Bowel Obstruction Surgery: Everything You Need to Know

Bowel obstruction surgery is done if you have partial or complete blockage of the bowels, which can occur in your small intestine or large intestine

A surgeon uses either minimally invasive laparoscopic surgery or complex open surgery for more serious bowel obstructions. In some cases, damaged parts of the bowel need to be taken out (surgical resection). Other techniques like stenting, colostomy, cutting adhesions, or fixing the blood supply to the tissue (revascularization) may be necessary to save parts of the bowel.

This article will cover why bowel obstruction surgery is needed and what to expect if you have surgery for a bowel obstruction.

An x-ray showing a small bowel obstruction
 

When Is Bowel Obstruction Surgery Needed?

A bowel obstruction can happen suddenly (acute) or may come on slowly over time (chronic).

Sometimes, providers try to use other treatments first before doing bowel obstruction surgery. In emergency situations, bowel obstruction surgery is needed right away. 

A 2018 study looked at what happened to almost 10,000 people who had emergency surgery for small bowel obstructions. The overall death rate was 7.2% within 30 days, but having surgery that was delayed by more than 72 hours was associated with a 39% higher chance of dying within 30 days.

Bowel obstruction can quickly become life-threatening. Surgery is done to save your small or large intestine and to prevent the dangerous complications of an untreated bowel obstruction like:

  • Chronic abdominal pain, nausea, and vomiting
  • Prevention of food and stool from passing through the bowels
  • Permanent intestinal damage
  • Problems with blood flow in the bowels
  • Necrosis (tissue death) of intestinal tissue
  • Bleeding or leaking from the intestines
  • Fluid and electrolyte disturbances

These complications can lead to serious health problems like hypotension, multi-organ failure, or even death. A complete intestinal obstruction is a serious medical emergency that needs immediate surgery.

Indications and Assessment

If you have symptoms of bowel obstruction—like severe pain, intermittent cramping, or changes in bowel movements—your healthcare provider will do a physical examination to check your abdomen and your bowel sounds.

Diagnostic testing can usually show how many obstructions there are, where they are located, and what’s causing them. 

You will probably need an abdominal X-ray, computed tomography (CT) scan, or ultrasound. You may need an intravenous (IV, in a vein) injection of contrast material for these tests to help the pictures show up clearly.

barium enema is a more invasive imaging test in which a small amount of contrast material is put into the rectum to help show the intestinal structures.

You will also have blood drawn so your complete blood count and electrolyte levels can be checked. You will do a urinalysis, which shows your electrolyte levels and can also show signs of an infection.

sigmoidoscopy or a colonoscopy might also be part of your workup for bowel obstructions. These procedures use a camera that goes up into your colon to look at the inside of your bowel.

Bowel conditions that may require surgery include:

  • Mechanical obstruction: A blockage inside the passage (lumen) of the small or large intestine can be caused by cancer, inflammatory bowel disease IBD), swelling, or infection.
  • Constriction: Something outside the intestines can create pressure on the inside. For example, from a cancerous tumor or scar tissue that often forms after abdominal surgery or radiation therapy.
  • Rotation: Twisting of the intestine can happen if you have scar tissue, muscle disease, or nerve disease.
  • Hernia: A weakening of the abdominal muscle wall can form a pocket, which may squeeze the intestine.
  • Myopathy or neuropathy: Congenital or acquired conditions that prevent the intestinal muscles from moving can make the intestines collapse, which compresses the lumen. It can also lead to distorted movements of the bowel.
  • Ischemic colitisA loss of blood flow to a part of the intestines can happen if you have certain conditions, like a blood clotting disorder.

Surgery as a Second-Line Treatment

If bowel obstruction is caused by swelling (edema), inflammation, or hard feces, your provider may try conservative treatments before bowel obstruction surgery.

These options are used when a person is medically stable and the bowel is not in immediate danger or necrosis, or when the risk of surgery is very high (for example, because you have an underlying disease, like heart disease).

