Bowel Obstruction in Doomsday

I’ve got a sort of morbid fascination with viewing the total collapse of our medical system.  So many medications are in short supply.  Sometimes it’s not the medications that are the problem, but rather the supplies or equipment to deliver the meds.  Sometimes it’s staffing issues.  Nothing about these difficulties is going to be resolved soon.  It’s only going to get worse, and people are going to die from trivial illnesses that were previously so easily resolved with medications or surgery.  Bowel (or intestinal) obstruction is one of those conditions that may well become life-ending without advanced medical care.

To begin, bowel obstruction is just what it sounds like—the bowel, either the small or the large intestine—becomes physically blocked such that food and feces cannot pass.  The causes, symptoms, and treatment vary depending on whether the small or large intestine is affected.

Here’s what The Ship’s Medicine Chest and Medical Aid at Sea has to say about it:

Intestinal Obstruction

Complete blockage of some portion of the intestines may be caused by the accumulation of hard fecal matter, a strangulated hernia, adhesions (sticking together) of the coils of the intestines, tumors, or kinks in the bowel.  There is usually a sudden onset of severe abdominal pain, without fever, accompanied by constipation.  There may be nausea, vomiting, and after a matter of hours or days, the abdomen may become distended with gas. 

Treatment

Medical advice by radio should be obtained.  In the meantime, the patient should be kept at absolute bed rest.  Food and water should be withheld except for ice chips which may be taken by mouth.

The obstruction may be a fecal mass in the rectum which can be removed by an enema (sodium biphosphate and sodium phosphate solution).  Sometimes it is necessary to remove pieces of the hard fecal matter from the rectum by hand.  A rubber glove or a rubber finger-cot should be worn.  However, the bare finger can be used.  The gloved finger should be lubricated with petrolatum and inserted gently into the patient’s rectum.  If a mass of hard fecal matter is felt low in the rectum, it should be broken up by gentle movement of the finger so that it can be passed by the patient, or helped out by the finger or the enema. 

Applying a hot water bottle to the abdomen may relieve pain.  Fifteen drops (0.3 ml) of tincture of belladonna may be given in a quarter glass of water every six hours.  If the pain is severe and the patient’s condition seems to be getting worse, morphine sulfate 10 mg should be given intramuscularly.  To repeat the morphine sulfate, medical advice by radio should be obtained.

If the patient goes into shock, he should be treated as described on p. 57.  If vomiting continues, it may be necessary to replace the fluid by giving 1,000 ml dextrose 5% and sodium chloride 0.45% solution intravenously.  Medical advice by radio should be obtained.[1]

That concludes the information from The Ship’s Medicine Chest.  The fact that “medical advice by radio should be obtained” is repeated three times within the entry should suggest that this is an extremely serious problem.  Further information from Survival and Austere Medicine, 3^rd Edition may help diagnose, treat, or recognize the inevitable outcome if surgery is not available.

Small Intestine

Obstruction of the small intestine usually results from a previous surgery that causes adhesions.  Symptoms include nausea, vomiting, and central abdominal pain and distention.

Treatment

• Nothing by mouth
• If available, insert a nasogastric tube (to relieve excess pressure and fluid from inside the stomach)
• IV or rectal fluid administration. 
• Pain relievers (through IV or rectal administration)
• Anti-emetics—anti-nausea and vomiting medication (through IV or rectal administration)

Then all that can be done is to wait and see.  The patient will either improve with the above care or die.[2]

Large Intestine

Obstruction in this area usually is due to cancer.  In contrast to small intestine obstruction, the onset is generally much more gradual, even to the point of being imperceptible, until the situation is very serious.  Symptoms include abdominal distention, pain, and reduced or absent bowel movements and gas.  The course of the disease is as follows:

• The intestine becomes more distended.
• The blood supply is impaired by the pressure exerted by the untreated intestinal distension.
• Due to the reduced or absent blood supply, the intestinal wall infarcts and dies.  This part of the wall will then perforate and peritonitis develops. 
• The patient will die without surgery, and antibiotics will not help. [3]

Other causes of bowel obstruction include:

• A ball or knot of roundworms[4]
• A section of the intestine pinched in a hernia[5]

Additional symptoms:

• Steady, severe pain in the belly—it is swollen, hard, and extremely tender and hurts more when palpated.  The patient will try to protect the stomach by doubling up the legs.  Listening with a stethoscope (or even just putting the ear to the abdomen) will reveal no sounds—nothing but silence.[6] 
• There may be sudden projectile vomiting that shoots out three feet or more.  It may contain green bile and smell or look like feces.[7]
• Even though the patient is constipated due to intestinal obstruction, there may be a little bit of diarrhea or some bloody mucus.[8]
  

Links to related posts:

Alternative Methods of Administering Medication

Rubbing Alcohol Aromatherapy for Nausea  

Anti-Nausea Medications and Treatment Options

Constipation—Risk Factors, Prevention, and Treatment in a Collapsed Society 

Book Review--The Ship's Medicine Chest and Medical Aid at Sea 

Book Review--Survival and Austere Medicine, 3rd Edition

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[1] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 163-64.

[2] Survival and Austere Medicine, 3^rd Edition, 2017, 168.

[3] Survival and Austere Medicine, 3^rd Edition, 2017, 169.

[4] David Werner, Where There Is No Doctor, 1992, 94.

[5] David Werner, Where There Is No Doctor, 1992, 94.

[6] David Werner, Where There Is No Doctor, 1992, 94.

[7] David Werner, Where There Is No Doctor, 1992, 94.

[8] David Werner, Where There Is No Doctor, 1992, 94.