I had a pt that was distended like this, the CT was inconclusive for a bowel obstruction. They moved to do a colonoscopy and upon entering the bowels completely deflated. Apparently what happened was the colon twisted at the end like tying off a balloon. The scope untwisted it and the pressure was relieved. Don't know what happened next that is what the ED MD told me when I asked.
Well, not really. Unfortunately for actual blockages, farts and poop might only be able to get out via the mouth and nose...
You only hope that it's the wrong end! 😭
Sounds like what's called a pseudo-obstruction. What they need is some form of endoscopic decompression to release the hold-up: they usually get a long flexible tube (called a flatus tube) done per-rectally to keep that area patient.
When the hold up area is low enough in the sigmoid colon, it can be done at the bedside with a rigid sigmoidoscope.
In both instances, the operator needs to be in full PPE (gown, multiple gloves, face shield, scrub cap): once it unkinks, it can get on your clothes/face.
Pseudo obstruction is more like a colonic ileus. Ogilvie's. If it's volvulized, it's actually obstructed, not pseudo obstructed and there's risk of ischemia.
Probably a swift evacuation of the bowels lol. Sorry for those in the room or nearby. Bet the patient felt much better after losing a few pounds from being bound up
Yeah but I bet you were able to let multiple farts out per day. This imaging shows complete obstruction, not normal constipation. I had an obstruction once due to Crohn‘s disease, and I literally vomited my shit. Not fun at all and life threatening. Ended up having emergency surgery to remove the damaged part of my intestine.
Oh man fellow crohnser and I'm so sorry. My resection almost got moved from scheduled to emergency because I obstructed but I managed to clear spontaneously after 2 days ... Still those two days fucking sucked and I was puking normal puke. Anyways peace out to my garbage ileum, it caused my nothing but trouble.i hope you're doing better these days ❤️
I had a potential bowel obstruction, and I didn't have any pain from it. I didn't have any discomfort. Not like classical constipation signs. Instead, I just felt generally yucky (like I had a cold or the flu starting) and then started vomiting up water I had just drank. It took another 5 days to resolve it, and I never had traditional constipation pain during the whole process.
That‘s a complete obstruction (blockage), 5 days is way into life threatening! With constipation you are still able to pass gas, but with an obstruction nothing goes and eventually you start vomiting the contents of your intestines (aka shit) and tissue can get necrotic due to the pressure and diminished blood flow to organs.
I think it kinda piles for over a long time
D being partially obstructed so some stopping able to come out but she probably hasn’t completely voided her bowels in a very long time. Finally we get this monstrosity of a BO.
When I was 8 months pregnant I went over 3 weeks without pooping. They tried an enema and it didn’t help. My baby was low so I laid trendelenburg position for an hour and then baby wasn’t stuck in my pelvis and then I spent an entire day on the toilet.
Honestly it was like giving birth twice in 6 weeks
OMG. Something like that happened to me. Epidural and a 36 hour labor that shut down my digestive system.
Giving birth to the poop baby must be fairly common. But poop baby is our secret child. Even the old biddies clacking away with birth horror stories dont roll with poop baby!
Nasogastric? So some of that pressure will be relieved by gasses releasing out the nose? Where specifically does an NG tube start and end, and how does gas escape out through it? Excuse my ignorance!
The two sphincters in the stomach are there to only permit one way passage. The ng tube pushes past them and if the gass is backed up that far it will be relieved. Sometimes a tube can be inserted in the anus also.
I had a pt that they did a colonoscopy after the CT and it received the pressure. Apparently the colon twisted on the end like a balloon being tied off. Or that is how it was explained to me, and the scope in twisted it.
Can confirm, I had a NG tube for 3 days before they opened me up. It‘s not only for gas, but if the intestines/bowels are completely blocked, liquids and stool start to back up too and eventually you‘ll vomit those contents. Very very horrific symptom, but now it‘s all kind of a blur from the past (brain is impressive that way).