Conservative therapies for a bowel obstruction include:

  • IV fluids and medication: Electrolytes and fluid are given through an IV to treat or prevent dehydration and fix an electrolyte imbalance. Medications are given to soften stool, induce intestinal motility (peristalsis), and relieve nausea and vomiting.
  • Enema: A nozzle is inserted into the anus and liquid is injected into the rectum. You are asked to hold the liquid for a set time, then sit on the toilet to evacuate your bowels. 
  • Nasogastric tube: A long, thin tube is passed through the nose into the stomach and down to the intestine. This tube can be used to suction out waste material that’s above the blockage, relieve gas build-up, and decrease swelling.
  • Colorectal tube: A long, thin tube is inserted through the rectum into the colon and used to remove fluid, gas, and inflammation.

If these treatments do not relieve the blockage, surgery might be the next step.

According to a study published in the journal Medicine, recurrent bowel obstruction—especially after abdominal surgery (such as for cancer)—will usually continue to be a problem if it’s repeatedly treated with conservative therapies. There’s also a higher chance of resolution with surgery instead of conservative treatment.

What’s Involved in Bowel Obstruction Surgery?

Bowel obstruction surgery usually consists of two parts: 

  • Removal of any material that's blocking the intestines (such as feces, cancer, a polyp, an infectious abscess, or a twist in the bowel)
  • Repair of parts of the intestine that the obstruction may have damaged

This surgery is done in a hospital under general anesthesia. It can be emergency surgery or, in some cases, planned in advance. 

You might have a laparoscopic (minimally invasive) procedure, which is done with a few small incisions. Or, you might need an open laparotomy with a large incision. The extent of the blockage is not necessarily the main factor when it comes to deciding whether you will need a major procedure or a minimally invasive one.

There are several techniques used in bowel obstruction surgery, including:

  • Removal of an obstructive lesion
  • Blood vessel repair
  • Resection of severely damaged areas of the intestines
  • Creation of an ostomy (a hole in your abdomen through which waste can exit the body)

When deciding on an approach, your surgeon will consider the number and location of the blockages, the cause of the bowel obstruction, your risk of infection, and any previous surgeries you’ve had.

Who Shouldn’t Have the Surgery?

Bowel obstruction surgery is a major procedure, but since it can be a life-or-death situation, the pros often outweigh the cons for many people. 

However, the cause of the obstruction is considered alongside a patient’s age and overall health. In some cases, surgery may not be the best option for the patient when all these factors are taken into account. 

Older patients with bowel obstructions are a key example. 

A review of research published in the World Journal of Emergency Surgery notes that "frail" patients with small bowel obstruction who are over age 70 have a greater risk of poor outcomes after bowel obstruction surgery than peers who are in better overall health. In fact, the impact on quality of life and mortality may outweigh the benefits of the surgery, depending on the cause of the obstruction.

Chronic bowel obstructions that cannot be fixed with surgery may happen in some patients, particularly people with advanced cancer. This can be caused by narrowed structures and/or large tumor size.

Potential Risks

In addition to the standard risks of surgery and anesthesia, possible complications of bowel obstruction surgery include:

  • Edema (accumulation of fluid and inflammation)
  • Infection
  • New, persistent, or worsened bowel obstruction after surgery
  • Damage to nearby organs in the body
  • Formation of scar tissue (adhesions) in your abdominal cavity that increases the risk of another intestinal blockage in the future
  • Incomplete healing of the regions of your intestines that are sewn together (anastomotic leak), which may cause urgent life-threatening problems
  • Post-surgical problems with your ostomy (colostomy, ileostomy, or J-pouch)
  • Temporary paralysis (freezing up) of the bowel, known as paralytic ileus

How to Prepare

An acute bowel obstruction can be extremely painful and often leads to a visit to the emergency room. For acute and chronic bowel obstruction, surgery may happen within a few hours to up to three days after the diagnosis.

Location

Bowel obstruction surgery is performed in the hospital in an operating room.

What to Wear

For the surgery and remaining hospital stay, you will wear a hospital gown. It is recommended that you arrive for your surgery wearing loose-fitting clothes that are easy to change in and out of.

