Bowel Obstruction: Common yet Dangerous

[MsJacquiiC]

Once bariatric post-ops reach goal, it's easy to become complacent. Even the most compliant person can look in the mirror and seeing a "normal" body staring back, forget how it took major surgery to get to that point.

A number of things can cause a bowel obstruction... The best way to diagnose a bowel obstruction is with a CT scan or upper GI with a small bowel series.

However, the digestive track of a gastric-bypass patient will never be normal, and post-ops need to be aware of complications that can arise. The most common complication for Roux-En-Y patients is a bowel obstruction.

Causes of Bowel Obstruction

A number of things can cause a bowel obstruction: a too-large piece of food stuck in the intestines, severe constipation, scar tissue, or tangled intestines.

The first two causes are the usual culprits behind bowel obstructions occurring within the first year after bariatric surgery. The latter two typically arise two to four years after surgery.

Though all bypass patients are at risk of a bowel obstruction, a 2006 study out of Hackensack University in New Jersey found that those who had laparoscopic Roux-En-Y have the highest incidence. The study, published in "The Journal of the American College of Surgeons" in September of that year, found 10 percent of lap Roux-En-Y patients suffer from bowel obstructions.

The researchers behind the study believe lap RNY leaves behind minimal adhesions --- scar tissue -- allowing the intestines to float and move around freely. Open RNY tends to produce "thin, diffused upper abdominal adhesions that may then stabilize the bowel and prevent internal hernias and bowel obstruction," according to the study.

Bowel Obstruction Symptoms

Regardless of cause, bowel obstructions are serious health threats for bariatric patients and require immediate medical attention. Symptoms include:

• Abdominal pain or cramping
• Abdominal distension
• Gassiness but inability to pass it other than by belching
• Pain when eating or drinking
• Vomiting
• Diarrhea
• Constipation

The symptoms of a bowel obstruction are similar to that of appendicitis and gall bladder attacks. The best way to diagnose a bowel obstruction is with a CT scan or upper GI with a small bowel series.

However, doctors unfamiliar with bariatric surgery may disregard a bowel obstruction as a naturally occurring kink in the intestines. Because surgery is almost always required, it's best that anyone suspecting a bowel obstruction seeks treatment from an experienced bariatric surgeon.

Tonya Luiz is a journalist and a surgical weight loss consultant and educator who had emergency surgery for a bowel obstruction January 2007. Her blog, Inside Out, is at Inside Out. To read about her bowel obstruction experience, click on the March 3 posting, "No immunity from complications." To reach her, e-mail tonya@bariatricnetworkassociates.com.

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Laparoscopy Laparoscopic surgery, also called minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgical procedures. Laparoscopic surgery belongs to the broader field of endoscopy. The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system.

Gall Bladder A small pear-shaped sac that stores and concentrates bile. It is connected to the liver (which produces the bile) by the hepatic duct. Sometimes the substances contained in bile crystallize in the gall bladder, forming gallstones. These small, hard concretions are more common in persons over 40, especially in women and the obese. They can cause inflammation of the gall bladder, a disorder that produces symptoms similar to those of indigestion, especially after a fatty meal is consumed. Gallstones may pass out of the body spontaneously; however, serious blockage is treated by removing the gall bladder surgically.