surgery for obstruction in small bowel

My mother had a hysterectomy due to cancer. While in the hospital they discovered her small bowel was obstructed (through a CT Scan) and are draining her stomach with the tube down through her nose into the stomach.  They are talking about doing surgery.  Does anyone know anything about this.  When they did her hysterectomy they had problems with her heart and did not think she could handle another major surgery.
thanks for any information you could give me

[kimbacat]

there are a lot of reasons where surgery for a bowel obstruction is necessary.  but since your Mom just had surgery, the most likely reason for her obstruction could just be that her bowel is still asleep (post-surgical ileus).  our bowel does not like to be handled, touched, moved, poked or prodded.  some people's bowels are particularly sensitive to manipulation during surgery.  time and the NG tube to relieve pressure are the standard approach for obstructions.  if her obstruction is due to adhesions or other things, surgery might be inevitable.  

I've had quite a bit of bowel and other abdominal surgery.  I've had a lot of bowel obstructions for a variety of reasons.  let me know if you have any specific questions.

[s.mcm]

The nurse said that my mom's bowel was not paralysed, there was a blockage.  I am still waiting to speak to the Dr. to get more details.  If they do surgery (hopefully the bowel was not strangulated and they wont have to remove part) do you have anything you can tell me about that?  I know I sound vague but we just dont know more right now and my Mom never asks the Dr questions. (he comes to early in the morning to the hospital so I have to wait for him to return my calls)  thanks so much

[kimbacat]

yeah, I know those docs come in waaaaay too early in the am.  it's great that you are calling the docs.

I'll take a guess here.  there is either something stuck or adhesions have caused a kink in the bowel and is blocking things.  adhesions are just scar tissue that has formed in the abdominal cavity that can kind of tie up the bowel.  she might clear the obstruction on her own if there is something stuck (food bolus).  or her gut might unkink itself and no longer block the bowel.  but...... it might not.  that's the problem with obstructions.  you don't want to jump right in and do surgery, but you also don't want to perforate the bowel or have a large portion of the bowel die off while you are waiting for the obstruction to clear.  I've had all 3 types of problems, post-surgical ileus, food bolus stuck and adhesions quite a few times.  I can tell you what I've learned and what my experiences have been (ovaries removed, 3 bowel resections and my gallbladder removed).  

you can't really tell exactly what's going on until you go back in.  they're going to want to do a full, midline incision so that they can really look around and check the entire length of the bowel.  if it's adhesions, they can just cut away the adhesions and 'unkink' the bowel.  and as long as none of the bowel has lost circulation for too long and has died, that's all they'll need to do.  if there is something stuck inside the bowel, they'll have to remove it.  depending on where it is and how big it is will determine how they go about doing it.  if they do remove some of her intestine, they will reconnect the 2 ends.  and chances are it won't make a bit of difference to her digestion.  it's a tough surgery because of the big incision.  and not to totally gross you out, but they actually do take all your bowel out of your abdomen.  so it does take a while for everything to kind of get back into place and settle down.  she is going to hurt afterwards, but a morphine PCA should take care of that.  if she does have a PCA, make sure they set it so that she has enough of a continuous dose that she is comfortable enough to get some sleep.  she should only have to push the button for breakthrough pain, not for ongoing relief.  getting up and walking around afterwards is the best thing she can do.  if she's not in intensive care, they'll probably have her sitting up in a chair the same day.  have her use a pillow to hold against her abdomen when she coughs, laughs, sneezes, etc.  it really does help.  personally, I prefer to keep the foley catheter in for as long as they'll let me.  cause getting in and out of bed is tough, really tough.  (guys have it soooo much easier).  if she is having problems, have them get her a portable john that can sit right next to the bed.  that will make it a little easier.  they won't let her eat afterwards until she passes gas.  so if she's shy about that, she won't be when this is over.  that'll be the number one question everyone will ask her.  and it could take quite a few days before she passes gas.  then she'll be allowed clear liquids.  if she can keep them down and still keep passing gas for 24 hours, they'll bump her diet up to full liquids and then to solids.  they'll want to actually see any stool that she passes.  and watch out for the post anesthesia blues.

from a patient's perspective, the best thing you can do is to be there and stay there as her advocate at least for the first 24 hours.  it was a tremendous comfort knowing I had someone there that was going to make sure I was comfortable, would make sure that the pain meds were working, that I was getting the right meds at the right time and would go get a nurse if I needed one.  have her use the buttons on the bed to raise her head rather than trying to sit up.  don't be afraid to touch her, hold her or to help her move around afterwards.  offer to wash her back, her face or help her wash her hair.  they have pretty good products out now to wash up with that don't need water.  have them change her linens as often as she needs them, but at least once a day.


hope I answered some of your questions.  let me know if I can help with anything else.  best of luck to you and your Mom.

[s.mcm]

you have been a great help!  thanks so much!  Sounds like you have been through alot.  It is great that you can pass on your knowledge to others.

[helpfulgal]

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