Partial bowel obstruction

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EruditePaul
Regular Member


Date Joined Jan 2006
Total Posts : 315
   Posted 9/12/2017 8:08 AM (GMT -7)   
Hi, how can you tell if it is partial bowel obstruction rather than the regular pain from Crohn's Disease?

Yesterday I experienced abdominal pain "in waves" (which is like come and go). I can feel a lot of gas moving around and gas pain. My experience tells me I was having partial intestinal obstruction from the multiple strictures in my small intestine. I know it is not complete obstruction because I could still pass gas and have bowel movement during the day. Today I feel better as I guess the obstruction resolved itself somehow.

The thing I am worried is complete intestinal obstruction. How bad is it to walk into a ER with complete obstruction and the doctors have to do emergency surgery? Would it be much better to have elective surgery before the emergency happens?

Thanks

NiceCupOfTea
Elite Member


Date Joined Jan 2010
Total Posts : 10092
   Posted 9/12/2017 8:38 AM (GMT -7)   
For me, I had unbearable pressure at the site of the obstruction, as well as the classic wave-like pain. It never got to the point of me needing emergency surgery, as it always cleared eventually. There would be a pop, a gurgle, and an immense feeling of relief for a few seconds until the pressure started again. Rinse and repeat for a few more hours until everything was finally through. I should add that the gurgling sounds could get ridiculously loud, like a blocked-up drainpipe unclogging itself.

It's always better to have elective surgery if you can. Emergency surgery comes with a higher risk of complications and the surgeon doing it may not be an experienced Crohn's surgeon. I dunno how bad your strictures are, but it sounds like it may be time for a surgical consult.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)

straydog
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Date Joined Feb 2003
Total Posts : 15320
   Posted 9/12/2017 8:39 AM (GMT -7)   
I can tell you with a complete obstruction the pain is just unbelievable. I was always admitted, put on something for pain, throwing up & an IV. Complete bowel rest for however many days was needed. Mine did not require surgery, they resolved on their own. I always went to ER when I was sitting on the pot going from that end & throwing up in a trash can at the same time. My first resection was done because not only did I have a complete obstruction but I also had an abscess, making it an emergency surgery. I was out of the country on vacation, lol. I can laugh now but I wasn't then.

My advice is if you are having some issues call your gi. If he isn't available go to ER & let them check you out.
Susie
Moderator in Chronic Pain & Psoriasis Forums

EruditePaul
Regular Member


Date Joined Jan 2006
Total Posts : 315
   Posted 9/12/2017 9:03 AM (GMT -7)   
Thank you, NCOT and Susie, for sharing your knowledge and experience.

The last time I saw a GI specializing in Crohn's was 2009, when he ordered an abdominal CT Scan, which I did. But then he was trying to treat my Crohn's, which I declined, because he said something like 90-95% of my strictures are fibrosis with little inflammation. I am treating myself basically with herbs.

My first "partial bowel obstruction" (from self-diagnosis) was 2011. I have had approximately 5 episodes of "partial obstructions" since then, because I know the abdominal pains "in waves" and nausea feeling are signs of "partial obstruction". Those pains usually last 8-15 hours before they subside.

I am trying to hang in there (delay as much as possible) until I absolutely need a surgery, since I do not have other Crohn's complications. I am also travelling outside the U.S. next month for vacation. Today I did call an IBD center in my local area teaching hospital and waiting to hear back.

Labradorite
Veteran Member


Date Joined Sep 2009
Total Posts : 996
   Posted 9/12/2017 9:25 AM (GMT -7)   
You do not want to wait until it is an emergency. It will make everything so much more complicated and dangerous. If you are getting these warnings, you need to take it seriously. Otherwise the likelihood of it happening at the most inconvenient time is pretty high and then you have no choices (probably can't choose your doctor or the quality hospital because who knows where you will be when it happens). If your issue is mainly mechanical there is no reason you can't go back to treating it your way after the surgery. Good luck!

EruditePaul
Regular Member


Date Joined Jan 2006
Total Posts : 315
   Posted 9/12/2017 10:13 AM (GMT -7)   
But the surgery comes with costs. I will live with shortened bowels for the rest of my life, or, could end up with short bowel syndrome or constant diarrhea, which would make my life much more miserable than it is. Even worse, new strictures or bowel obstruction could happen again at the surgery sites.

