Super Safi’s Monday Morning Musings 72 – Bowel Obstruction

Morning Musically-Minded, Medically-Minded, Masticators!

(Today’s post is sponsored by the letter “M”)

Over the past 600+ episodes, The Simpsons has taken us on an amazing journey involving music, science, and food to name a few concepts.

And what better way to start your week, than by discussing some of these concepts Monday morning?

So let’s get started this week by talking about a medical emergency.

In the seventy second episode of The Simpsons, Selma’s Choice (Season 04, Episode 13), Marge, Patty, and Selma’s Aunt Gladys has passed away from a bowel obstruction.

Marge: “Kids, I have some bad news. I’m afraid your great-aunt Gladys has… passed on.”
Bart: “Gladys, Gladys… about yea high, blue hair, big dent in her forehead…”
Marge: “No… Gladys looked more like your Aunt Patty.”
Bart thinks for a moment; then shudders: “Oh yeah, there she is.”

Much to Hoemr’s chagrin, the family has to go to the funeral instead of going to Duff Gardens. On top of that, Homer is so upset that the funeral is not catered that he starts weeping hysterically at the casket. Marge mistakes Homer’s tears for food as tears for her beloved aunt.

After the funeral service, lawyer Lionel Hutz plays Gladys video will.

Lionel Hutz: “Hi, I’m Lionel Hutz, executor of Gladys Bouvier’s estate. She left a video will, so I earn my fee simply by pressing this “Play” button. Pretty sweet, eh?”

The will continues with distribution of assets including a grandfather clock to Patty and Selma, her potato chips that resemble celebrities to Marge (which Homer proceeds to eat right away), and Jubjub to her sister Jackie.

Aunt Gladys: “To my sister Jackie, I leave my pet Iguana, Jub-Jub.”
Jackie Bouvier: “Why didn’t she just leave me the bowel obstruction that killed her?“

But have you ever wondered what a bowel obstruction is?

Bowel Obstruction

According to Health Canada, a bowel obstruction is a blockage of the small intestine or large intestine (as intestines are also known as bowels).

The most common reasons for bowel obstruction in the small intestines are adhesions (75%), hernia, cancer, and strictures associated with Crohn’s disease. As for bowel obstructions of the large intestine, the most common reasons are cancer (60%), diverticulitis (20%), volvulus (5%), and fecal impaction.

The exact symptoms of obstruction depend on the location and severity of the obstruction. The higher the level of obstruction, the more acute and rapid the onset of symptoms.

Symptoms of small bowel obstruction include:

• Pain moderate to severe
• Intermittent waves of pain (every 4-5 minutes)
• Relative comfort between waves of pain
• Constant severe pain if bowel strangulation (up to 40% of cases of small-bowel obstruction)
• Vomiting frequent, violent, bilious when obstruction is high
• Vomiting feculent when obstruction is lower
• Abdominal distention; prominent when obstruction is low
• Reduced rectal gas and stool passage
• Weakness

Symptoms of large bowel obstruction include:

• Pain moderately severe (generally less acute than in small-bowel obstruction)
• Colicky
• Distention present, occurs early, may be severe
• Vomiting usually late and infrequent, may be feculent
• Reduced or absent rectal gas and stool
• Sudden onset of severe pain is a classic manifestation of volvulus
• Change in size of stool indicative of possible cancer, increased risk if weight loss

Other conditions that mimic these symptoms of bowel obstruction include:

• Gastroenteritis/Enteritis
• Cholecystitis
• Constipation/Obstipation
• Diverticular disease
• Appendicitis
• Inflammatory bowel disease with distention
• Perforated ulcer
• Pancreatitis
• Mesenteric ischemia
• Ovarian distortion, pelvic inflammatory disease, ectopic pregnancy

Tests that a doctor may do include x-ray, CT scan, test stool for occult blood, perform urinalysis, measure hemoglobin, and check for increased white blood cells.

If untreated, complications include:

• Perforation
• Intra-abdominal abscess
• Strangulated segment of bowel
• Sepsis
• Hypotension, shock
• Death

Goals of treatment include relieving distention, maintaining hydration, and preventing complications. Treatment involves bed rest, no food by mouth, pain relievers, and antibiotics.

Now that we’ve learned more about bowel obstructions, be sure to come back next week when we continue our Monday morning musings with the next episode of The Simpsons.

Did you remember the episode? What’s your favourite Selma centric episode of The Simpsons? What about your favourite Simpsons medical reference? Were you familiar with bowel obstructions? Do you know anyone who’s ever had a bowel obstruction? Sound off in the comments below. You know we love hearing from you.