Do not wear any jewelry and leave anything of value at home.

Food and Drink

Surgery for bowel obstruction is typically done under general anesthesia. You should not eat or drink for about eight hours prior to general anesthesia. However, when the procedure is done as an emergency, you may not have had time to fast. 

Medications

Tell your surgical team about all the prescription and over-the-counter medications and supplements you are currently taking. Certain medications can cause problems during surgery. For example, blood thinners and supplements that may thin your blood can cause excessive bleeding during and after surgery.

What to Bring

In addition to personal care and comfort items like toiletries and a change of clothes, bring your health insurance documents and personal identification with you on the day of your surgery.

If you take any medications, bring a list of them with you. Some of these medications may need to be stopped or changed. Your healthcare provider might also prescribe new medications for you after your procedure.

When you’re ready to go home (discharged) after surgery, you won’t be allowed to drive. Make sure you arrange for a ride home before the day of your surgery.

What to Expect on the Day of Surgery 

Before the surgery, your healthcare provider will explain the procedure in detail, including a step-by-step description of the procedure, the risks of the surgery, and what a typical recovery looks like. You will be asked to sign consent forms as well. 

How long bowel obstruction surgery takes depends on how severe the obstruction is and what other work needs to be done. For example, a bowel resection can take one to four hours.

Before the Surgery

Before surgery, you will change into a hospital gown and have an IV put into your vein so you can get the fluids and medications that you need. You will be taken to the operating room and moved to the operating table.

Your anesthesia provider will give you an IV sedative to help you relax. Then an endotracheal tube (breathing tube) will be inserted through your mouth and into your windpipe before it's connected to the ventilator to help you breathe during the surgery. The anesthesia medication makes you unable to move or feel pain during the procedure.

foley catheter is placed in the urethra to collect urine. You may also have a nasogastric tube placed into your nose and down to your mouth to collect blood and fluid from your stomach during surgery.

The surgical staff will swab your abdomen with a solution that kills germs and put a drape around the surgical area to prevent infections.

When you are fully under anesthesia, your surgery will begin.

During the Surgery

Your surgeon will figure out the best technique to use to clear the obstruction based on its location, size, and cause. Much of this planning will occur before your surgery, but some decisions have to be made during surgery. 

For example, they may find that you have cancer invasion into the intestine that will require a more extensive resection than was planned. Or your surgeon may see adhesions in multiple locations that need to be removed during your surgery.

Laparoscopic Bowel Obstruction Surgery Steps

Minimally invasive surgery uses thin scopes, which are tubes inserted through one or more tiny incisions in the abdomen. Alternatively, endoscopy, in which a tube is placed into the mouth, or sigmoidoscopy, in which a tube is placed into the rectum, can also be used to treat the blockage.

With minimally invasive laparoscopic procedures, the surgeon uses a computer screen to view the intestines and the obstruction. Sometimes, the trapped stool is broken apart and suctioned out through the tube. Or a polyp or tumor might be removed, followed by repair of the adherent intestinal tissue. A stent might be placed if the obstructed area is prone to recurrent obstruction, such as due to nerve or muscle impairment.

Any abdominal incisions will be closed with stitches or steri-tape. Your wound will be covered with sterile gauze and tape to protect it.

Open Bowel Obstruction Surgery Steps

Open surgery is necessary when the intestines are strangulated from a rotation or compression, or if the obstruction is caused by loss of intestinal blood flow. With an open laparotomy, the surgeon might make up to a 6- to 8-inch abdominal incision to get to the bowel obstruction and do decompression and repair.

