Know the Risks of Intestinal Blockage

A Member’s Perspective

We recently lost a friend and long time OH member to a condition known as “intestinal blockage.” Her loss is absolutely heartbreaking for the many OH members who knew her. However, her tragic situation also presents us with an opportunity to become better informed about a risk that any of us can face—a risk that doesn’t always have to have such a tragic outcome. I know it was a wake-up call for me, because I have spent time in the emergency room with severe abdominal pain, cramping and vomiting. My diagnosis was simply gas. If there is a next time, I will be more vocal and more insistent about my treatment.

The definition of intestinal blockage is an obstruction of the small or large intestine. It may occur after weight loss surgery. We need to be aware of the symptoms, and we certainly need to be proactive in the emergency room. According the Merck website, 85% of partial small bowel obstructions will be resolved without surgery, but 85% of complete small bowel obstruction will require surgery to repair. We need to know what it is and what causes it and we must take a proactive stand if we suspect we have it.

The onset symptoms of a blockage are cramping, vomiting, and constipation, the inability to pass gas, abdominal distention and tenderness. The most common causes of small intestine obstruction are adhesions, hernias and tumors, but also may include intussusception, volvulus and stricture. Common causes of obstruction of the colon are cancer, diverticulitis and volvulus but may also include intussusception, impacted feces, and stricture. It is important to understand these causes and to recognize the symptoms. If strangulation occurs, the blood supply to the intestine is cut off and gangrene may occur in as little as 6 hours. If the bowel ruptures, peritonitis will result.

Adhesions are scar tissue bands that may bind organs together and may be the result of any abdominal surgery. Intussusception is when the intestine or colon folds in on itself like an accordion. Volvulus is a twisting of the bowel and a stricture is the narrowing of the outlet to the stomach or a narrowing of the colon. With so many OH posts about constipation, this should be a concern for those who suffer from it since constipation may also cause it.

What should you do if you have abdominal pain? Go to the Emergency Room, immediately. You must make it clear that you have had gastric bypass and that you suspect intestinal blockage. Demand x-rays. CT scans and MRI often do not show a blockage. X-ray is the best way to show the location of a blockage and air around the intestine which may indicate rupture.

If you would like to read more about intestinal blockage, here are two trusted websites with excellent information.

http://www.mayoclinic.com/health/intestinal-obstruction/DS00823

http://www.merck.com/mmhe/sec09/ch132/ch132g.html#sec09-ch132-ch132g-1050

- Charlotte Carlile (http://www.obesityhelp.com/member/charlie/)

A Surgeon’s Perspective

Small bowel obstruction can happen after any operation. Some obstructions resolve without surgery – but determining whether it is likely to resolve without intervention is a surgeon's call, based on their judgment and experience. It would not be in the patient's best interest to have every bowel obstruction taken back to the operating room, and would lead to many unnecessary operations. Complete or partial bowel obstructions cannot always be judged by any given x-ray, CT scan, or other test. More than a test, it would be important to have a surgeon examine the patient, and make a determination.

Some patients have warning signs: they get partial obstructions periodically, get better, and are fine for a period of time. If you are having these symptoms, talk to your weight loss surgeon about the symptoms: when they occur, how long they last, whether the pain is constant, or whether it is colicky. Note what things you have eaten before you get the pain; is it vegetables, is it dairy products, is it anything with gluten in it? Also tell the surgeon whether food helped the pain, or made it worse. Let the surgeon know if you have had nausea and vomiting with the pain, whether you had diarrhea, and whether you developed a temperature. Learn how to take your own vitals—your pulse, your temperature—even your blood pressure. Clearly, you should not try to diagnose yourself, but learning all you can to present a coherent picture to your surgeon will be helpful. Some may have lactose intolerance, which can be very painful, or gluten intolerance, or be developing gallbladder disease, or a partial obstruction. If you have a number of these episodes your surgeon may want to take you to the operating room when you are feeling okay, just to explore you and see if there are any adhesions; we would much rather take care of the problem in an elective manner, when you are well and healthy, than when you are very ill in an emergency room.

