Bowel Obstruction: Small Bowel

What is a small bowel obstruction?

A small bowel obstruction is a blockage of the small intestine. The small intestine begins at the end of the stomach and ends where the colon (large intestine) starts. The blockage makes it hard for the contents of the bowel to pass through and out of the body.

How does it occur?

The small bowel may become blocked when it is trapped inside the abdominal cavity in scar tissue or outside the abdominal cavity in a hernia.

• Adhesions are the major cause of small bowel obstruction. Adhesions are bands of scar tissue that form after surgery. The adhesions grow between sections of the bowel and may trap loops of bowel.
• A hernia is a weakness in the wall of the abdomen through which the bowel may protrude and become trapped.

Other causes include:

• inflammatory bowel disease, such as Crohn's disease
• inflammation from other abdominal problems, such as diverticulitis
• intussusception, which is the intestine folding into itself, cutting off normal flow of partly digested food and eventually cutting off blood flow to the tissues
• a twisted or knotted bowel
• a narrowing of the bowel that has been present since birth
• cancer.

Sometimes the blockage cuts off blood flow to part of the bowel. When this happens, the bowel is said to be strangulated. The lack of blood flow can cause death of some of the tissue (gangrene) and can be life threatening.

What are the symptoms?

The symptoms of a blocked small bowel may include:

• a cramping pain in the abdomen that comes and goes
• a tender and swollen abdomen
• vomiting
• diarrhea or trouble passing gas or stools
• severe, constant pain if the blood supply has been cut off.

How is it diagnosed?

Your healthcare provider will review your symptoms, take your medical history, and examine you. Your provider will ask about previous surgeries, bowel blockages, and hernias. You may have the following tests:

• blood tests
• X-rays of the chest and abdomen
• X-rays of the bowel after a barium enema.

How is it treated?

The blockage will need to be treated at the hospital. A tube may be passed through your nose and into your stomach to decrease the pressure of bowel gas. Usually surgery is done as soon as possible unless the symptoms go away and your bowels quickly start working again.

If you need an operation, the surgeon will make a cut through the wall of your abdomen and relieve the blockage. The surgeon may remove a portion of bowel. Sometimes this can be done with a laparoscope. (A laparoscope is a thin tube with a light and tiny camera that can be put into your abdomen through a small cut.)

You will need IV fluids to replace fluids from vomiting and diarrhea. You may need to take antibiotics for infection.

How long will the effects last?

How long the effects last depends on what caused the blockage and whether the bowel has been strangulated. Even if you have an operation for treatment, an obstruction could occur again in the future.

How can I take care of myself?

• Follow your healthcare provider's instructions.
• If you have surgery, get up and walk as soon after surgery as is reasonable. Walking helps get the bowel to start moving again.

How can I help prevent small bowel obstruction?

You may have little control over preventing an obstruction. Scar tissue may form in the abdomen from surgery, injury (such as penetrating wounds or auto accidents), and infections (such as appendicitis). Being active after any surgery or bowel injury may help prevent adhesions. If you have a hernia in the abdominal wall or groin, ask your healthcare provider if repair of the hernia would help prevent a bowel obstruction.