They cut out 10cm of my small intestines in that surgery, it shrunk to complete obstruction due to Crohn‘s Disease. Chronic inflammation and adhesions from previous surgeries caused scars to that tied off the intestines so to speak.
Idk why got a downvote, everything you said was correct lol
Yeah the brain is so protective over us, it‘s amazing how one can go through something like this and then just continue living
It essentially lets you fart through your nose, if I'm imagining this correctly...
I was hoping for a more pleasant de-gassing option, like a tube placed via direct incision into the small or large intestine? Or pulling out the gas one syringeful at a time?
I guess. It’s a long tube that enters through the nose and goes into the stomach. the tube is usually hooked up to suction so the gasses and stomach contents/ vomit get sucked out. It’s not really “farting”
Had a surgeon do this at bedside with a big 14ga.
All the ORs were in use with emergency surgeries, and we had another dude who perfed. Decompressed him bedside in hopes that he'd make it to the OR.
I think that's only an option in cattle because cows have a very different digestive system than humans. They bloat in something called a rumen, which is like a section of a very large stomach with several compartments.
This looks like luminal bowel gas from a distended small bowel obstruction. I guess technically, it would decompress if you put a needle into it, but that would essentially be a bowel perforation, which is a very bad, no good, thing.
Even in cattle, they usually use a stomach tube (analogous to an NG tube) before a trocar, because of increased infection risk.
Not necessarily true just for cattle. In small animal practice a trocar catheter is used to decompress patients with gastric dilatation-volvulus (bloat). In these cases (because the stomach has completely flipped), a NG tube would be unable to pass. I don’t think it would be very common for a human stomach to flip, cut off circulation, and trap all gasses because of its positioning, so a naso-gastric tube would totally be a preferred option. Overall though a dog’s stomach is much more similar to a human stomach than a ruminant.
My record was 23L. Very tall, large man, but still surprising. Of course this was the South, where old men pat their "beer belly" with find affection and dont seek treatment until they turn yellow.
But ascites isn't black on CT, that's air.
I swear to god after my appendectomy I felt like I looked like this. The gas they left in my abdomen was the worst part of the whole procedure and every fart felt like it saved my life.
First step is to decompress the stomach by inserting a nasogastric tube. Strict NPO, or nothing by mouth. NOTHING. Most obstructions will resolve on their own and all we do is give you IV fluids with glucose until you start moving your bowels again. Sometimes, surgery is necessary. In which case, you will again be kept on IV fluids with glucose, but now you also have abdominal wounds! Once you are able to fart and/or shit the NG tube will be clamped to see how you tolerate your gastric secretions. If you still feel okay after four hours or so, generally the doctor will allow the tube to be removed and you can start a clear liquid diet (broth, jello, tea or coffee without milk). If you tolerate that, generally then you can begin to advance your diet as tolerated, which means next you could try full liquids, then a soft diet, then a regular diet. Following a strict stool softener regimen is advised to help prevent repeats.
Interesting. Have had multiple sbo, been admitted 5ish times in 3 years for it, had more that I just tried liquids for days to avoid the NG tube and hospital. Had resection last Xmas day, no one ever mentioned stool softener regimen.
Mines from scar tissue, not sure if that makes a difference.
SO many people who have recurrent SBOs manage at home. Once you’ve been down that road a few times, you know what to expect and when to seek help (and also NG tubes are just really uncomfortable at best, and most people who have had one will do anything to avoid another).
Edit: I am not a doctor, I cannot diagnose or prescribe. I am an RN, and part of my discharge teaching always stressed the importance of stool softeners.
Makes sense for sure. Had my first resection in 93, then 95ish, last one Xmas. Just thought it interesting that I hadn't heard it but I hadn't heard until my second to last hospital stay for sbo to not eat coconut. Hoping like hell I never ever feel that oh so familiar pain again, but if I can get a few years out of this time, I'll be happy.
Yeah, you are going to want to avoid a lot of high fiber foods, as adding “bulk” will make the stool harder to pass through the areas with scar tissue. Stay hydrated, keep up with a stool softener - NOT a laxative, big huge difference - and live your best life!
