Introduction
Also referred to as 'intestinal obstruction', a bowel obstruction occurs when there is some form of blockage in the small intestine (referred to as a small bowel obstruction) or large intestine (referred to as a large bowel obstruction). With bowel obstruction, the normal process of the movement of food and liquid from the stomach through the intestines is affected.
Bowel obstruction can be a very dangerous condition, as food, gastric acid, gas and liquid can build up behind the blockage and ultimately cause a rupture where the contents leak into the abdominal cavity. A bowel obstruction is potentially life threatening and requires immediate medical attention.
Bowel obstruction can be either partial, or complete (where nothing is able to pass the blockage), and is classified as either 'simple' or 'complicated' – the latter describing where the blockage has already caused other issues.
Symptoms
The following symptoms may indicate bowel obstruction:
- Abdominal pain / cramping (which often comes in waves, and can be severe).
- Abdominal swelling / bloating.
- Nausea / vomiting.
- Unable to have a bowel movement or pass wind.
- Constipation / diarrhoea (diarrhoea is more common when there is a partial blockage).
- Appetite loss.
Causes
A bowel obstruction is due to a mechanical obstruction, where there is some physical barrier present in the intestines. Common causes include:
- Adhesions in the intestines – these are sections of fibrous tissue that sometimes form after abdominal surgery.
- Hernia.
- Cancer or tumours in the intestines.
- Inflammation (e.g. Crohn's disease or diverticulitis, which can thicken the intestinal walls).
- Intussusception – this occurs primarily in children under 3 years of age (although it can occur in adults) and is where one section of the intestine folds back into another section.
- Foreign object present in GI tract (generally when swallowed).
- Gallstones (rare).
- Infection.
- Radiation therapy.
- Severe constipation / impacted faeces.
- Twisted bowel ('volvulus').
Tests & Diagnosis
The first step in diagnosing bowel obstruction is a physical examination and review of medical history. X-ray tests are often required, with the most sensitive test being a CT scan of the abdomen.
Treatment
Although there are a range of non-surgical treatments for some types, a bowel obstruction often requires immediate surgery. This depends on the cause, whether the obstruction is in the small intestine or large intestine, the duration of the obstruction, whether there is a strangulated hernia present, and how unwell the patient is.
