildup and inflammation)
- New, persistent, or worsening bowel obstruction after surgery
- Damage to nearby organs of the body.
- The formation of scar tissue (adhesions) in the abdomen, which increases the risk of recurrent bowel obstruction in the future.
- Incomplete healing of the stitched areas of the intestine (anastomotic leakage), which can cause urgent, life-threatening problems.
- Postoperative ostomy problems ( colostomy , ileostomy , or J-bag )
- Temporary paralysis (freezing) of the intestine, known as paralytic intestinal obstruction.
Purpose of bowel obstruction surgery
Bowel obstruction can happen suddenly (acute) or it can slowly get worse over time (chronic).
When specific causes are to blame, conservative measures can be tried before considering bowel obstruction surgery. In other cases, surgery is the main treatment option and is sometimes urgently needed.
Bowel obstruction can quickly become life threatening. The operation is done to preserve the small or large intestine and prevent dangerous complications that can occur if the obstruction is not treated, including :
- Chronic abdominal pain, nausea, and vomiting.
- Prevent food and feces from passing through the intestines.
- Permanent intestinal damage
- Problems with blood flow in the intestines.
- Necrosis (death) of intestinal tissue
- Bleeding or loss of the intestines.
- Fluid and electrolyte disturbances.
In severe cases, these problems can cause hypotension, multiple organ failure, or death. Complete ileus is a serious medical emergency that requires surgery .
The sooner significant intestinal obstruction is removed, the better the chances of survival. Surgery within the first 36 hours reduces the mortality rate to 8%, while postponing surgery after 36 hours results in a mortality rate of 25%.
Indications and evaluation
If you have symptoms of a bowel obstruction, such as severe pain, cramps that come and go, changes in bowel movements, your doctor will perform a physical exam to monitor your stomach and bowel sounds.
Diagnostic tests generally allow you to determine the number of obstacles, their location, and the cause.
You will most likely have an abdominal X-ray, computed tomography (CT) scan, or ultrasound. These tests usually include an intravenous (intravenous) injection of contrast medium. A barium enema is a more invasive imaging test in which a small amount of contrast medium is injected into the rectum to help visualize intestinal structures.
In addition, your blood will be drawn so that a complete blood count and electrolyte levels can be monitored. And they'll do a urinalysis that reflects electrolyte levels and may show signs of infection.
Rigmoidoscopy or colonoscopy may also be part of your diagnostic test. These are invasive diagnostic procedures that use a camera that passes through the colon to visualize the structure within the intestine.
You may need surgery for a bowel obstruction if it is determined that you have one of the following problems:
- Mechanical obstruction: Blockage of the lumen (passage) of the small intestine or colon may be due to cancer, inflammatory bowel disease (IBD) , edema, or infection.
- Constriction – Pressure from outside the intestines can create pressure. This can happen due to cancer or scar tissue that often develops after abdominal surgery or radiation therapy .
- Rotation – Twisting of the intestine may be due to disease of the scar tissue, muscles, or nerves.
- Hernia : When the muscular wall of the abdomen weakens, a pocket can form that can compress the intestines.
- Myopathy or neuropathy: Congenital or acquired conditions that interfere with proper movement of the intestinal muscles can cause intestinal collapse, lumen constriction, or can lead to distorted movements.
- Ischemic colitis : Loss of blood flow to part of the intestine can be the result of a bleeding disorder.
Surgery as a second-line treatment
If your bowel obstruction is caused by swelling, inflammation, or hardened stools, your healthcare provider may try conservative treatments before bowel obstruction surgery.
These options are used when the patient is medically stable and the intestines are not in immediate danger or necrosis, or when the risk of surgery is very high (for example, due to an underlying medical condition, such as heart disease).
Conservative treatments include:
- Intravenous fluids and medications: Electrolytes and fluids are given intravenously to treat or prevent dehydration and restore electrolyte balance. Medications are prescribed to soften stool, stimulate bowel movements, and relieve nausea and vomiting.
