Bowel Obstruction

[DianaCox]

[THIS IS A PLACE HOLDER FOR A GREAT BOWEL OBSTRUCTION POST THAT SOMEONE ELSE WROTE]

In addition to this, I wrote the following post several months ago (I think just writing it was therapeutic - I never had another bout, but this information could help someone else.)


I would like to post an email I wrote to my surgeon, and his response, and ask if any of you who had a bowel obstruction had any preliminary symptoms like mine, to give me some idea of whether YOU would have gone in and had the CT scan sooner, knowing what you know now.

My email:
I have been having occasional issues – becoming more frequent for the last 18 months or so, now happening maybe 2-3 times/month – that are developing into a kind of pattern. I don’t know what is setting them off, nor whether what I am feeling is cause or effect – not even sure it is DS-related, though I assume it likely is.

I will bloat up rather quickly, not related to a food that I can identify as the possible culprit. And then the bloat starts to hurt in a very specific place, left side, approximately where my left ovary is (I am several years postmenopausal). This is followed by spasms of very painful cramping that takes my breath away and makes me yelp in pain (8.5 on a scale of 10) that last 2-3 minutes, followed eventually by very very painful passing of gas and pooping (painful in the spot where the spasms are occurring, not my rectum or anus). The episodes last 30-60 min, and leave my abdomen sore for a day or so. I am not constipated, and my poops at worst are formed but relatively soft – never hard.

I’m wondering if I’m developing adhesions/intermittent bowel obstruction/intussusception in a specific place? If so, is there anything that can be done proactively to diagnose and if necessary treat it BEFORE it becomes a medical emergency? I have read that these need to be diagnosed by CT WHILE an episode is going on, and they don’t (yet) last long enough to get to an ER, convince someone to do the CT with contrast, etc., so I’m dubious, but I thought I should ask.

My 10 year check up will be in August.

His response:

I'd probably go ahead and get an abd/pelvic CT scan with PO and IV contrast at some point as a baseline...it may even show something (doubtful though.) Certainly if the symptoms persist long enough to get to an ER and have an emergent scan, that would be the thing to do (but let's hope that that doesn't happen!) Aside from that, I don't have any other suggestions aside from coming in for an exam as your 2012 labs look great and you haven't identified any trigger food or activity to implicate.
​

I don't want to get irradiated for no reason - the "doubtful though" has me thinking I need more reason than that. But for those of you who have had a bowel obstruction, did you have prodromal symptoms like I'm having? Or did it just happen out of the blue?

Thanks in advance - and I hope this thread will be a useful compendium of experiences for others in the future!

Just for future reference for any DSer who needs a CT scan - I asked Rabkin what the CT order should look like, in case I need to go in, in particular for the oral contrast media - I have had oral contrast before my DS, and puked at glass 5 of 8, but when I had a CT at his hospital in ~2004 (I thought I was having a bowel obstruction, but it was just the worst food poisoning ever), they gave me a few little Dixie cups of cranberry flavored medium and it was quite tolerable, even though I was quite ill - his answer was:

As far as the CT goes, it can be done locally but the images and not just the printed report should be sent here to be reviewed. The CT would be an abdominal and pelvic CT with IV and PO contrast (baratric protocol: 250 cc of PO contrast instead of the routine liter!)

In case anyone needs to know what to demand if they end up in the ER.

 

[conceit]

Thanks! Very helpful indeed. I am going to keep this info. on hand at all times. Maybe this could get stickied? I'd vote, if so.

 

[Sandy]

I appreciate the notation on what a bariatric CT order should read. I am currently experiencing intermittent abdominal pain that occurs shortly after eating. It's not being triggered by a particular type of food but rather by the act of having eaten. I've had a partial bowel obstruction previously that cleared itself while I was in the emergency department so this is a familiar pain in a familiar location. At this point I may be playing a sort of Russian Roulette but I'm not running myself to the doctor or emergency department yet. It's been going on for the past few days but the pain only lasts for about 30-45 minutes before I hear the chyme move through my intestines and the pain subsides. I've put myself on a liquid/soft diet for the time being and that is helping.

So, I guess to answer your question, I am doing the same in not hurrying to get a CT w/contrast. I have a baseline CT and at this point it's doubtful that anything is going to show up on a new scan unless the obstruction lasts long enough to get to the emergency department and go through the triage process to finally getting the CT w/contrast.

 

[MsBatt]

Interesting thread. Three years ago I had a bowel obstruction that resolved itself in the hospital, fortunately. I did not have any warning, really---it was a Saturday, I got up and had my normal two BMs, went shopping, felt fine, but a little gassy. I remember telling my mo I REALLY wished I could fart, but that's not uncommon.

As the day went on, the gas pressure got worse and worse. Once home, I was actively trying to fart. I even did that thing where you get down on your knees and put your left shoulder against the floor, but no go.

By about 4 PM, I was in some serious pain, and began to feel queasy. Suddenly it hit me---this might be an obstruction! Since I live about 45 minutes from the nearest hospital, I told mom I needed to go, ASAP.

By the time I got there, I was barfing---barfing enough that I got taken immediately back (instead of being left in the waiting room for seven hours like I did with 7 broken ribs and a collapsed lung.)

Even so, it was around 8 before they confirmed I did have an obstruction. They then started trying to insert an NG tube. (That's another story---let's just say they had to get an infant tube before they succeeded.) Then they gave me a WONDERFUL shot of something.

I stayed in the hospital until sometime on Monday.

This was, without a doubt, the worst pain I have ever experienced, and I've had a LOT of pain. Multiple abscessed teeth, a dry socket, and the above-mentioned collapsed lung and 7-count 'em-7 broken ribs. I can only assume the people who ask "Should I call the doc?" have, at most, a partial obstruction.

 

[DianaCox]

Also - my elderly and medically very fragile mother had a bowel obstruction a couple of years ago - I freaked the hell out when I found out that they had just put her in the hospital with an NG tube - I called in some chits and contacted Elariny's office (I have met him and helped a couple of his patients), and asked him to take over my mother's case, as she was at a hospital where he has privileges in VA, and he takes Medicare. He assigned one of his residents - who was WONDERFUL to my mom, watched over her, and stayed in touch with me - and totally agreed that decompression with NG tube was the right thing to do - she recovered without the need for surgery, and so far, it has not recurred.

I had no idea that bowel obstruction was not cause for immediate surgery - sometimes, it is not. A good thing to know.

 

[MsBatt]

Yeah, the surgeon who saw me did my hernia repair and treated me when I broke all those ribs, and I really like him. He was already aware that I had designer guts, so he didn't freak when he saw my test results, I guess. He told he he wanted to make me comfortable and give it a chance to fix itself, and I'm VERY glad he did, and it did.