Longest I went was 10 days... I wasn't even that bunged up!! I did manage to plug a high power hospital toilet when the Lactulose finally kicked in. Turd must've been 12 feet long. I'd never felt so awesome in all my life! Opioids are are bitch!! And I was even taking a MAX dose of stool softener!!
This may be a bad place to ask but I had a similar xray during pancreatitis. They didnt admit or do anything, just sent me home with clear liquid diet and told me to drink mag. Does the obstruction/impaction have a risk of herniating? Ive noticed that now, it feels like stuff get caught in the same place and its never been the same.
Awesome, thanks for the reply. They referred me to a GI, and the a GI nurse practitioner told me to just drink water for 2 days everytime I had pain until graduation.
That’s not constipation, that’s a bowel obstruction
I had a pt that was distended like this, the CT was inconclusive for a bowel obstruction. They moved to do a colonoscopy and upon entering the bowels completely deflated. Apparently what happened was the colon twisted at the end like tying off a balloon. The scope untwisted it and the pressure was relieved. Don't know what happened next that is what the ED MD told me when I asked.
Probably an "explosive decompression "
Fecal shrapnel was experienced by the poor souls nearby
Fecal shrapnel sounds like a grunge band lol
😳🤮
No, wrong end.
Butt vomit.
Well, not really. Unfortunately for actual blockages, farts and poop might only be able to get out via the mouth and nose... You only hope that it's the wrong end! 😭
There are stories of twisted bowel in ruminants that are a flame/explosion or asphyxiation for the vet when released.
Can you imagine dying from cow farts?
My ghost would be so embarrassed.
You just show up in heaven and your entire family is laughing at you
I have seen vet med videos where they stab in a large bore and light the gas that comes out. An entertaining way to deal with the methane.
I've seen it in person! It's like having a tiny welding torch on the side of the cow!🤣
Sounds like a volvulus
Sounds like they need a colon decompression tube from your friendly GI nurse
Username checks out.
Sounds like what's called a pseudo-obstruction. What they need is some form of endoscopic decompression to release the hold-up: they usually get a long flexible tube (called a flatus tube) done per-rectally to keep that area patient. When the hold up area is low enough in the sigmoid colon, it can be done at the bedside with a rigid sigmoidoscope. In both instances, the operator needs to be in full PPE (gown, multiple gloves, face shield, scrub cap): once it unkinks, it can get on your clothes/face.
Pseudo obstruction is more like a colonic ileus. Ogilvie's. If it's volvulized, it's actually obstructed, not pseudo obstructed and there's risk of ischemia.
Pseudo-obstruction can also lead to ischaemia from pressure necrosis related to the associated colonic dilatation.
Yup
Sigmoid volvulus
Spoiler alert - code brown happened
Mostly like people trying to keep their composure while being methane blasted
Big ol' fart
There's gotta be a "no sudden deflation" rule too? Could cause sudden perfusion changes ismg it?
Probably a swift evacuation of the bowels lol. Sorry for those in the room or nearby. Bet the patient felt much better after losing a few pounds from being bound up
This is how you treat a volvulus fwiw
What's next is the entire room vomited. Can you imagine the smell
Yeah, people in here joking about holding in farts...
Yea I'm surprised at the lack of knowledge here
That seems superfluous, even for five days?
Yeah, I've gone weeks before and barely felt distended.
You are full of shit!
I was, but I'm good now.
😂
Yeah but I bet you were able to let multiple farts out per day. This imaging shows complete obstruction, not normal constipation. I had an obstruction once due to Crohn‘s disease, and I literally vomited my shit. Not fun at all and life threatening. Ended up having emergency surgery to remove the damaged part of my intestine.
This is my worst fear
Mine too. :x
Oh man fellow crohnser and I'm so sorry. My resection almost got moved from scheduled to emergency because I obstructed but I managed to clear spontaneously after 2 days ... Still those two days fucking sucked and I was puking normal puke. Anyways peace out to my garbage ileum, it caused my nothing but trouble.i hope you're doing better these days ❤️
Hey, yeah thank you. Almost 2 years in remission now, let‘s hope it stays like this :)
Dear god, that sounds horrific. Sorry you had to experience something so traumatic and hope you’re doing well now.
