Small bowel obstruction

Dear Ask The Doctor: My son is completely paralyzed from the chest down and has been for 22 yrs. he is 22 yrs old. His has a blockage (most likely scar tissue, seen in a cat scan) and possibly an ilias now after a colostomy surgery. Here are the facts: He has a cecostomy to his intestines. (a button he would flush to have bowel movements through his rectum, it has been in for years but replaced last year) His intestines have always been in great shape before this surgery He got the colostomy because of getting a flap from a wound surgery right before (which looks great) His health is generally good. Just some infections: UTI's once in awhile and or impactions. An impaction was cleared out during the colostomy surgery. He healed well from the flap surgery that took place 5 weeks before, his intestines worked well. Consistent food and ensures going through without a problem. This colostomy looks good but has only released minimal thin and somewhat thick liquid after 5 days until the 12th day of his stay. Now there has been nothing for 3 days. I pleaded after the fifth day and everyday after for nutrition and calories to be put into him because of weight loss( 24lbs going from 112 – 88lbs), we received help only on the 12th day when the GI doc started 3,000 calories from a pic line. He has been steady receiving minimal bolus fluids to stop dehydration. Since the op because of constant nausea he has been throwing up thin and thick dark green guck or having dry heaves. In fifteen days he has been only able to eat at one reeses, a grilled cheese sandwich, and 2 bites of a hot dog. I believe after time I suctioned out the remains. I started suctioning through his peg tube to prevent him from throwing up and this helped. The doctor now has required him not to eat or drink anything and has attached suction to the peg tube he has. To see if that takes the pressure off the intestines. He continues to say that his intestines will just start up. His GI doc says he doesn’t think so. His doc said normally it only takes 3-5 days for the intestines to work and it has been 15 days. My son wants to eat and to get out of the hospital. (A stay of 5 weeks for the flap surgery and not 15 days here and the doc says he will continue to wait.) For 12 days he refused to say it was a blockage and even refused to give him even an x-ray which I pleaded for. After much barraging about my concerns he called for a GI consult on the 12th day and that doc was appalled at numerous things but kept his respect at the same time. He called for the x-ray and barium test which concluded it was a blockage. In the mean time my son threw up 24/ 7 until the 8th day when I started suctioning him every hour. My question finally. What do you think of all this. No one really knows. Our doc is just seemingly living in La La land I think he is quietly afraid it was caused from his surgery (he commented “this isn’t caused from the surgery”) I am not mad I am only concerned for my son. The GI doc says he needs another surgery to correct this and said we just have to wait until this doc finally realizes it. I am hoping you might know something about this and might know something else we might try or say. I really like this doctor he is a wonderful man and I know if this was caused by the surgery it is nothing he did wrong per se. I just want was is best for my son and my desperate enough to write here because I am afraid to ask for a second opinion from a doc in the same hospital and have nowhere else to turn.

Dear Tim: Based on your description of your son's symptoms as well as the findings of the xrays, it seems your son likely has small bowel obstruction from scar tissue. The usual management for this condition is rehydrate the patient with intravenous fluids and observe for resolution. If resolution does not occur in a reasonable time (about 3-5 days) then surgery may be indicated. Given the duration of his symptoms I think he may need surgery to relieve his obstruction. His surgeon may be reluctant to perform the operation because of the possible complications which can occur. Possible complications include damage to small intestines. These complications are more likely to occur because of the number previous surgeries he has had. It is somewhat of a catch 22; the obstruction is unlikely to resolve on its own but the surgery required to relieve the obstruction may create other problems. Despite this difficult situation, surgery seems to be the only option that will help.