Bowel Obstruction

Treatment Overview

If you have a partial or complete bowel obstruction, you will probably enter the hospital for treatment. Treatment usually starts with supportive care, such as IV (intravenous) fluids and medicines to relieve symptoms while waiting to see whether the bowel obstruction goes away on its own.

If these treatments fail or if you are diagnosed early as having a complete bowel obstruction, you may need surgery to remove the obstruction. You may also receive antibiotics through an IV to prevent infection.

If you have had partial small-bowel obstructions in the past, you may be able to watch and wait to see whether your symptoms improve. However, this is done only in certain cases under a doctor's close supervision. You will be on a liquid diet until symptoms improve.

Nasogastric suction

Fluids and gas may build up because they are not able to move past a blockage. When this occurs, a tiny tube called a nasogastric (NG) tube is placed through your nose and down into the stomach to remove fluids and gas and help relieve pain and pressure.

Nonsurgical treatments

Nonsurgical treatments may help relieve symptoms, clear a bowel obstruction, or allow time for you to gain strength before surgery. These treatments may include:

• Enemas. Using enemas of air, barium, or a product such as Gastrografin usually can clear an obstruction that occurs when one part of the intestine folds like a telescope into another part (intussusception). For more information, see the topic Intussusception.
• Stents. In some cases of obstruction, doctors may place expandable metal tubes called stents in the large or small intestine to help intestinal contents move forward. If you need surgery, a doctor may place stents to help you gain strength before surgery.¹ Stents may also provide an alternative to surgery, allowing you to avoid a colostomy and a colostomy bag.²
• Medicines, which can help relieve pain, nausea, and vomiting or help reduce the amount of stomach secretions.

Surgery

You may need surgery if nonsurgical treatment is not able to clear a partial obstruction. If the bowel is completely blocked or the blood supply to the bowel is cut off (strangulation), surgery may be the first treatment.

During surgery, a general surgeon or a colon and rectal surgeon removes the blockage or the section of blocked intestine. Surgery for bowel obstruction, including obstructions related to diverticulitis, Crohn's disease, twisting of the intestine, and some cancers, is often done laparoscopically. This means that surgery is done with a lighted scope and instruments inserted through a small incision.

You may need a colostomy temporarily or permanently after surgery. In a colostomy, the diseased part of the intestine is usually removed, and the upper part of the intestine (where the stool continues to be made) is sewn to an opening in the skin. Stool continues to be made in the upper part of the intestine and passes out of the body through the colostomy. The stool collects in a disposable bag that you place on your skin over the colostomy opening.

Special considerations

Treatment for an obstruction caused by twisting of the intestine includes several methods, such as straightening out the twisted segment. This treatment is often used if it is necessary to delay surgery.

If you have an obstruction caused by inoperable cancer, your doctor may use stents to allow the intestines to function and medicines to reduce the amount of digestive fluid.

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Author:	Monica Rhodes	Last Updated: May 16, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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