Deadly adhesions: Weight-loss surgery could turn fatal

Lisa Marie Presley, the only child of rock ‘n’ roll legend Elvis Presley, was rushed to hospital after she reportedly complained of stomach pain in January, and subsequently succumbed. It was later revealed that the cause of death was ‘strangulated small bowel’ or obstruction in the small intestine caused by adhesions which occurred in the aftermath of a bariatric surgery she underwent years ago.

Bowel obstructions occur when there is a blockage in the intestines, impeding the normal passage of food, fluids and waste through the digestive system. “This blockage can happen in either the small intestine (small bowel obstruction) or the large intestine (colonic obstruction). They can be of two types – mechanical (or physical) and functional,” says Dr Prarag Dashatwar, Senior Gastroenterologist, Kamineni Hospitals.

Causes

Mechanical obstructions may be caused by various factors:
Impacted faeces
Gallstones
Tumours (both benign and cancerous)
Adhesions, hernias or foreign objects.

“On the other hand, functional obstruction happens when the digestive tract’s contents cannot be moved along by the intestinal muscles because of erratic muscle activity or nerve damage. Functional bowel obstruction may be caused by conditions like paralytic ileus, which can result from abdominal surgery, infections, or some medications,” adds Dr Dashatwar.

Complications

Depending on the severity and duration of the obstruction, there can be a variety of complications.

“If the increased pressure inside the intestines due to persistent obstruction causes the intestinal walls to rupture, it can be serious, as the intestinal contents will leak into the abdominal cavity, resulting in peritonitis, an infection. Further, the blocked portion of the bowel may twist, impairing blood flow and resulting in tissue death, a potentially fatal condition known as strangulation,” explains Dr Dashatwar.

“Malnutrition is another potential complication, as prolonged obstruction interferes with nutrient absorption, resulting in deficiencies in vital vitamins and minerals. Overall, bowel obstruction has significant implications for the body’s health and functioning,” he stresses.

Symptoms

Abdominal pain and cramping, which may occur in waves and are typically concentrated in the affected area.

Vomiting, with bilious (greenish-yellow) colour indicating an obstruction in the upper small intestine, and feculent (foul-smelling) vomit indicating an obstruction in the lower bowel.

Distended abdomen, which is hard to the touch.
Inability to pass gas or have a bowel movement.
Disrupted balance of electrolytes and fluids in the body, causing dehydration. Imbalances in crucial minerals like sodium, potassium, and calcium can also occur.

Treatment

“Bowel obstruction typically requires hospitalisation. The doctor will administer medication and fluids intravenously. A nasogastric (NG) tube may be inserted through the nose into the stomach, to help alleviate symptoms by releasing fluids and gas. In some cases, partial blockages improve without intervention, though the doctor may recommend a balanced diet that is good for overall wellbeing. Enemas can also tackle blockages by increasing pressure in the bowels. For patients who are not fit to undergo surgery, a stent, or a mesh tube, can be inserted into the intestine to open up the bowel. While some will only require the stent, others may need surgery after their condition stabilises,” says Dr Rajiv Manek, Consultant General & Laparoscopic Surgery, Wockhardt Hospitals.

Undesirable consequences of bariatric surgery

For obese people, weight-loss surgery can no doubt be a lifesaver, but if recovery doesn’t go as planned, it can prove fatal. Bacteria from the digestive tract entering the abdominal cavity through a rupture or perforation in the intestine caused by an obstruction resulting from the surgery can lead to a severe infection.

Dr Rajeev Reddy, Consultant GI and Minimal Access Surgery, Landmark Hospitals, explains, “The normal body’s reaction after any abdominal surgery is to develop a gummy tissue between the bowel loops, which normally goes away eventually. Occasionally, the bowel forms a mass by adhering to the scar and to each other. The likelihood of developing adhesions rises with the complexity and length of the procedure. Any abdominal surgery entails a 70%–90% risk. The adhesions could result in obstructions that eventually rupture the intestines, resulting in faecal contamination that can prove fatal.”