Preventing Small Intestine Scar Tissue Blockage - Need Advice!

Good morning,

I need some of the valuable experiences from my fellow ostomates. My friend has a colostomy but has been having very bad episodes of blockage. She is currently doing chemo and thought that was the culprit but as it turns out, a hospital visit for this last one came with a scar tissue diagnosis. She was told nothing could be done about it because if they operated, she would just develop more scar tissue in a short period of time. She was told to just drink lots of water. I have read back on the forum and the only advice I see is Vitamin E. Anyone have any suggestions to prevent a blockage in these circumstances or have a surgical solution that worked or not?
Your help is appreciated!

Puppyluv

Yikes! Sorry to hear about your friend... that's a bit of a sticky wicket! I had a gastro try to dilate scar tissue with a balloon, but that just resulted in a busted balloon. Neither him nor the balloon were the 'sharpest tools in the shed', if you know what I mean. Scar tissue can be physically massaged (stretched) if you can reach it, but the results are only temporary. I don't have a good answer for you. I've often wondered why a "stent" of sorts couldn't be inserted after the scar tissue was stretched, but there must be an obvious reason I'm not thinking of. Impairment of peristalsis around the stent comes to mind, but with the rest of the bowel pushing... it should be fine. Especially if the stent is just a hair bigger in diameter than the preceding bowel. But what do I know? I'll poke around later on the interweb and see if I can find any new tech to address your friend's problem. Wish there was something better I could tell ya!

Regards,

Bob

Thanks, Bob,

You make me laugh! Your internet skills are awesome! I fished around a little bit and they want to address INS or colitis, which do not apply. I too will do some searching. She doesn't have a lot of resources where she is. All help is appreciated!  
Puppyluv

Hey pup. I have quite a bit of adhesions, the GI recommended me for physical therapy and the therapist worked on various types of massage to physically break the adhesions and gave me exercises to improve my range of motion. I feel like it helped quite a bit. You might have your friend ask her doctor about that.

Bob, I am with you. There should be a stent, or someone should come up with a stent, to help. I had radiation, and it caused scar tissue on my ureter tube. The tube goes from your kidney to your bladder. They put a stent in that tube to keep it open. The downfall is that it has to be changed every six months. You have to be put to sleep so you don't move, as it can cause them to puncture the tube. The tube could also collapse, and they would not be able to put the new stent in. It is a quick procedure if all goes well. I keep hoping they will come up with one that doesn't have to be changed.

Thanks, I will pass that along. I have heard of that helping if the spots can be identified. I appreciate your sharing!

Pup nbsp

Hi Pup,

She's talking about ART (Active Release Technique), a deep tissue massage.   But how you do that through the abdominal wall is beyond me.   But hey, if it works.......it works!!!   Next time I see my Chiro I'll ask for more details.   But I'm hoping I never have to see my Chiro again........professionally that is.    

;0)

Bob

Thanks.  

One of the reasons that stents have not been used for the lower GI tract might be how mobile it is and that the major stimulus for peristalsis is bowel stretch. Stents, I expect, would interfere with peristalsis in that respect. They look like they are used for upper GI tract issues occasionally.

Actually, what she did was called visceral manipulation, which maybe that's the same as what Bob mentioned, but she focused on moving my organs during sessions and gave me exercises to do to increase my flexibility and range of motion in my hips, shoulders, and spine. And we worked on strengthening the muscles on my ostomy side, which was considerably weaker than my non-ostomy side.  

Thanks for the info. How long did you do the therapy and how much did it help? 

Hi MBT!

I'm with you.   The interesting thing is that stents are basically wire cages in a tube shape.   So what prevents them from making a stent out of a spiral-wound stainless wire?   That would compress and stretch with the bowel and not impede peristalsis.......think of your dryer hose without the skin.   It would still support the bowel wall, not letting it narrow, but would move with it.....sort of like a Chinese finger puzzle.   I wonder if folks are looking at that type of thing.   I'm oversimplifying, of course.........but any tube design that doesn't collapse on itself would do the job......if it could flex and get longer and shorter as the bowel does......like a spiral-wound hose.   Very interesting.    

Thanks!

Bob

Well blow me down..........as Popeye would say...........I just Googled "Can a stent be placed in the intestines" and it seems there are already a lot of existing stents for just such a thing. Just hit 'Images' after you do that search and you'll see they have colonic stents, luminal stents, etc, etc. There's even an endoscopic view of a stent in place in the colon. Pretty cool! So why has no one ever received one that we know of??? OK, another question for my gastro. That poor gal is gonna hate seeing me.....my list of questions is already a page long and I haven't even made the appointment yet!!

Ciao!

Bob

Thanks Bob! Lovely said she had one but not in the small intestine. Always a great question to ask for those that have blockage issues! Dang, possible solution to end a world of pain and worry! Ya just never know til ya start digging huh?

