Possible small bowel obstruction

[jeffforester]

I'am 35 years old and have an extensive history of SBO. Starting when I was 3 with a ruptured apendix setting up peritonitis, 2 weeks later surgery for SBO. At 10 years old SBO resolved with NG tube. At 15 years old SBO emergency surgery & 3 weeks later back in the ER for another SBO- they tried to resolve it by putting a Cantor tube down and pushing it thru little by little but it didn't work & another sugery was performed, adhesions were so bad they had to perform a ileo-transverse bypass of 1/3 of my small bowel. The 1/3 diseased portion was, according the sugeon, snarled up with the cantor tube in it & adhered to the right side of my abdomen. They elected to leaving all the bypassed portion in at that time leaving me with +-14 ft of functional small bowel. 3 more SBO occured after this, 2 at 17 years of age & 1 at 18 years of age.
God has allowed me to have the past 18 years free of obstructions, until now. Starting in December, 2005, I began to have sharp pains on my left side, below my rib cage radiating around to my belly button. It seems to have progressivly gotton worse each week, the past 2 weeks I've had diarrhea, bloating, & cramping after eating & have lost 8 pounds (200 to 192). On 1/18/06 my wife took me to the ER after having an all day episode of these symptoms, X-Ray & CT showed no blockage. Again, on 1/23/06 I see a GI specialist, he refers me to a surgeon (my surgeon thats done all my prev. surgeries has retired)who admits me to the hospital for observation, based on my symptoms and history. Again, X-Ray & upper GI Barium study shows no obstruction, I was released the next day. This surgeon says if I do develope a SBO that requires surgery that it could very well be "life threating" and there may not be much "mechanically" that he could do due to whats already been done. He was not at all optimistic.  So, after all this, my question is- Is it possible to have a partial SBO that comes & goes without detection on test? And, in my case of severe adhesions & the extensiveness of my history- what are the options in the case of a complete SBO that doesn't resolve itself with a NG Tube?   Thanks, Jeff

[Kevin Pho, MD]

Yes, it is possible for a partial SBO to come and go, and not show up on a diagnostic test.  

With the history of surgeries and previous SBOs, a surgical option likely would have the most benefit.  An ileostomy can also be considered as well.  

These options should be discussed with your personal surgeon.

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.

Kevin, M.D.
kevinmd_b

[B_Johnson]

Well yes, partial obstruction is possible and may not show up on a barium series.  I dont know about life threatening, but the next possible step could be ileostomy it depends where they find the obstruction and how large the section of bowel is. You can only have so much small bowel resected since that is where the majority of nutrient absorbtion takes place. The more surgery you have the greater risk you have for adhesions.

Have they investigated other causes for the pain?

[jeffforester]

No- they have not done further investigation into causes of pain.

[surgeon]

ileostomy is not in any way a probable "next step," in fact would be an unusual (but not impossible) outcome of surgery. It would depend on where the obstruction is and what can be done about it. It's highly unlikely that ileostomy would be a necessary solution. Also, with as much time as has passed since your last operation, it's likely that another one -- should it become necessary -- would be easier; adhesions tend to soften with time. Finally, as has been said, partial obstruction can be hard to diagnose. If the pattern recurs often enough, exploration may well be the best approach.

[jeffforester]

I also found it unusual that an ileostomy would be suggested as my next step. According to my last "Record of Operation" in 1985, written by my surgeon, "they were not able to free from the proximal ileum to the cecal area and due to the extreme vascularity and extreme inflammatory process at hand it was decided to do an ileotransverse bypass procedure".

As of now my symptoms continue. An upper GI last week shows no obstruction, but it also doesn't show the 1/3 bypassed portion of my bowel. Since it was left in place my surgeon said food may or may not go through. I'm wondering could this area be giving me my problems?? Last week I didn't have much luck with a doctor diagnosing my exact problem, nor seemingly being interested in trying to diagnose my problem. I meet today with a new surgeon that hopefully can shed some new light on my situation.

