How long can a person live with a blocked intestine?
Mzee Ringo* was a 70-year-old man from Kimara suburb who was referred to our facility in Dar es Salaam.
For two weeks, Mzee Ringo bore pains in his abdomen including abdominal distension; a condition that occurs when substances accumulate in the abdomen causing its expansion.
Mzee Ringo, a petty trader and married with two children was in a distressed state when he was brought in.
A spectrum of tests were immediately done and it came to light that he was suffering from what we commonly call an instestinal/bowel obstruction. This called for an emergency surgery.
In a nutshell
An intestinal obstruction occurs when your small or large intestine is blocked. The blockage can be partial or total, and it prevents passage of fluids and digested food. If intestinal obstruction happens, food, fluids, gastric acids, and gas build up behind the site of the blockage. Just what was happening with Mzee Ringo.
And a section of the bowel gets blocked such that stool cannot pass through.
The bad news is that this condition, though sounds treatable, it contributes significantly to high morbidity and mortality.
One of the studies done in Tanzania revealed that obstructed hernia is the most common cause of bowel obstruction whilst in the western world post operative adhesions [bands of fibrous tissue that can form between abdominal tissues and organs] is the most common cause.
This old man had bowel obstruction that was considered to be secondary to adhesions.
However, in children the most common cause is the so called hirschsprung disease; a birth defect as a result of missing nerve cells in the muscles of the baby’s colon.
Tuberculosis can also cause bowel obstruction. In a study done in Tanzania by Dr Challya P and others in Northwestern Tanzania, where 118 cases of tuberculosis bowel obstruction were reviewed, the researchers eloquently raised issues explicated above.
The researchers also found that tuberculosis bowel obstruction is more prevalent in HIV patients.
The same study also mentions surgical site infection as the most common postoperative complication.
Emergency surgical intervention is considered to be a standard treatment for patients with mechanical obstruction. But late medical intervention increases mortality and morbidity, thus it must be handled with utmost care, attention and emergency.
Mzee Ringo’s sad story
The man was subjected previously to a surgical procedure known as laparatomy, a procedure involving a huge incision via abdominal wall to gain access into abdomen.
It’s from this surgery that caused this problem of “bowel obstruction”, the peril you can scarcely imagine.
Usually internal tissues and organs have slippery surfaces, keeping them from sticking together as the body moves, what a boon to your internal organs!
But in a stark contrast, abdominal adhesions causes those tissues and organs in the abdominal cavity to stick together, thus readily occasioning bowel blockage.
The mechanism of adhesions formation is a complex biological process, however, surgeons may prudently strive to prevent them from happening.
Mzee Ringo was diagnosed through a plain abdominal x-ray. If circumstances allow, then you may be asked to do an abdominal CT scan, which is said to have a sensitivity of 90- 94 per cent. Usually the scan is costly and in some regions inaccessible.
Before surgery
His abdomen was hugely distended, he was instructed not to eat anything and he was kept on non-operative management. Even a nasogastric tube was inserted, of course he didn’t like the tube and he wanted it to be removed as it’s the case with many other patients in Tanzania.
It’s sad that Mzee Ringo didn’t survive after facing serious complications thereafter. The question now is, how long can a person survive after being diagnosed with a bowel obstruction, such as Mzee Ringo?
According to www.virtualhospice.ca, health experts say that there are certain factors that determine the answer to the aforementioned question. It says:
The length of time someone can live with an obstruction depends on several factors:
• Overall strength and condition
People who are active and have a fair amount of reserve strength and energy do better than people who are very weak.
• Degree of blockage
A full blockage is a bigger problem than a partial blockage. With a partial blockage, people usually can sip fluids or take ice chips, which lengthens survival time.
• Effect of treatments
If treatments can decrease the blockage or reduce pressure, then the person may be able to sip fluids or take ice chips, which lengthens survival time.
• Complications
Complications may reduce survival time. There may be infections such as pneumonia, or intestinal bleeding. The obstructed bowel may not be getting enough oxygen, or the bowel may become perforated, that is, a hole may develop in the intestinal wall. These complications are unpredictable, and may bring death within a few hours.
A condition like Mzee Ringo’s mandates immediate medical attention. If you experience any symptoms such as not able to pass bowel or gas, stomach pains and swelling of belly, do not wait longer. Go to any nearby hospital immediately.
*Not his real name
The author is a medical doctor, public health activist and researcher based in Dar es Salaam.