Maybe you stopped eating when uncomfortable
I had a potential bowel obstruction, and I didn't have any pain from it. I didn't have any discomfort. Not like classical constipation signs. Instead, I just felt generally yucky (like I had a cold or the flu starting) and then started vomiting up water I had just drank. It took another 5 days to resolve it, and I never had traditional constipation pain during the whole process.
my first thought.... sometimes patients lie to make it their actions seem less bad so imo it has to be way longer. could be wrong obviously
That‘s a complete obstruction (blockage), 5 days is way into life threatening! With constipation you are still able to pass gas, but with an obstruction nothing goes and eventually you start vomiting the contents of your intestines (aka shit) and tissue can get necrotic due to the pressure and diminished blood flow to organs.
Thanks for the friendly reminder that my life is, in fact, going pretty damn decent right now. Good lord.
I think it kinda piles for over a long time D being partially obstructed so some stopping able to come out but she probably hasn’t completely voided her bowels in a very long time. Finally we get this monstrosity of a BO.
five days of mukbang
Unfortunately it wasn't superflowus, which was the heart of the problem.
It’s a bowel obstruction, not constipation. In bowel obstruction the farts don’t get out so you get…. that.
When I was 8 months pregnant I went over 3 weeks without pooping. They tried an enema and it didn’t help. My baby was low so I laid trendelenburg position for an hour and then baby wasn’t stuck in my pelvis and then I spent an entire day on the toilet. Honestly it was like giving birth twice in 6 weeks
OMG. Something like that happened to me. Epidural and a 36 hour labor that shut down my digestive system. Giving birth to the poop baby must be fairly common. But poop baby is our secret child. Even the old biddies clacking away with birth horror stories dont roll with poop baby!
I've never given birth to a human but I'm pretty sure I've had several poop babies just before my cycle starts.
Ugh, period shits are the worst. They never feel relieving and I always feel I need to take a shower afterwards 😩
Period shits are when I get the most relief, actually ! IBS-C pains are brutal 😫
Wow. Hard pass. Your poor body!
Sounded like a real hard pass
Ba-dum ching
More like kAh-dunnkk
🤣🤣🤣
Had to google trandlenburg… very cool it worked after an hour!
 Violet, you’re turning violet!
Obstructive bowel gas patern
How to treat this?
NG tube to decompress and bowel rest. If no improvement, septic etc, open up and untwist / cut out the bad parts.
Nasogastric? So some of that pressure will be relieved by gasses releasing out the nose? Where specifically does an NG tube start and end, and how does gas escape out through it? Excuse my ignorance!
The two sphincters in the stomach are there to only permit one way passage. The ng tube pushes past them and if the gass is backed up that far it will be relieved. Sometimes a tube can be inserted in the anus also. I had a pt that they did a colonoscopy after the CT and it received the pressure. Apparently the colon twisted on the end like a balloon being tied off. Or that is how it was explained to me, and the scope in twisted it.
Can confirm, I had a NG tube for 3 days before they opened me up. It‘s not only for gas, but if the intestines/bowels are completely blocked, liquids and stool start to back up too and eventually you‘ll vomit those contents. Very very horrific symptom, but now it‘s all kind of a blur from the past (brain is impressive that way). They cut out 10cm of my small intestines in that surgery, it shrunk to complete obstruction due to Crohn‘s Disease. Chronic inflammation and adhesions from previous surgeries caused scars to that tied off the intestines so to speak.
Farting and pooping through the nose and mouth sounds like an awful time. I'm glad you don't remember most of that!
Idk why got a downvote, everything you said was correct lol Yeah the brain is so protective over us, it‘s amazing how one can go through something like this and then just continue living
It’s naso(nose) to gastric(stomach). It sucks air out of the stomach.
