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Scared about possible partial small bowel obstruction
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Scared about possible partial small bowel obstruction

Hoping you can help answer a few questions. I am a 35 year-old female with a history of constipation predominant IBS, redundant sigmoid colon, gastritis, asthma, high BP (monitored), endometriosis and polycystic ovaries. The IBS and redundant colon has never been much of a problem (easily resolved with diet changes and Equalactin) until I had laproscopic surgery for fertility in October. The surgery involved laproscopic removal of a fibroid tumor, and was a difficult 3-hour surgery. About 6 weeks after surgery, I began having severe problems with chronic constipation. Normal medications and Equalactin did not resolve. Put on 6-week trial of Zelnorm (seemed to make worse). After stopping medication, I had virtually no bowel function (never happened before). GI doctor ordered the following tests: blood work, chest and abdominal x-rays, small bowel series (taken just prior to onset of constipation and left sided pain), colonoscopy (taken just after onset of constipation, but before left sided pain), CT scan and stool culture. All tests were normal. One week after colonoscopy, constipation worsened and I developed left sided crampy pain (just above hip area, across from belly). Pain worsened tremendously after eating (about 15 minutes after finishing eating) and was accompanied by severe bowel distension on left side. This problem started around the first week of February and has gotten slowly worse each week. Only thing that helps motility and cramping is combination of daily Miralax and Librax (and Phazyme with meals). With Miralax, I am having 1-2 daily movements (not constipated), but feeling painful pulling feeling in area of distension after BM. More pain in area of distension after BMs. My GI doctor and GYN doctor have suggested two possibilities:
1. Development of abdominal adhesions from my October surgery
2. Possibility of partial small bowel obstruction

My GYN doctor has suggested going back for a second-look laporoscopy in June to assess and possibly remove adhesions. This surgery would be done in coordination with a colon surgeon. Also has recommended repeating GI series to eliminate poss. of partial small bowel obstruction (since left sided pain, distension, and constipation did not begin until after small bowel series).

Questions:
1. What are the chances that I could be struggling with a progressive, partial obstruction that has been going on 3+ months? My GI doctor is reluctant to do another test as one was just done in January.
2. What signs should I look for that would suggest a partial obstruction? (Note: Bloating, cramping and distension is extremely painful after eating - distension is somewhat reduced in the morning, but worse and BMs.)Pain seems to get slightly worse each week. Am planning vacation to Bermuda in 4 weeks and would like some resolution (in case there could be a problem). GI follow up scheduled for 5/23, surgical consult on 5/27.
Any advice? Very scared about SBO.
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233190_tn?1278553401
Hello - thanks for asking your question.

1) The symptoms you are describing may be consistent with partial small bowel obstruction.  You may want to consider a plain film or CT scan to further evaluate this.  

2) The most common symptoms of small bowel obstruction are abdominal distention, vomiting, and crampy abdominal pain.  Abdominal pain is frequently described as periumbilical and crampy, with paroxysms of pain occurring every four or five minutes. Some clinicians feel that progression from crampy to constant pain is a sign of impending strangulation.

I would suggest a referral to a surgeon for further evaluation with plain films or a CT scan.  I would suggest a more urgent evaluation rather than waiting until your appointment.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
6 Comments
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Avatar_n_tn
bloating, cramping, distention, all are symptoms compatible with partial SBO. The cause would likely be the adhesions; that's what they do if they cause problems. It might be useful to get a plain abdominal film while you are having symtoms (symptoms) to try to tell if the gas is building up in the colon or in the small bowel. Seeing a colon surgeon sounds like a good idea.
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Avatar_n_tn
Does partial SBO sound like something emergent that I need to be immediately concerned about, or is it OK to wait until my appointment in two weeks? Am I in immediate danger of developing a complete obstruction? Should I continue my vacation plans as long as thing s don;t get significantly worse?
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Avatar_n_tn
One more question: If there is a potential of a partial small bowel obstruction (which has been going on for over 3 months), should I avoid taking the Miralax? Will it complicate a partial SBO? My only other option is going back to the Eqaulactin. Will gas pills during meals help?
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Avatar_n_tn
It's only truly emergent when it's a complete obstruction, or when the partial obstruction is such that you can't eat or drink. Of course, it could change at any time and become complete (if that's what it is)-- likewise, it could remain just as it is forever. So, unfortunately, no one can answer your question exactly. But as long as you are getting along, waiting for your appointment ought to be safe. As to the laxatives -- again, it's hard to see the future. If what you are doing seems to be working, I'd keep with it unless things change.
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Avatar_n_tn
Hello everyone!!!!!  I have had a complete colectomy, double hernia, and a closed loop obstruction. So the only thing that's going to come out of this is you feeling better in the long run.
Trust me there is no greater feeling then knowing that the problem that you have is gone in the beg. you might question yourself and think why did I do this, but it will all work out.
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