Thanks,

Bob

Yeah, Bob, Dr. Google can be a minefield! My intuition about the spiral stent is that it would be likely to migrate and eventually perforate the bowel : ( If it manages not to perforate, then it would just be passed out with stool, an unfortunate waste of money.

I went for 8 weeks. It helped quite a bit. My body was more well aligned by the end and my range of motion had increased on most of the measures she used to keep track of progress.  

Thanks for all the great information, guys! I have passed this along to my friend, and now she has some ammo to sit down and discuss all this with her doctor. I just cannot imagine going through all the pain several times a month!
Puppyluv

Hi MBT,

  I'm finding this topic a bit fascinating as I learn more.   I put a quick primer below for you guys to read what it's about.   Definitely check it out online for more info if it's something you're interested in.   What's below is a few years old..........what they're working on now is a Magnesium alloy biodegradable stent!   And the current metal stents do work like a Chinese finger puzzle.   They are expanded once placed and then stay expanded due to the way they are wound.   I would think that being an open mesh........once placed it would be very difficult to remove, as it's a skeletal framework that the intestinal lining will quickly grow around.   It's all pretty fascinating, and from the sheer volume of info I've found it seems to maybe not be a mainstream treatment, but certainly not rare.   The fistula thing is what caught my eye.........I didn't think there was anything that could be done for a fistula other than to slice it open like a fillet and let it heal.   This does change the game a bit.   And for blockages......wow!   Definitely going to pick my poor Gastro's brain on this one.

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Gastrointestinal and oesophageal stenting:

What is stenting?
Stenting is the placement of a stent inside your body. A stent is a mesh tube made out of metal which can be inserted into a passage in the body (such as a vein) to act as a skeleton and keep it open. You may be advised to have a stent placed if you have a blockage in your gullet or bowel which is caused by a tumour.

Symptoms of a blockage in the gullet, stomach or small intestine include being unable to consume an adequate amount of food, nausea and vomiting. If you have a blockage in your large intestine you may find it difficult to go to the toilet.

A stent may also be used to keep a fistula open, which is a connection between the gastrointestinal tract and the organs or tissues around it.

How does the procedure work?
Before the procedure, the interventional radiologist will outline the obstruction with contrast material under X-ray. You will have a local anaesthetic in your throat and be under mild sedation for the procedure. The interventional radiologist will introduce a device containing a wire and a catheter through your mouth and to the blockage in your gullet or small intestine. After the narrowing has been reached with the wire, a tiny balloon will be introduced and will slowly expand to dilate the area around the blockage.  

Once the area has expanded enough, the interventional radiologist will implant the stent to bridge the blocked segment and keep it open. Sometimes a second dilation with a balloon is needed to help the stent expand better.

If the blockage is in your large intestine, the procedure will be performed through your anus, but otherwise the steps will be identical.

If you are being treated for a fistula, a stent covered with a membrane will be placed across the fistula before the procedure to protect it from the contents of the intestines.  

Why perform it?
The aim of stenting for blockages in the gullet caused by a tumour is palliation, meaning the procedure is carried out to relieve any symptoms or pain caused by the blockage. Your symptoms should be relieved after the procedure and you will be able to eat normally again.

If you have an acute obstruction in your large intestine, meaning the blockage must be treated straight away, you may be advised to have this procedure as a bridge to surgery. This means you can choose to have the necessary operation later and avoid the risk of emergency surgery.

If you have a fistula, this procedure will protect it from the contents of your intestines and will allow the fistula to seal over time.

What are the risks?
One of the risks is stent migration, meaning it may move to another part of the body. It is also possible that the blockage will return, due to tumour overgrowth or if food or faeces develops into a solid lump in your rectum.

You may experience pain, bleeding or a delayed injury to the intestine, but these are rare.

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Regards,

Bob

Think it's a common thing although not mentioned as a side effect. I ended up in the hospital 2 years after having my urostomy due to bladder cancer.

Rushed in by ambulance after 1 week of puking to be told that I'd die if they did not operate immediately.

I was told that it was all as a result of scar tissue that "glued" my small intestine together.

Was the worst 4 months of my life and was iller than when I had the actual cancer.

And yes, it could happen again. The more surgery you have, the bigger the chance.

That just sounds like a no-win situation! Damn if you do and damn if you don't.  
Mao, my friend has had her surgical consult but has not committed to surgery. Talked about diet control and so far it is working. No blockages but it is no fun not being able to eat anything worth eating.  Today she has a second consult but with a nutritionist that can help her fine-tune the diet. Surgery is still not out of the question. It certainly would be tough having surgery as well as chemo. Hoping she finds an answer she can live with!

Puppyluv