Depending on the cause of the obstruction and how much intestinal damage there is, your surgeon may also need to do one or more of the following procedures: 

  • Surgical resection: A portion of the colon is removed if there is an invasive mass, such as cancer.
  • Removal of adhesions: If you have scar tissue squeezing your intestines from the outside, this may require careful incisions to cut them away, although scar tissue can come back. 
  • Stent placement: A stent, which is a tube that holds the intestine open, can placed in the intestine to allow for the passage of food and stool and help prevent another blockage. This can be necessary when a bowel obstruction is recurrent or when the intestines are severely damaged.
  • Colostomy/ileostomy: If your intestines are damaged or inflamed, a permanent or temporary ileostomy or colostomy, which is an artificial opening in your abdomen for waste or stool evacuation, may be needed. Sometimes, these are temporarily placed to prevent a severe gastrointestinal infection from spreading throughout the body. However, it is possible that the ends of the intestines cannot be reconnected, in which case these openings might be needed for the long term.
  • Revascularization: Ischemic colitis may require the repair of the blocked blood vessels that supply blood to the intestines (revascularization).

When the surgery is completed, the surgeon will use dissolvable sutures to close internal incisions. The outside (external) incision is sealed with stitches or surgical staples and the wound is covered with sterile gauze and tape.

After the Surgery

Once the surgery is done, anesthesia is stopped or reversed and you will slowly start to wake up. As your anesthesia wears off, your breathing tube will be taken out and you will be moved to the recovery room for monitoring.

You will be groggy at first but slowly become more alert. Once you are awake and your blood pressure, pulse, and breathing are stable, you will be taken to a hospital room to begin recovering.

Your IV will stay in place so you can continue to get medications and fluids for the rest of your hospital stay. Likewise, your urinary catheter will stay in place until you are physically able to get out of bed and walk to the bathroom on your own. 

Some people recovering from a laparoscopic procedure can get out of bed several hours after surgery, but it may take a few days before you feel steady on your feet.

Recovery

After surgery for a bowel obstruction, your stomach and intestines need time to get back to normal function and heal. The amount of time that will take depends on the procedure you had and any other health conditions you have, such as colon cancer.

Most patients stay in the hospital for between five and seven days after bowel obstruction surgery. It can take several weeks or months to fully return to normal activities.

Your medical team with work with you to manage post-surgical pain. Opioids, which are typically used to relieve pain, can lead to post-operative constipation so your surgeon may want to avoid prescribing them for you after bowel obstruction surgery.

Nonsteroidal anti-inflammatory medications (NSAIDs) can also be risky as they can cause bleeding in the stomach or intestines.

Before Discharge

Your healthcare providers will confirm that you can pass gas before you will be allowed to drink small amounts of fluid. When your body shows signs that it is ready, your diet will start with clear fluids and slowly advance to soft foods.

You'll be given instructions on wound care, medications, signs of infection, complications to look out for, and when you need to make a follow-up appointment. Make sure you understand all of your healthcare provider's instructions and call the office with any questions or concerns.

If a colostomy or ileostomy was needed, you will have a tube with a bag attached to collect stool. Your nurse will show you how to care for it before you go home.

Healing

Some patients may need a visiting nurse to check on the wound as it heals, oversee colostomy/ileostomy care, or give them tube feedings.

Once you are home and on the road to recovery after bowel obstruction surgery, here are some things to keep in mind:

  • Wound care: Follow your healthcare provider's instructions on caring for your wound and any precautions you need to take when bathing. Watch for signs of infections, such as redness, swelling, bleeding, or drainage from the incision site.
  • Activity: Moving around throughout the day will help to prevent blood clots and promote healing. But you need to avoid strenuous exercise or lifting heavy objects until your wound has healed completely (about four to six weeks). Do not exercise until your provider tells you it’s OK. 
  • Diet: Your provider may prescribe a soft GI diet for up to six weeks after surgery, which is a diet low in bulk fiber. You’ll need to avoid fresh fruit (other than bananas), nuts, meat with casings (such as sausage), raw vegetables, corn, peas, legumes, mushrooms, stewed tomatoes, popcorn, potato skins, stir-fry vegetables, sauerkraut, whole spices (such as peppercorn), seeds, and high-fiber cereals (like bran). It may take several weeks before you can tolerate regular food. Your nasogastric tube will stay in place until you are ready for your usual diet. Some patients need to continue to receive nutrition through a feeding tube after returning home.
  • Medications: Maintaining regular bowel movements is important for preventing future blockages. Your provider may put you on a bowel regimen of stool softeners, such as Miralax (polyethylene glycol 3350), along with medications such as Senna to promote bowel movements. Follow your healthcare provider's instructions for taking these medications.