If my "partial bowel obstructions" happen every month, I probably need a surgery. But mine only happens anywhere between 6 months and 1.5 years, averaging once per year for the last 6 years. I have had Crohn's Disease for 23 years and have lived with confirmed strictures for 17 years. I am thinking if I could toughen it out for another 5-10 years. With all that said, I am waiting to hear back from my local hospital to seek opinion from a Crohn's expert. Thanks

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 15320
   Posted 9/12/2017 11:15 AM (GMT -7)   
Have you ever had surgery? Are you on any maintenance meds?
Susie
Moderator in Chronic Pain & Psoriasis Forums

EruditePaul
Regular Member


Date Joined Jan 2006
Total Posts : 315
   Posted 9/12/2017 12:01 PM (GMT -7)   
I have had Crohn's Disease for 23 years (definitively diagnosed in 1994). The doctor found small bowel strictures in 2000 through Upper-GI w/ small bowel follow-through. I never had any surgery, though I think it is eventually inevitable some time in the future. I would rather have my surgery in my retirement age when life is less hectic. My current maintenance medicine and for the past 23 years has always been herbs. Unfortunately my herbal doctor passed away in 2009, so I have been on the same med.

gumby44
Veteran Member


Date Joined Nov 2007
Total Posts : 4387
   Posted 9/12/2017 12:28 PM (GMT -7)   
My suggestion is that you either have a small bowel follow through test or another CT scan since it has been so long since you have been tested. That will give you a good idea of how bad the strictures are and it might help you judge how much time you have to play with. If you end out with a full bowel obstruction and your bowel bursts, then you can become septic and die. You have to decide for yourself how much risk you are willing to take.
When I had my partial obstruction prior to surgery, I was in crazy pain and couldn't pass gas and was vomitting. they got it under some control with IV steroids and I had to remain on liquids until I could have my surgery. I had no doubt in my mind that I needed surgery and I wished that I had done it sooner.
A surgeon can tell you how much bowel needs re-secting and you need to lose a lot of bowel before having short bowel syndrome. I have not been on Crohn's meds since my surgery in 2014.
58 yr. old female, diagnosed with Crohn's in terminal ileum Sept-Oct. 2007. Dx. with c.difficile 1/12, 10/14, 11/15, 1/16. Fecal transplant on 2/24/16, and so far, no more c.diff!

5/20/14: Ileo-colic resection surgery after stricturing and partial bowel obstruction.
Not currently on any Crohn's meds and in remission, but struggling with bad IBS.

Labradorite
Veteran Member


Date Joined Sep 2009
Total Posts : 996
   Posted 9/12/2017 12:34 PM (GMT -7)   
Well, my answer is based on your initial question as to what the risk is with emergency surgery. I don't think you are going to find anyone that would disagree that waiting puts you at a much higher risk and that going into the ER with an obstruction is hugely dangerous.Of course there are always with surgery too. Its your body and health and you have to make that choice. My experience has always been that people's bodies are not always going to wait until its convenient for a problem to happen, but this has been your normal for a while so its really a decision you will have to deliberate with your new doctor. Just know all the risks of waiting and choose the option that has the possible outcomes you'd prefer to deal with.
Find out how much of the bowel at this point is involved and would have to be removed as it most likely changed since your last imaging.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 15320
   Posted 9/12/2017 12:58 PM (GMT -7)   
Do not rely on "not having a bowel movement" to indicate a complete blockage. I hope this nurse you called can help you. I think by doing nothing you are putting yourself at risk if you are having problems. The goal is to avoid surgery if possible, but a person has to be realistic about treatment at the same time.

Who knows you may never need surgery, but if you do, I sure hope it is not on an emergency basis. Partial obstructions can be dealt with in the hospital without surgery.
Susie
Moderator in Chronic Pain & Psoriasis Forums

NiceCupOfTea
Elite Member


Date Joined Jan 2010
Total Posts : 10092
   Posted 9/12/2017 1:49 PM (GMT -7)   
17 years is a long time to have strictures; I'm surprised you haven't run into serious issues sooner. Deffo get tests and have a consult with a colorectal surgeon. If your strictures haven't got any worse in all that time, then maybe you can carry on as you are without surgery. But honestly, I think you'll probably need surgery. If they are multiple, short strictures, ask the surgeon if you are a candidate for strictureplasty - that avoids having any bowel cut out, but the results don't necessarily last.

@gumby - That sounds like a total obstruction to me, not a partial one.
Dx Crohn's in June 2000. (Yay skull)
Tried: 5-ASAs, azathioprine, 6MP, Remicade, methotrexate, Humira, diets.
1st surgery 20/2/13 - subtotal colectomy with end ileostomy.
2nd surgery 10/7/15 - ileorectal anastomosis. Stoma reversed and ileum connected to the rectum.
Current status: Chronic flare. Do I have any other kind?
Current meds: 50mg 6MP; Entyvio (started 3/11/16)
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