Small bowel obstructions leading to death of the small bowel and, ultimately, to the death of the patient happen far too often. Weight loss surgeons are very familiar with this, and take weight loss patients back to the operating room much faster than other surgeons might. CT scans can and do show blockages, and are helpful—but it is going to the operating room that is far more helpful than any particular scan. It must be remembered, however, that even if a surgeon is notified, and takes a patient back as soon as possible, some patients may die.

The bottom line: if you are in pain, go to the emergency room where you had your surgery, or notify your surgeon and find out where he or she would like you to go. If you are in a strange city and are having pain, it is best to go to a hospital where they have weight loss surgeons on staff.

-Terry Simpson, MD, FACS

Terry Simpson, MD, FACS, is medical editor for ObesityHelp and has been doing weight loss surgery since 1991. He has written several books about weight loss surgery, including Weight Loss Surgery: A Lighter Look at a Heavy Subject. His second edition of The Road Kill Diet: Recipes from the Journey of Alaska to Arizona will be published shortly by Amazon.

http://www.obesityhelp.com/morbidobesity/bariatric+surgeon+profile+Terry+Simpson+fnd.html

12 Comment(s)

Comment by sassykiki on Jul 21, 2008 at 01:53pm

Tha is so sad my heart goes out to her family yes we need to be AWARE of our bodies and signs and symptoms I recently had my RNY surgery in Jan o8' and I'm only 6 months post -op and there are times that I dont feel good. After I had surgery I could not pass gas then about after about 2 months I started passing gas ALOT lol lol and I was concerned about that because I was used to being gassy, but everybody is different and like I was saying we have to be aware of the signs......

Comment by wolfsen on Jul 21, 2008 at 02:43pm

Thank you for this timely information. I spent Saturday doubled over in pain and trying to decide whether to go to the emergency room. I was 350 miles away from my surgeon. I called the doctor on call but he said there was nothing he could do and go to the emergency room. I waited and finally the pain left and I'm okay but I will handle it diferently next time.

Comment by jla734 on Jul 21, 2008 at 06:30pm

My heart goes out to her family. We will keep her family in our prayers. One question is this mostly a concern for certain types of WLS or for ALL including lapband?

Comment by MeltingMamaish on Jul 21, 2008 at 07:32pm

Thank you Charlie, this is extraordinarily important.

Comment by danabky on Jul 22, 2008 at 09:33am

Thanks Charlie, As you know, I suffered with this for MANY years and since NOTHING showed up on xrays or scans, the doctor dismissed me as being "FOS" (full of shit) I went to another surgeon and begged for exploratory. He took me on and sure enough. I had a "void" in the Messentary area. When you get really skinny, you lose all the fat cushioning the intestines so therefore it creates many "voids." This allows the intestines to move around like "snakes in a snakepit" making them kink and unkink. The doctor said my kink was SO bad that I almost suffered intestine death of a specific area (necrosis) and ALMOST required a colostemy bag. I was in really bad shape. Luckily he found it in time and listened to me. This happened to me at the SIXTH year out although I had symptoms early as 4-5 years post. You are NEVER out of the woods. I almost died from this. What sucks is that they will make you take EVERY test in the world and NOTHING will show up and they like to dismiss it as "gas" or in your head. Well of course I was full of 'shit'.. things were backed up for a REASON.. hello! Luckily I am a VERY persistent person. The new surgeons "tacked" down all my intestines now so they can't move around freely anymore. He also cleaned up a lot of adhesions. I have been great in the past year! This thing happens mostly in the Messentary or the Petersons space.

Comment by alwaysmandy on Jul 26, 2008 at 11:06am

My stomach hurts so bad sometimes, mostly in the middle of the night that I cry and literally curl up in a ball. I am worried about it because it never happened before I had WLS but I haven't been eating like I should lately or taking my vitamins on a regular basis. I am back on track with taking the vitamins but the stomach pain still continues. This was VERY helpful. I will contact a doctor on Monday unless it happens again this weekend in which case, I'll go to the E.R. Thank you!

