Bowel obstruction-sometimes called intestinal obstruction-occurs when a part of the digestive tract becomes blocked. This blockage can prevent food from passing through the digestive tract or waste from leaving the body, depending on where in the digestive tract the blockage is.
Bowel obstruction is a common, and sometimes serious, disorder. In the United States, approximately 20 percent of patients admitted to a hospital with critical stomach problems have some kind of bowel obstruction. Of those cases, about 80 percent are small-bowel obstructions, a blockage in the small intestine. The small intestine is where most food is absorbed and where most digestion occurs.
Small-bowel obstruction is known as a mechanical obstruction. The cause is something physically blocking the intestine.
Small-bowel obstruction can be caused by hernias and tumors. But the most common cause by far is post-surgical adhesions in the abdomen. Such adhesions form over or around tissue inside the body that has been damaged during abdominal surgery. The damage is caused by surgical incisions and is unavoidable. One study revealed that some 93 percent of patients who undergo major abdominal surgery develop adhesions.
The body heals itself quickly by rushing a protein called collagen to incision sites. Collagen forms into strong, microscopic fibrous strands, commonly known as scar tissue. Sometimes the adhesions fasten two organs in the abdomen together that are not normally connected to each other. This can cause complications by interfering with the normal function of one or both of the organs. Pain is the most common complication. Bowel obstruction is another complication.
Pain from adhesions following abdominal surgery is common. Patients have described the pain as sharp, stabbing or pulling. Some patients have difficulty walking because the taut adhesions cause pain and restrict normal movement.
The pain associated with bowel obstruction can be intense. Its often accompanied by nausea and vomiting. To further complicate the problem, bowel obstruction can cut off the blood supply to the affected part of the small intestine, resulting in death of the tissue of the intestinal wall. Tissue death can lead to tears in the intestinal wall and to a life-threatening infection called peritonitis (pair-i-tuh-NEYE-tis).
If the bowel obstruction is partial, where some food and liquid can pass through the digestive tract, the blockage may clear up on its own. In some cases, doctors use an enema to open the blockage. Some forms of physical therapy, in which physical therapists use their hands to break up the adhesions, have proven effective.
When adhesions cause severe chronic pain and other complications, quick-sometimes immediate-treatment is called for. The conventional treatment is surgery to remove the adhesions and any dead tissue surrounding them. The surgery is known as bowel obstruction repair.
Two types of surgery are used for bowel obstruction repair: traditional open surgery and laparoscopic surgery. In traditional open surgery, the surgeon makes a large, deep incision across the stomach, which allows direct access to the adhesions. In laparoscopic surgery, the surgeon makes several small incisions and, guided by a computer, inserts tiny lights and instruments such as lasers and cutting devices to remove the adhesions.
Every surgery, major or minor, carries certain risks. Risks associated with bowel obstruction repair include infection, heavy bleeding and temporary paralysis of the intestines. Another risk is the reoccurrence of the blockage because of the formation of still more adhesions, which can lead to repeated surgeries, which can lead to still more adhesions, and so on.