Hi Douglas

I have some experience with blockages...started in 2008 after almost 30 yrs with a k pouch. Once it starts it never seems to end! I had a couple ER runs after over 24hrs of hell and total dehydration and a couple post op Ileus.

We have found the site (s) and after one too many close calls decided on elective surgery with my laproscpic specialist. He cut adhesions, untangled a loop of bowel, patched a hernia and liberated a limb of gut that had stuck to the abdominal wall. It took under 3 hours, all closed surgery with no complications and 3 nights in hospital just in case.. 

He is not a pouch specialist bot a Lap specialist. 

My only complaint is that they can and do come back. Not sure of it is "a thing" or not but after 3 years I may need a redo.

Pick a surgeon who communicates well with you and makes you feel comfortable. 

Sharon 

Thanks SKIN69,

I'm starting to have some apprehensions about having adhesion surgery.  I've read in many posts on this site that a few here and there don't seem out of the norm.  My diet has been pretty wide open for the most part and I've begun to wonder if a more conservative-pouch friendly diet is really all I need.  Unless the pouch scope proves to be a clear sign that this won't be resolved with diet.

What's more concerning to me is that many times the surgeon misses an adhesion or creates more when they go in for removal.  My initial surgeon said that I had a lot of adhesions when they removed my gall bladder during my first blockage.

Smooth

Sometimes a badly located adhesion really has to be cut, if it's a recurrent problem. It's important to rule out other possible causes of the narrowing first, though. Is your doctor sure it isn't a stricture?

Scott,

He's not sure it is a stricture.  That's why I'm having a scope of my pouch in January.  My concern is that he is a pretty green surgeon and I'm not overly confident that he'll be able identify it accurately.  He is smart, cares and takes his work extremely seriously. But maybe stricture identification and adhesion surgery is covered in Surgery 101 and I'm over thinking it.

Wade

Hi Douglas   I have also been dealing with blockages the last couple of years last one two weeks ago,went to local hospital then they transferred me ocross the city to where my surgeon is located have done this three times now, went back for a scope last week as they had a theory about it being a scricture but no all clear, so now they think it could be machanical problem or adhesions . They have decided that next time I have an attack go back to local hospital and ask for medication called gastro grafin if this works deal with it this way each attack if not to send me back and go with lapro check not to sure about the gastro grafin anyone have thoughts on this drug lets know how you go might be able to give me some insight all the best Susan 

Thanks Sudie for your reply,

I've never heard of gastro gafin?  By searching other posts I've seen others use muscle relaxants to free up blockages (Amerix?).  

I truly believe I do have a narrowing above my pouch, but feel I can work around it by being more careful with my diet (the last two blockages occurred when I had All-Bran for breakfast. A very high fiber and I feel was likely the cause.)  I'll do the scope this January, but I'm likely to not have the adhesion surgery unless my surgeon is adamant that it must be done.

Douglas

Gastrografin is just a dye that blocks x-rays, like barium. It gets squirted up the bottom and allows the radiologist to get a good look at the inside wall of the bowel. It doesn't treat a blockage, except by accident when it flushes things away. Food doesn't really cause a blockage, but it is what can get stuck behind a narrowing. The narrowing, whether from a stricture in the bowel wall or a kink from bowel twisted around an adhesion, is the fundamental problem. 

Smoothdouglas, maybe find a less green surgeon?

I wonder if Gastrogafin is what they had me drink when they did the xrays for the follow-through?  Stuff was god awful tasting (I puked it up after the first xray).  They did say it also acted as liquid plumber for the guts and a few hours later it may have been what freed up my blockage.

As for the surgeon, I'm considering someone else if I have adhesion surgery.  The problem I'm having is that I live in a medium sized town basically 3 hours from any Colo-Rectal surgeon.  We are a regional medical center, and have two hospitals in our town, but just General Surgeons.  My J-pouch surgeon worked 3 hours away...and has retired.  I could simply try one of his associates, but I also don't want to end the relationship with this new surgeon.  The last two blocks have resolved under his care in town and I didn't have to be taken 3 hours by ambulance like I did in 2008 and 2009 to my J-pouch surgeon's hospital.

Decisions, Decisions...I guess that's why I'm here.

Just an update to my post.  I've not had any blockages since my last issue and had an endoscopy this AM.  The doc had no cause for concern and didn't identify any stictures of concern.  My blockages were are attesting to All-Bran causing a blockage both times in the last 6 months.

That is all.

Glad you are doing well and avoided surgery!  

After 5 blockages myself over an 15 month period, which we could never be certain if they were scar tissue/adhesion related or narrowing/potential Crohn's,  I finally had surgery due to a full obstruction that did not resolve after a week in the hospital.  They found 8 or so adhesion bands that needed to be cut.  To your earlier point...I needed the surgery to cut the bands, but it inevitably will cause more scar tissue.  I develop scar tissue more easily than most.  The good news is that we finally know that it was scar tissue and not Crohn's, which will make future decisions on what to do a bit clearer.  But now, after 2 years obstruction free...I sit and wait for another episode.  It took 3.5 years after my j-pouch surgeries for the adhesions to finally start causing problems.

So, my advice, which you really have no control over...wait as long as you can before having the surgery.  If you get to the point that you are having them every 2-3 months, however, it might be time to get some help.

CLZ, I think you're painting an overly dark picture. For adhesions to cause obstructions they have to end up in especially troublesome places. Most people with adhesions never experience an obstruction. Also, surgery to fix adhesions does have a fairly high rate of problem recurrence, but it's certainly not "inevitable." You may well never have another episode. Nevertheless, I agree that the recurrence rate is high enough that expectations should be limited.

Smooth,

I guess that that is good news...no stricture means that nothing obviously mechanical is at work...other than possible adhesions which do not show up on that sort of test.

Avoid the All bran, maybe switch to oatmeal? Something that hates your guts a little less? 

My worst blockage was caused by a can of coke...literally. (But I did something really stupid...I drank it in one long gulp, then immediately lay down with my legs up against a wall (that is how I relax my lower back)...I think that the air bubbles got caught in a loop of bowel...it felt like a horse kicked me in the gut and then everything came to a complete halt for 28hrs...the only thing that helped me was Gravol shots...they slow peristalsis and made me sleepy enough that I could get some rest in the hopes that it would pass...it eventually did, but not until it scared me to death.

Sometimes it is not the food but the physical position...I have found that I tend to get more blockages when I have been squatting down for prolonged periods of time...(like when I am cleaning out the bottom cupboards, gardening or playing with the G-kids...now I use a little step stool or sit on the floor.

So beware of which positions you put your body into prior to the blockages...it took me until the 3rd one to put the two ideas together...but with our altered anatomy and possible adhesions anything is possible.

You may wish to invest in a blender...sometime that can help too...Blending the chunky stuff.

Sharon

Hi Douglas   Just an update had another blockage was given the gastrografin orally but became guide I'll they put a tube Ng in was vomiting so hard came out of my mouth was transferred again to my surgeon ended up having surgery for adhesions by lapro he worked for one and a half hours leaving some behind he was surprised how many I had only been home a few day so will be a waiting game now to see if this resolves