Preventing and Resolving Post-Laparotomy Intestinal Obstruction: An Effective Shiatsu Method

American Journal of Chinese Medicine,  Wntr, 2000  by Haruhiko Saito

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The development of intestinal obstructions is one of the most troubling complications commonly seen in post-laparotomy patients. There are no clearly identifiable immediate causes, yet the symptoms progress relatively quickly once they show up, with the result that it is not unusual for surgery to be required to relieve these symptoms. Patients who have experienced the pain and distress of intestinal obstruction find their daily lives beset with constant anxiety that the symptoms will return unannounced, plunging them into new misery. This anxiety is all the greater in that the literature available for post-operative patients, including special medical texts, does not provide any clear information or guidance on how to prevent intestinal obstruction or how to relieve it should it occur.

About eight and a half years ago, I was operated on for stomach cancer, having about three quarters of my stomach removed. Following that, I recently published a short paper on "What I Learned from My Bout with Cancer" (Saito, 1997a) and have offered my professional views on posigastrectomy syndrome. These have then been reproduced in a number of prefectural medical association journals as well as on a national hospital's public website, thus giving them wide distribution and generating considerable feedback from both medical and patient communities (Saito, 1997b, 1997c, 1997d, 1999). The section on "Preventing Postoperative Intestinal Obstruction" was singled out by the Directors of the Japan Medical Association and other authorities for particular praise, and a number of people have urged me to have it translated for dissemination to the international community. This, then, is my experience, offered in the hope it might prove useful to others.

Accidental Discovery Born of Desperation

Because my medical history included not only the removal of three quarters of the stomach but also extensive removal of the lymph nodes, and because this surgery was followed by acute pancreatitis, I was a prime candidate for post-operative intestinal adhesion. Nonetheless, I was spared for nearly three years, and had virtually dismissed the possibility when I suffered my first attack of intestinal obstruction. Although this did not require invasive surgery, it was very traumatic and there was no way to avoid the anxiety and fear that I would again be visited by these sharp, unbearable pains. At its height, the pain defied treatment with the usual array of painkillers, and even intravenous injections of narcotics barely dented it.

I thus exercised every possible dietary and other care, but I was unable to stave off a recurrence. Less than four months later the symptoms of intestinal obstruction reappeared, this time in the still of the night. Because this was the second time, I was able to recognize the warning signs and was seized with mounting panic as the symptoms progressed relentlessly. I tried putting my finger down my throat to induce vomiting, but all that came up was a small amount of gastric juice and bile. At the same time, the sense of abdominal distention became increasingly conspicuous and increasingly painful. Taking a stethoscope I had at home, I put it to my abdomen and heard the metallic rasping said to be distinctive to intestinal obstruction. After tossing and turning in bed for some time, I made my way to the toilet and sat on the toilet bowl, hunched over enduring the pain. Although I pressed and kneaded my intestines in an effort to relieve the pressure, I was unable to induce a bowel movement or even the release of gas. Soon afterward, the intensity of the pain made it impossible for me to sit doubled up on the toilet. Determined to do whatever I could to avoid going back into the hospital and being tubed up, I sat praying for the power to endure for another minute and then one minute more, but the symptoms did not get any better.

When I had finally abandoned all hope and resolved to wake my wife and have her contact the duty doctor at the hospital where I worked, I pushed down on my pain and stood up. As I did, I straightened my back, put both hands behind me, and, in frustration, rubbed my back up and down vigorously a dozen or so times. Much to my surprise, this seemed to alleviate the pain a bit. Yet when I grew tired and stopped rubbing my back, the pain returned, as intense as ever. Deciding fatigue was preferable to pain, I rubbed my back vigorously again and found that, once again, the pain receded. Through repeated trial and error, I also discovered that it was more effective if I rubbed with my fists clenched than with my hands open.

Having been to hell and back, I was convinced that this self-administered back rub, which I had discovered quite by accident in agony, was the only way to relieve my intestinal obstruction. As the muscles in my back gradually unknotted, I slowly became able to think about what I was doing and to experiment to see if there was any left-right difference in the degree of relief offered by this vertical back rub. The result was that, in fact, only the right-hand side had any effect. Even on the right, I was gradually able to narrow the effective area down and to determine that the best effect was achieved in the area between the lower edge of the scapla to the upper edge of the iliac bone. Exploring this area by pressing forcefully with my thumb, I experienced a belch, heard my intestines begin to move again with an audible rumble, and then had a massive discharge of watery fecal matter. With that, my intestinal obstruction symptoms were virtually gone.