[ROSEANNF]

Jeff, My mother is having similar problems. She is in her 70's and has had two surgeries, galbather and a hysterectomy due to cancer and then the cancer treatment aftewards  she is also diabetic.  This past year she has suffered tremendously with similair symptoms, has taken all the upper and lower GI test as well as a stomach test.  All come out clean. Although her last test of the small intestines took three hours for them to try to get the barrium to go through but they say that the test was clean.  The doctors say she has so many adhesons that surgery would just worsen the situation.  She will have episodes where what she eats backs up, causing extreme gas pains, will not pass and the end result is vomiting and then diarrhea to follow.  This happens nearly every week.  She has resolved to the fact that she will have to live with it. I beleive there must be something that can be done.  Has anything been mentioned to you about a special diet that may help to ease the digestive process?

Worried Daughter

[jeffforester]

Interestingly enough, the doctors I've seen say that it shouldn't matter what I eat. Having first hand experience with the problem, I disagree with this. Currently, I try to stick mainly to soft foods, no fried foods, no ruffage, no steaks, etc, although I don't stick to this diet 100% of the time. Staying active & excercise could possibly help as well. As far as adhesions, it seems we don't hear enough talk about how serious of conditions they can cause. With technology, you'd think more could be done to resolve the problem. Overall, the best solution I've found is thru prayer- prayer that the lord would ease the discomfort and that he may lead the doctors to find better way to deal with the problem of adhesions & small bowel obstructions.

[Ann K]

Hi:

I'm sorry, but I don't believe that prayer is the answer.  For goodness sake, yes the mind and the body are so interconnected.  Why perform last rights (prayer) and start exploring some holistic medicine?  I think you will be very surprised.  

Please, there is so much out there...herbs, accupunture, cleansing.  If I were so far gone that I thought I'd have to "live with it" I'd go crazy.  

With all due respect to western medicine, all they can do is cut you open, or perscribe drugs.

I hope you'll explore these options.

Thanks.  Ann

[sbam1970]

Hello,
Well it sounds like I am reading my medical history after reading yours! I have only a few days ago gotten come home from hospital after a partial small bowel obstruction. (I am 35yo). I have lost count with how many I have had. I have a similar history with surgeries that started as a small child from a ruptured appendix, & have had several surgeries since for complications that have developed due to the adhesions. My first obstruction occured after a surgeon accidentally cut my bowel during a surgery in my early 20's. Initially they were very acute, severe cramps & vomiting which required the nasogastric tube. After several terrible episodes, they seemed to settle down a bit as I learned that diet & particularly hydration played a big role. However, after surgery for further damage to my bowel which resulted from a ceasarian section, I have developed regular crampy type pains around my navel & radiating to the right. Surgeons have told me that this is from partial obstruction, as I tend not to get some of the symptoms I used to get like bloated tummy & vomiting, but I still get the cramps that come & go & a tender tummy. I am very careful about what I eat & that I drink heaps of water, this definitely helps!

[Mommacar]

I have a 9yr old daughter who last year had an endoscopy showing a partially obstructed area of her small intestine. During follow-up tests it didn't show up. The Doc thought it was maybe spasming. She also has an intestinal motility disorder. The past month her belly pain has returned very strongly. She has been throwing up and compalining of belly pain from belly button and slightly to the left. Her breath smells so awful we have her brush her teeth and mouthwash to help but it smells very badly. They are going to redo the endoscopy/colonoscopy on the 28th of March. Any suggestions or has anyone heard of an obstruction being visible by one test and not any other?

[jeffforester]

Thanks for your comment, your the first person that I've ever heard of with basically the same problem I have. I was beginning to feel as though I was the only person around with such severity of adhesions & obstructions. It's actually an encouragement to here someone else has this problem and able maintain a relatively normal lifestyle by controlling your diet.