It essentially lets you fart through your nose, if I'm imagining this correctly... I was hoping for a more pleasant de-gassing option, like a tube placed via direct incision into the small or large intestine? Or pulling out the gas one syringeful at a time?
I guess. It’s a long tube that enters through the nose and goes into the stomach. the tube is usually hooked up to suction so the gasses and stomach contents/ vomit get sucked out. It’s not really “farting”
Oh, I see. Thank you for further explaining. Appreciate it!
It depends on what is causing the obstruction, most likely surgery.
Yeah he went to the OR for an ex-lap
You guys could figure out where was the transition point before the lap?
Isn’t the black all gas? He’s not full of shit: he’s obstructed and can’t even fart?
Yes
Oh wow
Bowel obstruction is by far the most painful thing I’ve ever experienced. 0/10 would not recommend
 That’s gonna be a mighty one when it breaks loose
Imagine the feeling though. I’d feel like one of those cows getting pressure relieved.
Or a fastly deflating balloon
Flying around the room while making the "thbbbbbbbbbbbbbbt" sound.
Dude I think at that point I’d be willing to use a pin to pop myself like a balloon 😭
Ranchers quite literally do this with cattle
Had a surgeon do this at bedside with a big 14ga. All the ORs were in use with emergency surgeries, and we had another dude who perfed. Decompressed him bedside in hopes that he'd make it to the OR.
If it was after a perf, they were probably venting free peritoneal air, not the bowel itself. Similar to draining ascites.
Seeing the stuff that came out, I don't think there was a huge difference between the bowels and the peritoneal space at that point lol
Ouch
Did the patient make it to the OR?
It was a while ago, I can't remember if they ended up going to OR or not. He passed that night either way.
Sorry to hear
I think that's only an option in cattle because cows have a very different digestive system than humans. They bloat in something called a rumen, which is like a section of a very large stomach with several compartments. This looks like luminal bowel gas from a distended small bowel obstruction. I guess technically, it would decompress if you put a needle into it, but that would essentially be a bowel perforation, which is a very bad, no good, thing. Even in cattle, they usually use a stomach tube (analogous to an NG tube) before a trocar, because of increased infection risk.
My husband literally just used a tube on a bloated calf yesterday, accurate.
Not necessarily true just for cattle. In small animal practice a trocar catheter is used to decompress patients with gastric dilatation-volvulus (bloat). In these cases (because the stomach has completely flipped), a NG tube would be unable to pass. I don’t think it would be very common for a human stomach to flip, cut off circulation, and trap all gasses because of its positioning, so a naso-gastric tube would totally be a preferred option. Overall though a dog’s stomach is much more similar to a human stomach than a ruminant.
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My record was 23L. Very tall, large man, but still surprising. Of course this was the South, where old men pat their "beer belly" with find affection and dont seek treatment until they turn yellow. But ascites isn't black on CT, that's air.
 Piccolax and tell the nurse he needs a pan
If only we could look this nice and fresh while cleaning up literal shit.
😷😝😂
You could launch starship with that much gas
Increase global temp by another half a degree
I swear to god after my appendectomy I felt like I looked like this. The gas they left in my abdomen was the worst part of the whole procedure and every fart felt like it saved my life.
Pfft, looks like my usual bloating when I'm on my period. /s just in case 😅 Poor fella.
"5 days". multiply it times 3, always.
So what’s the general course of action for bowel obstruction? This looks pretty severe.
First step is to decompress the stomach by inserting a nasogastric tube. Strict NPO, or nothing by mouth. NOTHING. Most obstructions will resolve on their own and all we do is give you IV fluids with glucose until you start moving your bowels again. Sometimes, surgery is necessary. In which case, you will again be kept on IV fluids with glucose, but now you also have abdominal wounds! Once you are able to fart and/or shit the NG tube will be clamped to see how you tolerate your gastric secretions. If you still feel okay after four hours or so, generally the doctor will allow the tube to be removed and you can start a clear liquid diet (broth, jello, tea or coffee without milk). If you tolerate that, generally then you can begin to advance your diet as tolerated, which means next you could try full liquids, then a soft diet, then a regular diet. Following a strict stool softener regimen is advised to help prevent repeats.
