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ER visit, obstruction missed on x-rays, sent home as "fine"

I've been experiencing obstructions quite often over the past year (probably 8-10 in a year) ... and since I went for a surgical consult a month ago where it was recommended that I go off all meds (specifically the pred) prior to surgery ... I've been obstructing almost every other day. Not fully every time, but definitely partially, with contraction-like pains, and nausea, and twice I had violent vomiting too. Seems like every time I ate something solid, I had to rest my mouth/bowel and eat nothing for at least 24hrs, and then I would finally feel ok again. It's been brutal. All of my disease is at the Terminal Ileum area, and I have a large stricture and a lot of scar tissue and inflammation. I've been living on a limited diet, but sometimes it does't seem to matter what I eat, and I get obstructed anyway. That section is coming out in August, which is just not soon enough for me.

On Saturday it happened again, I ate a bunch of food at a bridal shower, nothing too bad, but more than I normally would eat, and by that night I was in horrific pain, massive nausea, and it was all I could do not to vomit. I held it in, but it was difficult, I had to lay so still and not move, or I was gagging. Oddly, my bowels went into overdrive that night too (not sure if it was from the cramping against the obstruction or what), but I ended up having probably 15-20 bm's, all normal size/consistency, no diahrrea, every 20-30mins, all friggin night. And the contraction-like pains never subsided, they just kept getting worse. By morning I had not slept a wink, was in terrible pain, and decided it was time to go to the ER. I have never gone to the ER before for this. I always waited it out at home and eventually felt better as long as I ate or drank nothing.

ER experience was not a bad one ... it wasn't very busy, and I was brought in immediately, no waiting at all. They gave me morphine and a strong anti-nauseant which was nice, it was sweet relief for a change. No NG tube, thank god, because I wasn't throwing up anymore. They did an x-ray, and came back and told me that it came back clear, no obstruction. Which made no sense to me. So they had me drink water, and sleep in the ER that night, to see if I could keep it down. I did, so they sent me home.

Next day (yesterday), I got a call from the radiologist who had to look at my films and write up a report. Since it was Sunday when I was there, only the ER doc looked at my x-ray. Anyway, long story short, the radiologist said that there were "loops in my x-ray which indicate a bowel obstruction". And he seemed quite concerned that I was home, and asked me several times if I was nauseous or vomiting and made me promise that if I started vomiting that I would immediately come back. Interesting. I keep wondering if this had been found while I was there if there if the outcome may have been different. We have been praying that I can get the surgery sooner than later, and have been hoping for a cancellation. I live 2 hours away from the hospital where I'm having the surgery, only because I had to transfer to a GI up there because my local GI was on a personal hiatus for a few months (death in the family I think). Anyway, I have nothing against having the surgery here locally, but it's not really possible now because I'm booked up there and have been seeing a doc up there (and I do like him). So when I went to the ER, we were thinking that we might get an emergency surgery consult if I did have an obstruction, and I would have been glad. But because they didn't see it on x-ray until the next day and I was already released ... now it's too late. Ugh. I just want this OUT of me. I'm barely eating, I'm miserable every time I DO try to eat, I just want it done.

I guess the lesson learned is not to go to the ER on the weekend when there is no radiologist there. I also should have told the ER doctor that the normal protocol for an obstruction is "nothing by mouth, and complete bowel rest" so making me drink a large glass of water didn't help matters. Now I keep thinking that the ER staff just saw me as a drug-seeker, because in their minds I had a perfectly clear x-ray. So frustrating, considering how many times I have suffered in silence at home and cried and moaned my way through it with no help and no medication, and when I finally go to the ER, they diagnose me with NOTHING. Oh, and I should also say that the ER doc also prescribed Entocourt to me, a four-day course, which I questioned based on the fact that the surgeon specifically took me off steroids over a month ago and I have NONE in my system now and am only 5 weeks away from surgery. He said "oh, it's only a four-day course, it should be fine". I didn't fill it, and I don't plan to.

thanks for listening!
Angie
 
Wow, makes you wonder about going to the ER! I have a similar situation to yours. I've been having a lot of issues lately that I'm pretty sure can be blamed on scar tissue in my terminal ileum.

I'm on Remicade, started in August last year and since about my second infusion my tummy has been a grumbling monster! After my second to last infusion in March I started getting pain in my stomach along with the noises and this has progressed into torture now! I get so much pain that comes and goes in waves I don't know what to do with myself! I've never experienced anything like it before but it comes on strong, my tummy gurgles LOUDLY, I can feel things moving around in there then it dissipates and I feel fine. This usually only lasts for a few minutes and then it happens again, over and over and over...sometimes it lasts like this for days. Then after this, I'll have a few days where i'm pretty much ok and then it starts up again. Last week it lasted like this for 7 days (the first day or so the worst, the last few not as bad but still bothersome) and I, like you, hesitate to go to the ER because I know it will pass on its own if I just wait it out. I think I can tolerate the pain on most occasions because I know it'll pass. It's so weird being in excruciating pain one second then fine the next! I find myself confused about needing to go the hospital or not each time it happens cause I feel awful but ok all at the same time!:ybatty:

Anyway back to my point, haha...I finally got fed up and was worrying about this becoming a full obstruction or something so i took myself to the ER on Sunday also. Wouldn't you know when I got there, the pain stopped!!!! Grrrr, why does this happen?! So there I am trying to convince the ER doctor how horrible I was feeling when in reality, I was miraculously feeling ok. He did an ultrasound, blood work and took xrays. He said the xray showed a narrowing at the end of my small intestine where it meets my large (terminal ileum) and that this was probably causing partial obstructions and the pain I was having. He gave me T3's and Buscopan and told me to see my GI. I felt the same as you regarding the 'drug seeker' so I said I didn't need any IV pain meds while there...I think this only made them think I was crazier though! haha

Sometimes I hate doctors and the ER, I never feel sick enough to be there and I feel guilty for going even though I'm suffering in pain. My husband thinks its the best way to get tests done in a timely fashion when I'm really not doing well (good ol' Canadian health care system) which is true but I just hate feeling scrutinized because I look ok or because the pain has mysteriously subsided for the time being.

I saw my GI today but he hadn't received the results from the ER and the xrays yet. This I now realize is due to the same reason as you, no radiologist on duty on Sunday!! Now I too am wondering about the true nature of what was acutally shown by the xray! He's sending me for a CT scan to see the extent of what's going on in there and causing me so much pain.
 
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