Filming of "Wheel of Fortune" was halted last week when host Pat Sajak underwent emergency surgery. A message from the show's Twitter page :
"Our taping on Thursday was canceled because host Pat Sajak underwent successful emergency surgery to correct a blocked intestine. He is resting comfortably and looking forward to getting back to work."
The specific cause of the intestinal obstruction was not revealed but Sajak is expected to be out for about 2 weeks. During that time, co-host Vanna White has taken over Sajak's duties, while Disney characters Mickey, Minnie, Donnie, Goofy, and Pluto will be turning letters.
Sajak has hosted Wheel of Fortune since 1983. With Sajak returning for his 36th season in 2018–19, he became the longest-running host of any game show, surpassing Bob Barker, who hosted The Price Is Right from 1972 to 2007.
Intestinal Obstruction
Intestinal or bowel obstruction is a mechanical or functional blockage of the small or large intestine. According to the Radiological Society of North America, :
- Complete or high-grade obstruction, such that no fluid or gas pass beyond the site of obstruction.
- Incomplete or partial obstruction, such that some fluid or gas pass beyond the obstruction.
- Strangulated obstruction, such that blood flow is compromised, which may lead to intestinal ischemia, necrosis, and perforation.
- Closed-loop obstruction, when a segment of bowel is obstructed at two points along its course, resulting in progressive accumulation of fluid in gas within the isolated loop, placing it at risk for volvulus and subsequent ischemia.
Obstruction can occur in any segment of the intestines, but more commonly originates in the small intestine than in the large intestine.
Etiology
Causes of obstruction are classified as either extrinsic, intrinsic, or intraluminal. In industrialized countries, the most common cause of bowel obstruction is extrinsic- typically from post-surgical adhesions, and account for 65%-75% of cases of small bowel obstruction (SBO). Other extrinsic causes include hernias (10%-20%), malignancy (10%-20%), inflammatory bowel disease (5%), volvulus (3%), and other miscellaneous causes (2%). The causes of SBO in pediatric patients include congenital atresia, pyloric stenosis, and intussusception.
Intrinsic causes include bowel disorders which lead to bowel wall thickening. This can ultimately lead to strictures and obstruction. Crohn's disease is the most common cause of such strictures. Intraluminal causes are less common and usually are caused by ingestion of a foreign body that is unable to pass through the bowel lumen or the ileocecal valve. Large bowel obstructions (LBO), which comprise about 10%-15% of intestinal obstructions, and most commonly occur in the sigmoid colon, are caused by adenocarcinoma, diverticulitis, and volvulus.
Symptoms
Symptoms of intestinal obstruction include:
- Severe abdominal pain or cramping
- Vomiting
- Bloating
- Loud bowel sounds
- Swelling of the abdomen
- Inability to pass gas
- Constipation
Although many of the symptoms of SBO and LBO overlap, the timing, quality, and presentation often differ:
Diagnosis
Although a diagnosis of bowel obstruction may be suspected by the clinical history and physical finds, imaging studies are needed to delineate a definitive diagnosis. Important information received through these studies includes the location of the obstruction, whether it is complete or partial, and possibly an etiology.
Plain x-rays may be the most practical studies as they are readily available and are inexpensive. Classic signs such as "northern exposure," "coffee bean," and "whirl" signs may demonstrate a volvulus. Free air may point to a pneumoperitoneum.
However, if a patient is stable, an abdominal CT with PO contrast is highly sensitive and specific for detecting intestinal obstruction.
Treatment
Management of a patient with bowel obstruction is dependent on the patient's clinical stability plus whether the obstruction is complete or partial and the etiology of the obstruction.
Partial, low-grade obstructions may be treated with nasogastric tube decompression and supportive care.
Patients with complete, high-grade obstructions or with non-reducible or strangulated hernias require surgical intervention, as the risk of complications such as bowel ischemia, perforation, and sepsis increase over time.
Patients with Crohn's disease and malignancy also require illness-specific therapies.
Prognosis
With proper management initiated promptly, the prognosis of bowel obstruction is good. However, there is some evidence that obstructions treated nonoperatively with initial success have a higher incidence of recurrence than do those treated surgically.
A recent from Paul Karanicolas of Sunnybrook Health Sciences Centre in Toronto, and colleagues -- -- seems to confirm this. The study of 27,904 patients "showed that operative intervention for a first episode of [acute SBO] decreased the risk of recurrence to 13.0% from 21.3% for nonoperative management. Moreover, the risk of further recurrences increased with each episode until surgery, after which it declined by about 50%."
These findings dispute the classic thinking that surgery should be avoided if possible as it may increase the risk of adhesions. The authors stress that guidelines have not taken into account the long-term consequences of non-surgical intervention and that early surgical intervention may ultimately lead to better overall outcomes.
Michele R. Berman, MD, and Mark S. Boguski, MD, PhD, are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.