Bowel Obstruction

Also called:

• intestinal obstruction
• malignant bowel obstruction

A bowel obstruction occurs when the colon or the small bowel (intestine) becomes blocked or obstructed and contents are not able to pass through the bowel. The bowel may become partially or completely obstructed. Bowel obstruction is not as common as other bowel problems such as diarrhea or constipation.

Causes

Causes of bowel obstruction include:

• some cancers
  • common cancers that can cause bowel obstructions include stomach, colorectal, small bowel and ovarian cancer
  • cancers that spread to the abdomen and press against the colon and small intestine as they grow (such as ovarian cancer)
  • advanced cancers increase the risk of a bowel obstruction
• cancer treatment
  • people who have had abdominal or bowel surgery or radiation therapy are at greater risk
• constipation, causing a large amount of dry, hard stool to develop in the bowel (fecal impaction)
• scar tissue or a weakness or "rupture" of a section of intestine (frequently the small intestine) that pushes through an opening in an abdominal muscle (hernia)

Symptoms

The symptoms of a bowel obstruction depend upon its location and may include:

• abdominal pain
• swelling of the abdomen (abdominal distention)
• nausea
• vomiting
• constipation
• diarrhea – loose stool may seep past solid fecal matter that is blocked from moving
• inability to pass gas (flatus)
• bad-smelling (fecal) breath
• fever

A bowel obstruction can lead to a hole (perforation) in the bowel, causing bowel contents to leak into the abdominal (peritoneal) cavity and leading to infection (peritonitis). People with advanced stage cancer may develop chronic, progressive bowel obstruction.

Diagnosis

To help find out the possible cause of bowel obstruction, the doctor may:

• take a history of symptoms, bowel patterns, medications and treatments
• do a physical examination including feeling the abdomen, listening for bowel sounds and doing a digital rectal examination to check for fecal impaction
• order imaging or endoscopy tests
  • abdominal x-ray
  • barium enema
  • endoscopy, such as colonoscopy

Treatment

Treatment may be a combination of methods:

• Resting the bowel (no liquids or food by mouth) for a few days.
• Giving intravenous fluids to maintain fluid in the body (hydration). Giving electrolytes to correct imbalances.
• Inserting a nasogastric tube through the nose and stomach or an intestinal tube through the rectum and colon. This will help to relieve pressure, remove fluid and gas build-up.
• Inserting an expandable metal stent (a mesh-like tube) into the bowel, to help open up the blockage and keep the bowel open.
• Inserting a gastrostomy tube into the stomach by a simple operation to relieve fluid and air build-up in the stomach and deliver medications and liquids directly to the stomach. A drainage bag with a valve may be attached to the gastrostomy tube. When the valve is open, food drains into the bag, not the intestine. This allows soft food and liquid to be taken by mouth without causing any discomfort.
• Performing surgery to relieve the obstruction and remove the section of intestine that may have started to die (necrosis). A colostomy or ileostomy may be necessary.
• Giving medications to help relieve pain and nausea, if necessary.