- Enema – A nozzle is inserted into the anus and fluid is injected into the rectum. You are asked to hold onto the fluid for a time and then sit on the toilet to empty your bowels.
- Nasogastric tube: A long, thin tube is inserted through the nose into the stomach and into the intestines. This can be used to suck debris over a blockage, reduce gas build-up, and reduce bloating.
- Colorectal tube: A long, thin tube is inserted through the rectum into the large intestine and used to remove fluid, gas, and inflammation.
If these treatments don't remove the blockage, surgery may be the next step.
It should be noted that, according to a study published in the journal Medicine , recurrent bowel obstruction, especially after abdominal surgery (such as cancer), can persist with repeated conservative treatments and may be more likely to resolve with surgery.
How to prepare
Acute intestinal obstruction can be very painful and often leads to an emergency room visit. For acute and chronic intestinal obstruction, surgery can be performed within a few hours to three days after diagnosis .
The operation for intestinal obstruction is performed in a hospital operating room.
What to wear
You will wear a hospital gown during surgery and the rest of your hospital stay. It is recommended that you wear loose clothing that can be easily removed.
Do not wear jewelry during the operation and leave all valuables at home.
Food and drink
Bowel obstruction surgery is usually performed under general anesthesia . Ideally, you should not eat or drink for about eight hours before general anesthesia. However, when the procedure is performed urgently, preoperative fasting is not always possible.
It is important to inform your surgeons of all prescription and over-the-counter medications and supplements that you are currently taking. Some medicines can cause problems during surgery. In particular, blood thinners can cause excessive bleeding .
In addition to personal hygiene and comfort items, such as toiletries and a change of clothes, make sure you have your medical insurance documents and identification.
If you are taking any prescription or over-the-counter medications, be sure to bring your list with you. Some of these medications may need to be changed, or your healthcare provider may prescribe new ones after your procedure.
Once you are discharged, you will most likely not be allowed to drive, so arrange transportation in advance.
What to Expect the Day of Surgery
Before surgery, your healthcare professional will explain the procedure in detail, including a step-by-step description, the risks of surgery, and what a typical recovery looks like. Most likely, you will also be asked to sign consent forms at this time.
Depending on the volume of the procedure, the operation for intestinal obstruction can take from one hour to three and a half hours.
Before the surgery
Before surgery, you will change into a hospital gown and have an IV inserted into your vein so that you can receive the fluids and medications you need. You will be taken to the operating room and transferred to the operating table.
Your anesthetist will first prescribe an IV sedative to help you relax. An endotracheal tube ( breathing tube) will then be inserted through your mouth into your windpipe before connecting to a ventilator to help you breathe during the procedure. The anesthetic helps ensure that you cannot move or feel pain during the procedure.
A Foley catheter is inserted into the urethra to collect urine. A nasogastric tube may also be inserted into your nose and into your mouth to collect blood and stomach fluids during surgery.
The surgical staff will insert a germ-killing solution into your abdomen and cover the surgical area with tissue to prevent infection.
The operation will begin after confirming that you are fully anesthetized.
During the operation
Your surgeon will determine the correct technique to remove the obstruction based on its location, size, and cause. Most of this planning will take place before surgery, but some decisions can also be made during surgery. For example, you may have a cancerous invasion of the intestine that requires a more extensive resection than originally planned. Or your healthcare provider may see additional adhesions in various places that need to be removed during surgery.
Stages of laparoscopic bowel obstruction surgery
Minimally invasive surgery can use thin endoscopes, which are tubes that are inserted through one or more tiny incisions in the abdomen. Alternatively, endoscopy , in which a tube is inserted into the mouth, or sigmoidoscopy , in which a tube is inserted into the rectum, can be used to treat the obstruction.
