I have repeated problems with a partly blocked small bowel going back to abdominal cancer surgery in 1990. This is an extremely common health problem. About one in ten patients who have had a major abdominal operation, have repeated bowel obstructions long after the surgical incision has healed.
There was no choice. I had to have surgery. A CT scan had showed that I had about 8 plum-sized malignant lymph nodes in my upper abdomen spread out between my kidneys on both sides of the aorta. We had tried to make a diagnosis by doing a needle biopsy through my back. There was enough tissue to know the growth was malignant, but not enough to do all the tests that were needed for definitive identification. Accurate diagnosis was critical. I had to have surgery. The incision extended from my breastbone to my pubic bone. They took out my spleen and several of the nodes. It was an extensive operation. The surgery proved that I had diffuse, b cell, large cell, lymphoma. Accurate diagnosis led to chemotherapy, radiation treatments, and a cure of a disease that would have surely been fatal. I could not be more grateful for the excellent surgical care that I received.
After surgery, scar tissue forms as part of the healing process. One of the most common long-term complications of abdominal surgery is small bowel obstruction related to this scar formation which can narrow the bowel in the area. If the scar tissue blocks the bowel, it becomes obstructed if you eat something that doesn’t pass through the blockage easily. I have had episodes related to several kinds of raw fruit and vegetables. Bottom line, the food must be soft enough or small enough to pass through the blockage. Any time that does not happen my bowel gets blocked. Despite being very careful, I have had one or two episodes per year. That means that I have had between 30 and 40 major episodes and many hospitalizations. Most of the time, if I stop eating and drinking the food will finally pass and the pain goes away.
My last episode began late in the afternoon this past Tuesday. I felt that first crampy abdominal pain after eating some dried black-eyed peas that we not cooked long enough to make them softer. I hate that feeling because I know what is coming. Many times the pain gets worse and worse. It builds up slowly for 30 seconds to a high level of severity and then it eases off over a minute. That pattern is a colic type pain. With severe episodes it may reach a level of 8-10 out of ten. It is like the pain of any blocked hollow organ. So, it is like kidney stone or gallstone pain.
Bowel blockage is a terrible complication of surgery. If you are going to have abdominal surgery, be very sure that you really need it. Lisa Marie Pressley died of bowel obstruction that was caused by scar tissue formation after (bariatric) surgery to help her lose weight. She was found unresponsive at home and had a buildup of acid in the blood that was probably related to persistent vomiting and dehydration. When they got to her she was too far gone and could not be saved. Elvis Pressley’s daughter was only 54 years old. You would think that she had everything going for her. The story in the press says this is a rare complication of weight loss surgery. I don’t buy that. Ten per cent is common in my book. This is a great example of abdominal surgery that is done far too often. There are too many surgical solutions for problems that are best handled by other, totally benign, and inexpensive approaches. Surgery is not the answer for everything, but too many surgeons think that way. If you are a hammer, everything is a nail.
I am an internist who spent most of my career in preventive cardiology. At my worst, I weighed 307 pounds. I was desperate to lose weight. I hated being fat. Hated it!! But I never seriously considered weight loss surgery. Based on a very deep understanding of risks and benefits, I have always been convinced that weight loss surgery is a cure that is worse than the disease. There are more risks than benefits. Lisa Marie Pressley and many others are dead because of this unnecessary abdominal surgery. The answer to being overweight is really simple. We are heavy because we eat combinations of fat, salt, sugar, and carbs that we can’t stop eating. We can improve our health and lose weight completely safely by eating real, whole food.
The John’s Hopkins patient information site regarding bowel blockage says, “A complete blockage is an emergency and needs medical attention right away.” If the bowel becomes trapped in the scar tissue, the blood supply to the intestine may be cut off and the bowel may die. The bowel may rupture leading to severe infection and death. If you can’t drink and continue to vomit, low blood pressure, kidney damage and kidney failure can occur. In the picture, you can see a tube hanging out of my nose. That tube is attached to a suction machine that deflates the bowel upstream of the blockage to allow it to resume normal function. It also relieves the pain and vomiting. The tube is vital but it is the most uncomfortable part of the whole treatment. Once it has been in a few hours, it causes the worse sore throat you have ever had. That said, it is the path to improvement. It prevents bowel rupture, damage, and infection. Patients like this also receive fluids IV to keep their pressure up and to preserve kidney function. Lisa Marie did not get these important treatments.The acid buildup that Lisa Marie had may occur from these problems or infection. A blocked bowel is an illness and that may result in serious complications and death. Be sure you really need surgery. That is the best way to avoid the most common cause of bowel blockage.
This site is about better approaches to chronic diseases. My most recent problem was an emergency that grew out of my chronic partial bowel blockage, and I must give credit where credit is due. Our system is not good at treating chronic disease, but they are great at rescuing you in a crisis. I was miserable and sick. The clinical people who took care of me could not have been more competent, professional, or caring. I am grateful for the excellent care that I received. We will always need good hospitals and people like them. I also received a useful reminder that I can pass on as a tip for those of you who have recurrent problems like this.
I maintain a relationship with a cancer surgeon who has broad experience with patients who have had surgery and radiation treatments related to malignancy. I see Dr. Wesley Jones regularly. When I went to the hospital, I went to the emergency room which was full. I was very uncomfortable and weak. I was in the ER waiting room for two hours. Then I was in the ER being treated for a full day. Emergency rooms are loud, busy places. I had not slept the night before and I could not sleep in the ER. That said, the ER staff was great. They provided relief within minutes. Here is the tip. Dr. Jones knows about my condition, and he knows that I need admission when I have one of these episodes. He told me that I could call his office and bypass the ER for a direct admission to the surgery floor. That would have been much better for me and I could have bypassed the ER which did not have enough beds to accommodate all who needed them. I will do that next time. If you have a doctor and a problem that leads to repeated admissions, call his office to bypass the ER.
All good medical decisions require a determination of risks vs benefits. One of the most popular concepts in medicine today is “shared decision making.” Effective shared decision making requires enough patient education to really understand the risk vs benefit considerations involved. I seriously doubt that most patients get enough education to understand the long-term risk of repeated bowel obstruction. More on that in the next post.
Thank you for your candor & willingness to share your personal experience! Helpful to know ... glad you’re back to baseline. Thank you for this blog 🙏🏻
Hi, I wanted to highlight Carol's comment. My husband's experience in the emergency room led to hospitalization and abdominal surgery - surgery I will always wonder if it was necessary. I so wish we had gone to his doctor first - maybe there were other options. Take care of yourself..