Since I first posted my original comment on 1/26/06, my symptoms continued to worsen until I was hospitalized on 2/15/06, laparotomy performed on 2/17/06, where they took down an anastimosis (bypass) that was done in 1985 and then reconnected 6-8'of small bowel that for over 20 years has basically been nonfunctional(tangled from adhesions). After 2 weeks in the hospital, on 3/2/06, I still had very limited bowel sounds, no bowel function & continued to vomit. Another laporotomy was performed, when I was opened, doctors said "at this time" they  couldn't do anything due to extreme swelling and that my intestines "were like contrete". So, they placed a central line for TPN and a tube in my stomach rather than another NG tube. They planned to send me home on TPN & home health and wait 6 weeks and try surgery again. On 3/5/06 I began to have bowel function & on 3/7/06 I began eating & went home without TPN or home health. Today, 3/28/06 I continue to improve & regain strength & weight. Although, I'm along way from eating normally & have some tightness after eating on my right side. I'am doing as you do & drinking lots of water. Unfortunately, with our illness there is no miracle drug to cure the problem and doctors seem to have their limitations as well. I'm a Christian and a firm believer in God & prayer and looking back at the bleakness of my situation just 3 weeks ago, that's exactly what brought me thru.

[jeffforester]

In my experience a partial small bowel obstruction has been hard to impossible see from X-Rays and CT Scan. Although CT Scan seems to be the preferred method by the doctors I've delt with. As far as endoscopy & colonoscopy, most of us have 21' of small bowel & there isn't but so far they can push a scope from either end, so I'm not sure they'll be able to diagnose an obstruction this way either. Good luck with your daughter's problem.

[Rubyshoes]

I have had severe pain in the upper left quadrant radiating to the back for the past 7 years or so.  I have had all the tests and nobody knows what it is.  Yesterday my doctor diagnosed it as Shingles because of the hypersensitivity of my skin and the radiation of the pain to my back.  I have had my gallbladder and appendix out and a hysterectomy.  I have been a smoker for 40+ years and my cholesterol is high 293.  The lipids are very high.  ?

Do these symptoms ring a bell to anyone.  The pain is so severe at time it has me squirming and writhing with pain.  Next week I am having a small bowel follow through study following a CT scan that showed some dilated small bowel loops.  ??  Just wondering if anyone had anything like this out there.

[goody2shoooze]

My husband just had surgery for small bowel obstruction.  He has never had surgery before.  They found several adhesions in a single area, and the pathology report stated that he also had Chrones Disease.  This has been an ongoing problem for several months now, averaging a hospital visit every week or 10 days. He basically hasn't had anything to eat for 3 months, and literally not for 2 weeks other than an IV.  He has lost 50 pounds.  Currently he is 5 days post op and he is still confined to 1 cup of ice chips every 8 hours.  They don't hear significant bowel sounds.  I can't imagine how he could have bowel sounds when he hasn't eaten in so long, been totally on IV, and when he did try to eat he vomited.  He's been on a nasogastric tube for most of the last 3 months.  We are very frustrated by getting such limited information from doctors and nurses.  He's hungry!  Is this normal postoperative protocol?  It seems inhuman.  Thanks for sharing your stories.  Depressing to know this could now be his life.  But at least it helps to know how others cope.

[jeffforester]

I know how your husband feels when it comes to continued hospital visits, bowel obstructions & how miserable an NG tube is. If he's not on "TPN" (Total Parenteral Nutrition)yet, considering how much weight he's lost you might ask your doctor's about this. After 2 wks in the hospital they started TPN on me & it seemed to help.
Normally by 7th day post-op good bowel sounds & funtion should have returned, in my case it was 16 days after the 1st surgery (Feb 17th,'06) & 2 days after the 2nd (March 2nd,'06), fact is they did finally open up. Your husband is only 5 days post-op, hopefully in a couple more days bowel function will return. It is a good sign that he's hungry & has an appetite.
This may sound silly but have him try chewing surgarfree gum for 2 hrs, 3-4 times per day. I did this after my 2nd surgery & it may have contributed to speeding things up. Several of my friends & family members saw a segment on Good Morning America  about chewing gum after surgery will speed up the return of normal bowel function. Also- walk-walk-walk, he can't walk enough- as tough as it may be encourage your husband to wear a path in the hospital halls, this will speed up return of bowel function as well.
Tell your husband to try to keep his head up & remain positive & that someone will be praying for his recovery today!

[Msfullness]

Jeff, I was just wondering if it would be possible for you to try the camera pill? Theres a more professional name for it, but I dont remember what it is right now.  I dont know if insurance covers it.  I just remember reading about how it takes a ton of pictures as it passes through the digestive system.  Just a thought.

[holly986]

A related discussion, How do I know if I have a small bowel obstruction was started.