Comment by miniplk on Jul 28, 2008 at 10:03am

Thank you OH for addressing this issue. At 7 years post op I suffered from an intestinal blockage and needed emergency surgery. Fortunately for me I contacted a bariatric surgeon before going to the hospital. If you go to a hospital emergency room make sure, before you go, that they have a bariatric surgeon on staff or a bariatric surgery department. Hospitals are reluctant to open us up if they know you have already had bariatric surgery. Time is of the essence if you have a blockage. Be proactive in your own health care and know before you go if the hospital can help you. My condolences to the family and friends. This is a great loss for all of us.

Comment by amy watkins on Jul 28, 2008 at 01:31pm

I am so very sorry for this families loss. I know personally about blockages. I had one that required surgery back in Feb 06. Then this past April 6, 08 I had just got back from a 14 hour drive from my uncles funeral that was a friday night, saturday night I had such excruitiating pain, like no other, it started and came on very quickly around 11pm, (which I thought was gas) around 2:30am I finally went to the ER. A few hours later I was in surgery. I had a strangulated bowel from adhesions. A vascular surgeon was called in, he was the one on call. He wanted to wait till my surgeon the one who had done my RNY (who has stopped doing them many years ago) to come in monday and operate on me. Thank god they also called in a gastrologist, he told the surgeon that they can't wait, get me to the OR. When the surgery was done, the surgeon told my husband that we were lucky, if we had waited any longer I may not be here. He even gave my husband some pictures of my dead bowel. Its not a pleasant site, all black. After the surgery I went back into the hospital 3 more times, even had another surgery and after that one my intestines shut down, that was very unpleasant. Had the NG tube for 7 days, plus had it for 3 after the emergency surgery. I spent a total of 37 days in the hospital within a month and a half. Plus the surgeon who did the emergency surgery left me with an open incision. But I also suffer from those periodic excrutiating pains of the intestines kinking, (what I was told by another weight loss surgeon) I was praying that I would no longer get them since all of this, but there back, I had 3 the other night, I was terrified. I am so scared that this will happen again. I didnt realize how close I came to death. My surgeon told me that if you ever have abdominal pain lasting more than an hour, get to the ER. I pray none of you ever have to go through this, I am still so scared, plus I still have alot of pain in one part of my abdomin, I just had another CT scan this past thursday, waiting to hear the results. Im hoping this pain in muscular. Good luck to everyone and my deepest sympathy

Comment by NHskinnygirl on Jul 28, 2008 at 04:52pm

Charlie, Thank you so much for this info. As you know I have been having abdominal pains now for months and months. I replied to a post last night, and so many well meaning people, who have had or know someone going through what sounds like my tale of whoa, pleaded with me to be more pro-active on this very problem. I have copied and pasted your post and Dr. Simpson's to bring to my surgeon, next week when he is back from vacation. he has been watching me and he is a great listener, but now I'm scared and will surely be taking all this info with me. Thank you many times over, my friend.....

Comment by baby on Jul 29, 2008 at 04:47pm

I had this happen to me in April of this year and it isn't a very nice thing to go through. I had a total of four surgeries in less than 2 weeks. So please go to your local emergency room even if it does turn out to be nothing serious.

Comment by tbellluvsfashion on Jul 30, 2008 at 09:26am

I used to have pains but I hate takign medicine. I'm paranoid about the damage it cousld cause to my liver/pancreas due to personal past health issues. Last year I found and started using Dr. Shultz intestinal herbal formula for a week a few times a year. I love the stuff. It completely "cleans you out". I could never do the "colon cleanse" or detox programs I've seen. I just don't have the fortitude. But the herbal formulas stimulate the digestive system and make me feel better...although teh first time I did it I could be far from a bathroom for the first few days. It can be pretty gross to see what comes out of the body!

Comment by GaryLGreen on Jul 31, 2008 at 07:23am

I don't doubt what the good Dr is saying here but it seems counter-intuitive to me. If you've had WLS, say a VSG, you should be eating smaller amounts and therefore have fewer problems, yes? I'd like to understand the mechanics of obstruction. A more detailed explanation as to why it occurs.