Prognosis

The prognosis for bowel obstruction surgery can vary, and outcomes are different for patients based on factors like age and overall health. 

That said, the risk of dying after bowel obstruction surgery can be very high. Studies have shown that when people need surgery in an emergency, they are at a high risk of having complications both during surgery and right after.

Research suggests that anywhere from 5%-30% of people who get small bowel obstructions die within a month, and 10%-20% of people who have large bowel obstructions die within the same time.

One study that looked at around 300 people having emergency surgery for a small bowel obstruction found that the rate of dying within 30 days of surgery was about 13%, and the rate of dying after 90 days was about 17%. Even when people did not die after bowel obstruction surgery, the study found that about 28% of them had major complications within a month.

One study found that women over the age of 65 were the most likely to die after bowel obstruction surgery.

When to Call Your Healthcare Provider

Call your healthcare provider if you have any of these symptoms after bowel obstruction surgery:

  • Vomiting or nausea
  • Diarrhea that continues for 24 hours
  • Rectal bleeding or tar-colored stool
  • Pain that persists or worsens and is not controlled with medication
  • Bloated, swollen, or tender belly
  • Inability to pass gas or stools
  • Signs of infection, such as fever or chills
  • Redness, swelling, or bleeding or draining from the incision site
  • Stitches or staples that come out on their own

Coping and Long-Term Care

You’ll need to work closely with your gastroenterologist to get back to regular bowel function and prevent another obstruction, both right after surgery and in the long term. 

Treatment after bowel obstruction surgery is not one-size-fits-all and it may take several tries to find the right medication or combination of medications for you. If one medication does not help or causes side effects, tell your healthcare provider. They might be able to adjust your dose or switch you to something else. 

You may be asked to keep a diary of bowel movements, including frequency, volume, and consistency based on the Bristol Stool Chart, which rates bowel movements on a scale of 1 (hard) to 7 (runny).

Possible Future Surgeries

If you have had a colostomy or an ileostomy, you might need to have another procedure to get your bowels re-attached once the inflammation goes down. Your provider will discuss this plan at your follow-up appointment.

Generally, bowel obstruction surgery provides long-lasting relief. However, there is a chance of having another bowel obstruction, especially if the reason you had the first one is a chronic or incurable condition. In these cases, you may need to have surgery again in the future.

Lifestyle Adjustments

Once you recover from a bowel obstruction and surgery to fix it, you’ll need to maintain bowel health and regularity. You may want to work with a dietitian to come up with an eating plan that contains the right amount of fiber for your needs.

It is also important to drink at least eight 8-ounce glasses of water daily to make sure you are hydrated and to help prevent a recurrence of constipation. Regular exercise can also help to keep stool moving through the intestinal tract. Have your healthcare provider-approved plan for treating constipation in place in case it does happen.

If you have an ostomy, know that you can lead an active lifestyle but will have to make some adjustments. This may mean timing your meals so you won't have to empty your pouch at an inconvenient time, keeping the pouch clean, and wearing clothes that are comfortable and convenient.

Summary

Bowel obstruction surgery is done when there is a blockage in your intestines. A surgeon can go in with a small incision (laparoscopic) or a big incision (open) to clear the blockage and see if parts of your bowel have been damaged. If the damage cannot be repaired, part of the bowel might have to be taken out. Other procedures like stenting, colostomy, cutting adhesions, or fixing the blood supply to the tissue can also be part of bowel obstruction surgery.

Bowel obstruction surgery can take some time to recover from. Maintaining bowel regularity and treating constipation quickly can help you avoid another surgery.

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By Julie Wilkinson, BSN, RN
Julie Wilkinson is a registered nurse and book author who has worked in both palliative care and critical care.