Symptoms of small bowel obstruction, which is a block in the small intestine, can look deceptively similar to that of other conditions.
Take for instance, the case of a young man of 32 who landed up in hospital with abdominal pain and vomiting. When a CT scan revealed a block in his small intestine, the doctors thought that the man’s childhood bout with tuberculosis had returned to bother his guts. But anti-tuberculosis medications did not work, and the blocked part had to be surgically removed. It was then that doctors understood the real reason for the obstruction—a neuroendocrine tumour in the intestine.
Recalling the case, Dr Harsh Shah, gastroenterologist and hepato-biliary pancreatic surgeon, Apollo Hospital, Ahmedabad, emphasises the need for a keen clinical evaluation for small bowel obstruction.
Our small intestine is an organ measuring up to six metres long and digests the food we eat, while extracting energy and nutrients from our meals. “The small intestine relies on rhythmic muscular contractions called peristalsis to continuously propel food forward in a wave-like motion,” says Dr Shah. But its width—just 2-3cm in diameter—makes the small intestine more likely to clog, blocking the flow of food.
These blocks can be of varying severity. While partial obstruction restricts the movement of solid food contents and allows fluids to move
What causes small bowel obstruction
The most common cause of small bowel obstruction is postoperative adhesion— in which scar tissue, which develops after surgery, sticks to the intestine and twisting and blocking it, explains Dr Shah.
There can be other causes as well, elaborates Dr Shah: hernias can obstruct or twist the intestine when intestinal tissue protrudes through defects in the abdominal wall; intestinal tumours, tuberculosis and Crohn’s disease can narrow the intestine; and volvulus, a condition in which the intestine twists on itself.
Small bowel obstruction is an emergency—and a life-threatening one at that—because of the complications that can arise out of it, says Dr Shah. The part of the intestine that lies before the block can swell and becomes distended or even perforate. Following it, sepsis will occur, and infection spreads inside the abdomen, he says. In some cases, the blood supply to the intestine can get blocked causing ischemia. Moreover, individuals with small bowel obstruction are unable to eat and become nutritionally deficient.
Symptoms of small bowel destruction
There are many symptoms observed in a person with small bowel obstruction.
- Pain usually occurs due to peristaltic movements against the area of blockage, as the intestine tries to empty itself. The person feels intermittent pain in the centre of the abdomen.
- Abdominal distension or visible bulging of the abdomen occurs when food and water accumulate within the intestine.
- Vomiting of food particles and liquids, usually greenish or yellowish in colour because of bile in the intestine.
- Constipation as food material cannot move towards the large intestine.
Diagnosis is crucial
The diagnosis of the condition begins with the doctor taking the person’s history and performing a thorough examination. Hernia or any prior abdominal operation is apparent at this stage.
More tests are required to identify the level and cause of the obstruction and help guide the treatment. Dr Shah suggests the following diagnostic measures:
- X-ray: An X-ray of the abdomen can indicate the presence of any small bowel obstruction.
- CT scan: A CT scan can identify the location of the obstruction—whether in the duodenum, jejunum or ileum part of the intestine. The scan can also show if it is partial or complete, and many times, the cause of the obstruction.
Even after these measures, doctors can many times be certain of the diagnosis only surgery.
Management
There are ways to manage a small bowel obstruction and all of them depend on the cause of the condition.
Non-surgical method: If the cause is adhesion following surgery, the person is not allowed to eat or drink anything. A small tube is inserted down the nose and through the food pipe to pull out the liquid contents in the stomach. This measure relieves the pain, discomfort and distension of the abdomen. Later, the person will be given intravenous fluids.
Surgery: An immediate surgery may be required for those with hernia and tumour.
Nutrition supplementation: People with the condition are intravenously given the basic minimum calories per day. They may also be given total parenteral nutrition—or medications containing proteins, fats and carbohydrates, elaborates Dr Shah.
The final word
The 32-year-old referred to at the beginning of this article has since recovered as his tumour was in the early stage. “We used to treat many people with small bowel obstruction on a daily basis. Although it is a common health condition, the key factor is timely detection and management of the obstruction,” says Dr Shah.