In minimally invasive laparoscopic procedures, the surgeon uses a computer monitor to view the bowel and the obstruction. Sometimes the engorged stool is broken open and suctioned out through a tube. Or, a polyp or tumor can be removed and the attached intestinal tissue rebuilt. A stent can be placed if the obstructed area is prone to recurrent obstruction, for example due to nerve or muscle damage.
All abdominal incisions are closed with sutures or sterile tape. And your wound will be covered with sterile gauze and tape to protect it.
Stages of bowel obstruction surgery
Open surgery is required when the intestine suffocates due to rotation or compression, or if the obstruction is caused by loss of intestinal blood flow. In open laparotomy, the surgeon can make a 6 to 8-inch incision in the abdomen to access the intestinal obstruction for decompression and repair.
Your surgeon may also need to do one or more of the following, depending on the cause of the obstruction and associated intestinal damage:
- Surgical resection: Removal of part of the colon may be required if there is an invasive mass such as cancer.
- Removal of adhesions: If you have scar tissue compressing the intestines from the outside, this often requires careful incisions to cut them, although the scar tissue may come back.
- Stent placement: A stent, which is a tube that holds the intestines open, may be placed inside the intestines to allow food and stool to pass through and prevent re-blocking. This may be necessary if the intestinal obstruction recurs or if the intestine is severely damaged.
- Colostomy / ileostomy: If your intestines are damaged or inflamed, you may need a permanent or temporary ileostomy or colostomy, which is an artificial opening in your abdomen to remove waste or stool. They are sometimes temporarily placed to prevent a serious gastrointestinal infection from spreading through the body. However, the ends of the intestine may not be able to be reconnected, in which case these holes may be needed for a long time.
- Revascularization: Ischemic colitis may require revascularization, which is the repair of blocked blood vessels that carry blood to the intestines.
When the surgery is complete, the surgeon will close the internal incisions with absorbable stitches. The external incision is closed with stitches or surgical staples, and the wound is closed with sterile gauze and tape.
After the operation
After the surgery is finished, the anesthesia is stopped or lifted and you slowly begin to wake up. When the anesthesia wears off, the breathing tube will be removed and you will be taken to the recovery room for observation.
At first you will be weak and gradually you will become more cheerful. When you wake up and your blood pressure, pulse, and breathing are stable, you will be transferred to a hospital room where you will begin to recover.
The IV will stay in place so you can receive your medications and fluids for the rest of your hospital stay. Also, your urinary catheter will stay in place until you can physically get out of bed and walk to the bathroom.
Some people recovering from a laparoscopic procedure can get out of bed several hours after surgery; After open surgery, it may take a few days for you to walk and urinate on your own again.
After surgery for a bowel obstruction, the stomach and intestines need time to restore normal function and heal. The amount of time it will take will depend on the volume of your procedure and any comorbid conditions you may have, such as colon cancer.
Most patients stay in the hospital for five to seven days after surgery for a bowel obstruction. It can take weeks or months to fully return to normal activities.
Your healthcare team will work with you to manage your postoperative pain. Opioids, which are commonly used for pain relief, can cause postoperative constipation and are rarely used after bowel obstruction surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be dangerous because they can cause bleeding in the stomach or intestines. …
Your healthcare provider will confirm that you may have gas before you are allowed to drink small amounts of fluids. Your diet will start with clear liquids and (when your body shows signs that it is ready) gradually switch to soft foods.
You will be given instructions on wound care, medications, signs of infection, complications to look out for, and when to make an appointment. Follow all instructions from your healthcare provider and call the office if you have any questions or concerns.
If a colostomy or ileostomy is required, you will have a tube with an attached stool collection bag. The nurse will give you instructions on how to care for him before you go home.
Some patients may need to see a nurse to check the wound as it heals, to monitor colostomy / ileostomy care, or tube feeding.
When you return home and are on the road to recovery, there are a few things to keep in mind:
- Wound care: Follow your doctor's instructions regarding wound care and precautions to take when bathing. Watch for signs of infection such as redness, swelling, bleeding, or drainage from the incision site.