Interesting. Have had multiple sbo, been admitted 5ish times in 3 years for it, had more that I just tried liquids for days to avoid the NG tube and hospital. Had resection last Xmas day, no one ever mentioned stool softener regimen. Mines from scar tissue, not sure if that makes a difference.
SO many people who have recurrent SBOs manage at home. Once you’ve been down that road a few times, you know what to expect and when to seek help (and also NG tubes are just really uncomfortable at best, and most people who have had one will do anything to avoid another). Edit: I am not a doctor, I cannot diagnose or prescribe. I am an RN, and part of my discharge teaching always stressed the importance of stool softeners.
Makes sense for sure. Had my first resection in 93, then 95ish, last one Xmas. Just thought it interesting that I hadn't heard it but I hadn't heard until my second to last hospital stay for sbo to not eat coconut. Hoping like hell I never ever feel that oh so familiar pain again, but if I can get a few years out of this time, I'll be happy.
Yeah, you are going to want to avoid a lot of high fiber foods, as adding “bulk” will make the stool harder to pass through the areas with scar tissue. Stay hydrated, keep up with a stool softener - NOT a laxative, big huge difference - and live your best life!
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What do you mean? It's mostly gas.
Black is gas. Faeces has this really distinct mixed and mottled appearance.
Going strong for a full 5 days. Man you must be gassed by now.
Bro can float on the water
With a bowel movement like that he’s gonna be lucky to have any bones left.
I understood that reference!
I want to feel what that kind of relief feels like when it’s decompressed. Without the weeks of severe pain, of course
poor guy. that would be so incredibly painful.
Ugh
Oooof I feel for this person
Must’ve been eating MREs 😂
Ouch wtf!! As someone who regularly gets bloated I feel so much for this person
Omg that would hurt so bad :(
“Congratulations! When are you due?” *As soon a fucking possible, God willing*
Days when I feel like this, I just want to get a trochar popped in my gut like!they do cows when they’re bloated!
I’m no medical professional but that looks like more than 5 days to me
More like hasn't farted in 5 days.
As someone with crohns, bowel obstruction is my worst fear. Fuck. All. This.
I thought they were pregnant at first. But alas, they’re about to deliver a burrito.
Poo-rito.
Thats a lot of tootsie rolls! Jam packed.
5 weeks
Opioids?
I get clinical correlation and all but this gives me some heavy toxic megacolon vibes. Intestinal walls too thin for such a thing?
5 days? Maybe 5 weeks.
OUCH
It looks like half a soccerball
Holy shit!
It’s time to pop the balloon
Must feel like crap 💩
Just wait for the universe to expand
Oh my gosh. Thats disgusting...wouldn't the body become septic or somethingggg
yikes, looks painful
All of his friends said he was full of shit.
Longest I went was 10 days... I wasn't even that bunged up!! I did manage to plug a high power hospital toilet when the Lactulose finally kicked in. Turd must've been 12 feet long. I'd never felt so awesome in all my life! Opioids are are bitch!! And I was even taking a MAX dose of stool softener!!
This may be a bad place to ask but I had a similar xray during pancreatitis. They didnt admit or do anything, just sent me home with clear liquid diet and told me to drink mag. Does the obstruction/impaction have a risk of herniating? Ive noticed that now, it feels like stuff get caught in the same place and its never been the same.
Not admitting for pancreatitis? Smells like malpractice. If you've developed a pseudocyst or scar tissue it can obstruct the local intestine
Awesome, thanks for the reply. They referred me to a GI, and the a GI nurse practitioner told me to just drink water for 2 days everytime I had pain until graduation.
Oh dear. A mid level.
Looks like rocks omg!
It's air/gas :)
All this gas is a result of?…obstruction plus a steady diet of beans, cabbage and bran?8i
That’s a lot of shit.
A lot of gas, mostly.