Bowel Obstruction
Key Points
- A bowel obstruction is a blockage of the small or large intestine by something other than fecal impaction.
- The most common cancers that cause bowel obstructions are cancers of the colon, stomach, and ovary.
- Assessment includes a physical exam and imaging tests.
- Treatment is different for acute and chronic bowel obstructions.
- Acute bowel obstruction
- Chronic, malignant bowel obstruction
A bowel obstruction is a blockage of the small or large intestine by something other than fecal impaction.
Bowel obstructions (blockages) keep the stool from moving through the small or large intestines. They may be caused by a physical change or by conditions that stop the intestinal muscles from moving normally. The intestine may be partly or completely blocked. Most obstructions occur in the small intestine.
Physical changes
- The intestine may become twisted or form a loop, closing it off and trapping stool.
- Inflammation, scar tissue from surgery, and hernias can make the intestine too narrow.
- Tumors growing inside or outside the intestine can cause it to be partly or completely blocked.
If the intestine is blocked by physical causes, it may decrease blood flow to blocked parts. Blood flow needs to be corrected or the affected tissue may die.
Conditions that affect the intestinal muscle
- Paralysis (loss of ability to move).
- Blocked blood vessels going to the intestine.
- Too little potassium in the blood.
The most common cancers that cause bowel obstructions are cancers of the colon, stomach, and ovary.
Other cancers, such as lung and breast cancers and melanoma, can spread to the abdomen and cause bowel obstruction. Patients who have had surgery on the abdomen or radiation therapy to the abdomen have a higher risk of a bowel obstruction. Bowel obstructions are most common during the advanced stages of cancer.
Assessment includes a physical exam and imaging tests.
The following tests and procedures may be done to diagnose a bowel obstruction:
- Physical exam : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor will check to see if the patient has abdominal pain, vomiting, or any movement of gas or stool in the bowel.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
- Electrolyte panel: A blood test that measures the levels of electrolytes, such as sodium, potassium, and chloride.
- Urinalysis : A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
- Abdominal x-ray : An x-ray of the organs inside the abdomen. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Barium enema : A series of x-rays of the lower gastrointestinal tract. A liquid that contains barium (a silver-white metallic compound) is put into the rectum. The barium coats the lower gastrointestinal tract and x-rays are taken. This procedure is also called a lower GI series. This test may show what part of the intestine is blocked.
Treatment is different for acute and chronic bowel obstructions.
Acute bowel obstruction
Acute bowel obstructions occur suddenly, may have not occurred before, and are not long-lasting. Treatment may include the following:
- Fluid replacement therapy: A treatment to get the fluids in the body back to normal amounts. Intravenous (IV) fluids may be given and medicines may be prescribed.
- Electrolyte correction: A treatment to get the right amounts of chemicals in the blood, such as sodium, potassium, and chloride. Fluids with electrolytes may be given by infusion.
- Blood transfusion: A procedure in which a person is given an infusion of whole blood or parts of blood.
- Nasogastric or colorectal tube: A nasogastric tube is inserted through the nose and esophagus into the stomach. A colorectal tube is inserted through the rectum into the colon. This is done to decrease swelling, remove fluid and gas buildup, and relieve pressure.
- Surgery: Surgery to relieve the obstruction may be done if it causes serious symptomsthat are not relieved by other treatments.
Patients with symptoms that keep getting worse will have follow-up exams to check for signs and symptoms of shock and to make sure the obstruction isn't getting worse.
Chronic, malignant bowel obstruction
Chronic bowel obstructions keep getting worse over time. Patients who have advanced cancer may have chronic bowel obstructions that cannot be removed with surgery. The intestine may be blocked or narrowed in more than one place or the tumor may be too large to remove completely. Treatments include the following:
- Surgery: The obstruction is removed to relieve pain and improve the patient's quality of life.
- Stent: A metal tube inserted into the intestine to open the area that is blocked.
- Gastrostomy tube: A tube inserted through the wall of the abdomen directly into the stomach. The gastrostomy tube can relieve fluid and air build-up in the stomach and allow medications and liquids to be given directly into the stomach by pouring them down the tube. A drainage bag with a valve may also be attached to the gastrostomy tube. When the valve is open, the patient may be able to eat or drink by mouth and the food drains directly into the bag. This gives the patient the experience of tasting the food and keeping the mouth moist. Solid food is avoided because it may block the tubing to the drainage bag.
- Medicines: Injections or infusions of medicines for pain, nausea and vomiting, and/or to make the intestines empty. This may be prescribed for patients who cannot be helped with a stent or gastrostomy tube.