- Activity: Exercising during the day will help prevent blood clots and speed healing. But avoid vigorous exercise or heavy lifting until the wound is completely healed (about four to six weeks). Don't exercise until your healthcare provider gives you permission.
- Diet: Your healthcare provider may prescribe a mild gastrointestinal diet for up to six weeks after surgery, which is a low fiber diet. In this case, avoid fresh fruits (other than bananas), nuts, battered meats (such as hot dogs), raw vegetables, corn, peas, legumes, mushrooms, stewed tomatoes, popcorn, potato skins, fried vegetables, sauerkraut , whole spices (such as peppercorns), seeds, and high-fiber grains (such as bran). However, keep in mind that it may take several weeks before you can tolerate normal food. The nasogastric tube will stay in place until this happens. Some patients continue to receive tube feedings after returning home.
- Medications: Regular bowel movements are important to prevent future blockages. Your healthcare provider may prescribe a bowel regimen with stool softeners such as Miralax (polyethylene glycol 3350), along with medications such as senna, to stimulate a bowel movement. Follow your healthcare provider's instructions on what to take and what to avoid.
When to call your healthcare provider
Call your doctor for advice if you experience any of the following:
- Vomiting or nausea
- Diarrhea that lasts 24 hours.
- Rectal bleeding or tar-colored stools
- Pain that persists or worsens and is not relieved by medicine.
- Bloating, swelling, or pain in the abdomen.
- Inability to pass gas or defecate
- Signs of infection, such as fever or chills
- Redness, swelling, bleeding, or drainage from the incision site
- Self-sticking seams or staples
Overcoming and long-term treatment
It is important to work closely with your gastroenterologist to restore normal bowel function and prevent re-obstruction. This applies to the time immediately after the operation and, in many cases, after the operation.
Treatment protocols are not universal and it may take several tries to find the right drug or drug combination for you. If a particular drug does not relieve you or you experience unpleasant side effects, tell your doctor, who may prescribe a different course of action.
You may be asked to keep a bowel diary, including frequency, volume, and consistency, based on the Bristol Stool Chart , which rates bowel movements on a scale of one (heavy) to seven (thin) .
Possible future operations
If you've had a colostomy or ileostomy, you may be scheduled for another procedure to reattach your intestines after the swelling subsides. Your healthcare provider will discuss this plan at your next appointment.
Surgery for a bowel obstruction usually provides long-lasting relief. However, there is a chance that the intestinal obstruction will recur, especially if the underlying condition that caused the intestinal obstruction is chronic or incurable. A new operation may be required.
Once your bowel obstruction has healed, it is important to keep your bowel healthy and regular. You may want to work with a nutritionist to develop an eating plan that contains the appropriate amount of fiber for your individual needs.
It's also important to drink at least eight 8-ounce glasses of water a day to ensure adequate hydration and prevent recurrence of constipation . Regular exercise can also help move stool through the intestinal tract. Make sure you have a doctor-approved constipation treatment plan in case it happens.
If you have a stoma, know that you can lead an active and healthy life, but you will also have to make some adjustments. This means that you should schedule your meals so you don't have to empty them at inopportune times, keep them clean, and wear comfortable, comfortable clothing.
Get the word of drug information
It may take some time to recover from surgery for a bowel obstruction. Working with your healthcare provider can help ensure proper healing and normal bowel function can be restored. It is important to maintain bowel regularity and promptly treat possible constipation to avoid recurrent bowel obstruction, especially if you have risk factors that may predispose you to a new bowel obstruction.
Frequently asked questions
Expect to stay in the hospital for four to seven days after your surgery. In some cases, you may need to stay in the hospital for up to two weeks after surgery for a bowel obstruction.
You can. If the colon is severely damaged or inflamed after surgery, you may need a temporary colostomy until the colon heals. If the damage is severe, you will need a permanent colostomy.