Bowel ostruction

A stand still of bowel passage is called bowel obstruction. There are two types: paralytic and mechanical obstruction.


Paralytic bowel obstruction is a disorder of the motility of the bowel. The causes are drugs (opiates, morphines, psycho pharmaceuticals, etc.), changes in electrolytes or trauma (e.g. following an abdominal operation, or bleeding into the abdominal cavity). Treatment is non operative and concentrates on removing and correcting the factors responsible for paralysis and stimulation of the bowel motility (e.g. by drugs).


Mechanical bowel obstruction always has a mechanical cause. In most cases adhesions following an operation are responsible for the obstruction of the bowel. Other causes are twisting of a bowel loop, incarceration in a hernial sack (see chapter on hernias), tumors or objects swallowed by the patient.


In bowel obstruction the upper section of the bowel distends and the patient experiences cramps and pain and eventually starts to vomit fecal material. If the stop occurs higher up in the digestive system, vomiting starts early. The upper digestive tract produces about 3 liters of digestive juices which have to be reabsorbed in the lower portion of the gut. A complete stop of passage can lead to heavy losses of fluid and electrolytes. If this process carries on for a longer period the bowel distends more and more and finally loses its protective function to prevent bacteria from escaping through the bowel wall into the abdominal cavity. The result is bacterial peritonitis, a potentially lethal complication.


Treatment of mechanical bowel obstruction is almost always surgical. Sometimes the problem can be managed laparoscopically. In most cases the bowel is extremely distended which makes laparoscopy very difficult and dangerous. Therefore most patients need an open operation for mechanical bowel obstruction.