What do you do for a possible blockage?

[meesh]

My boyfriend may have another full blockage. He has been dx with Crohn's for the past 13 years, has not had one surgery (fingers crossed) and was in the hospital over Christmas with a full blockage that was resolved with an NG tube, immense amounts of antibiotics and steroids. On Tuesday he did that test where you swallow the little pill camera (which his doctor apparently ordered by mistake?) and it got stuck somewhere in the small intestine. Now he is experiencing symptoms which he has only experienced once before, when he had a full blockage. When you suspect something is up but aren't completely incapacitated, what do you do? Last time, he tried a suppository laxative and when that didn't help we knew to worry. He's definitely eating enough (he's on an appetite stimulant) and hasn't had a BM since last night but last time it had been less than 48hrs since his last BM before it became a medical emergency. He has an xray for the camera on Monday, should we try the laxative and wait until then? Last time he almost had a surgery the night we went in, I'm just concerned that if we wait so long this time the same thing will happen.

 

[David]

If you suspect a blockage you should go to the ER. Don't wait for it to get really bad.

 

[kllyeve]

Yep, I'd be off to the ER as a full blockage can get bad fast.

pill cam - Haven't had one but I did think they were not recommended in people who had a history of partial or full blockages.

 

[Irene3]

I agree, full obstructions are horrible. best wishes xo

 

[Sybil Vane]

If he has symptoms, he should go now. I had a pill cam in my small bowel for a few weeks and it just backed up with food until it created one of the worst, sickening obstructions I've had. Eating on top of it, even though you're hungry, makes it worse.

 

[meesh]

Okay so he had a scheduled xray for the pill cam today and they said there doesn't appear to be a blockage but the cam is still there. He still has all of the symptoms of a blockage that he's only had once before and hasn't gone to the bathroom since Thursday. He's had Crohn's for 13 years so I think at this point he'd be able to tell the difference, is there anything else we can do?

 

[David]

Where specifically is it stuck?

 

[Ihurt]

Is it possible that he may not have an actual obstruction, but like a pseudoobstruction? Does he have motility issues? It may be that his intestines are just not moving very well and this could be the reason for his symptoms and him not using the bathroom for such an extent of time. I hope he gets better soon....

Okay so he had a scheduled xray for the pill cam today and they said there doesn't appear to be a blockage but the cam is still there. He still has all of the symptoms of a blockage that he's only had once before and hasn't gone to the bathroom since Thursday. He's had Crohn's for 13 years so I think at this point he'd be able to tell the difference, is there anything else we can do?

 

[meesh]

David, it's stuck in the small intestine, when his doctor called we asked if he knew exactly where and if it had moved between the capsule endoscopy and the xray but he said there was no way of telling. He hasn't been in for the past few days but now that he's had a chance to talk to us, he says judging by his history it's more than likely inflammation as opposed to constipation and gave us another script for prednisone.

For someone with Crohn's, he doesn't really have bathroom issues, just pain/lesions/cysts/major strictures so for him to not go for this period of time is unusual. He's usually very good about managing his pain and pushing through but he's totally immobile right now, he can get up if he has to but he's been laying in bed for a few days. He knows when something is off and even with the threat of an NG tube (speaking of which, can we ask for him to be twilighted or something with that? Shoving it in without any painkiller or anything seems a little criminal) and surgery he still wants to go to the hospital.

He's on an appetite stimulant so he's eating quite a bit, but nothing is happening. He's only about 6ft and 130lbs, he can't really afford to lose much more weight.

 

[David]

Everything you describe makes me feel pretty uncomfortable. You described all of this to the GI and he seemed unconcerned and felt prednisone would solve things?

 

[meesh]

It's making me uncomfortable too. Anthony described everything, and even knowing his history and that he was almost on the table 2 months ago, he decided to go ahead and tell him to wait. He did the same thing last time, 3 hours after he told him to take the anti-cramping meds we ended up in the ER with a full blockage and his small bowel dilated to an extreme. Like I said, he's had Crohn's for almost 14 years without a surgery and few major complications, that's not exactly typical. I've already found another gastroenterologist but is it too late for a second opinion?

 

[David]

It's never too late. Get that second opinion pronto and if you feel like he needs to head to the ER, do so. Don't wait until things progress too far.

 

[meesh]

We went into the ER last night, full small bowel obstruction. They don't seem to think it was caused by the camera, but its still stuck in the small intestine. Last time it cleared up with steroids and antibiotics, now they're leaning more towards resection. I'm so glad we came in, he was ridiculously blocked.

 

[David]

Thank god you went. Based upon what you were saying I suspected as much but am always a little weary of raising alarm, especially when a doctor says otherwise. I'm quite curious what the doctor who just gave him prednisone is going to say...

 

[meesh]

Surprisingly enough, we have yet to see his doctor. They attempted to schedule a surgery but his new doctor (another doctor from the practice that has been seeing him) vetoed it, since we live so close to NYC he wants us to see a Crohn's specialist. We're going to make every effort to get in with Fabrizio Michelassi, one of the top Crohn's specialists in the world who pioneered SSIS (side to side isoperistaltic strictureplasty.) We're excited to see someone who actually understands Crohn's and doesn't just have a vague idea of it

 

[David]

Very cool, I hope you get in!