Bowel Obstruction

What is it?

Bowel obstruction is a complete or partial closing or narrowing of a section of bowel.  It is a well-recognized and frequent complication of ovarian cancer. It can be caused by tumour growth on a specific site on the large or small bowel; it can be the result of surgical adhesions constricting the bowel; it can result from multi-sited cancer "seeds" causing pressure on the colon and it can be caused by a twist or loop in the bowel or possibly feces compaction.

Conventional Wisdom:

Bowel obstruction usually causes extreme pain - some patients report 9 out of 10 on the pain scale. Other symptoms include abdominal swelling, vomiting, constipation, lack of flatulence and dehydration. 

This condition is a medical emergency and requires immediate attention.  A CT scan and X-rays are used to confirm the diagnosis and hospitalization is often required.  Treatment of a bowel obstruction is based on the nature of the obstruction, the stage of the patient's disease and their overall medical condition.

Conservative management is usually the first course of action including the insertion of a nasogastric tube to decompress the gut, a saline IV for hydration and opioids for pain relief. Steroids can be used to reduce inflammation in both the bowel and peritoneal cavity as well as antispasmodics in calming the bowel. Drugs may also be given to reduce secretions into the gut causing significant improvement in nausea and vomiting.

If the bowel is only partially obstructed and cramping is not an issue, drugs to increase bowel motility may be introduced. Bowel obstruction can go from partial to complete, and back.

Bowel obstruction caused by tumour encroachment can only be resolved with effective chemotherapy or surgery.  Non-resectable bowel issues may require the partial or complete removal of parts of the small or large intestines.  These surgical procedures are known respectively as an ileostomy and colostomy.  Depending on the patient’s overall condition, these procedures may or may not be reversed.  For more information, here is an excellent link:
http://ovariancancer.about.com/od/surgery/a/stomacare.htm

Successful post-surgical management of an obstruction can require the patient to re-introduce food first on a liquid basis, then a semi-solid low fiber basis and then ultimately returning to a normal diet.

There are some cases where an obstruction is not operable or that the patient cannot withstand surgery or possibly refuses surgery.   As well, in patients with very advanced disease, they may no longer be a candidate for chemotherapeutic intervention. Sadly, in these cases, bowel obstruction and its side effects are the leading cause of failure in patients with ovarian cancer.

Self Help:

As stated above, most cases of bowel obstruction are medical emergencies so self-diagnosis and self-medication are not options. Having had a partial obstruction some years ago, I can attest to the extreme pain that only IV opioids can relieve.

Some of the causes of obstruction however are less dire and are not caused by cancer encroachment.  If your initial surgery involved the removal of sections of bowel, your remaining bowels have more room to move within the abdominal cavity.  This can lead to a very painful twist or kink – sometimes requiring surgery – but with careful intervention, can often resolve on its own. 

Some chemotherapies cause tremendous inflammation of the bowel leading to partial closure – this too can resolve with steroids and time. 

Bowel obstructions caused by adhesions or surgical adhesions are common.  In these cases, the bowel attaches itself to the abdominal wall or scar tissue attaches to the bowels.  Both issues can cause obstruction/partial obstruction and need to be surgically released.