Bowel obstruction Non-operative management: Difference between revisions
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==Overview== | ==Overview== | ||
Many patients without indications for surgery may initially undergo non-operative management of bowel obstruction. Non-operative treatment includes gastrointestinal decompression and water-soluble contrast. Success rates vary by etiology of bowel obstruction. Bowel obstruction caused by adhesion has a high success rate of resolving non-surgical, where as complete obstruction have low success rates. | Many patients without indications for [[surgery]] may initially undergo non-operative management of bowel obstruction. Non-operative treatment includes [[gastrointestinal]] [[decompression]] and water-soluble [[contrast]]. Success rates vary by [[etiology]] of bowel obstruction. Bowel obstruction caused by [[adhesion]] has a high success rate of resolving non-surgical, where as complete [[obstruction]] have low success rates. | ||
==Indications== | ==Indications== | ||
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**Early postoperative bowel obstruction | **Early postoperative bowel obstruction | ||
***Bowel obstructions that occur early on post-operatively are less likely to be strangulations | ***Bowel obstructions that occur early on post-operatively are less likely to be strangulations | ||
**Inflammatory bowel disease | **[[Inflammatory bowel disease]] | ||
***Must not be fulminant or having a history of refractory strictures | ***Must not be [[fulminant]] or having a history of refractory [[strictures]] | ||
**Gallstone ileus | **[[Gallstone ileus]] | ||
***The stone may pass during a period of observation | ***The stone may pass during a period of observation | ||
**Infectious small bowel disease | **[[Infectious]] small [[bowel]] disease | ||
***Such as those caused by tuberculosis and Crohn's disease | ***Such as those caused by [[tuberculosis]] and [[Crohn's disease]] | ||
**Colonic diverticular disease | **Colonic [[diverticular disease]] | ||
***May benefit from lone antibiotic therapy | ***May benefit from lone [[antibiotic therapy]] | ||
==Non-operative management== | ==Non-operative management== | ||
===Gastrointestinal decompression=== | ===Gastrointestinal decompression=== | ||
*Patients with excessive distension and severe symptoms of nausea and vomiting, nasogastric decompression may be carried out to | *Patients with excessive [[distension]] and severe [[symptoms]] of [[nausea and vomiting]], nasogastric decompression may be carried out to relieve symptoms. | ||
*Patients with chronic or recurrent bowel obstruction, long tube decompression may be useful in conservative management. | *Patients with [[chronic]] or recurrent [[bowel obstruction]], long tube [[decompression]] may be useful in conservative management. | ||
===Water-soluble contrast=== | ===Water-soluble contrast=== | ||
*Gastrograffin is introduced into the bowel in an attempt to relieve partial small bowel obstruction. | *[[Gastrograffin]] is introduced into the [[bowel]] in an attempt to relieve partial [[small bowel obstruction]]. | ||
*Gastrograffin is hypertonic drawing fluid to it in order to relieve edema of the bowel wall and to stimulate peristalsis. | *[[Gastrograffin]] is [[hypertonic]] drawing [[fluid]] to it in order to relieve [[edema]] of the [[bowel]] wall and to stimulate [[peristalsis]]. | ||
*Plain x-rays of the abdomen are taken within a 24 hour period of administration. | *Plain [[x-rays]] of the [[abdomen]] are taken within a 24 hour period of administration. | ||
*If gastrograffin is seen to reach the colon, then this is a good indication of success of non-operative management, otherwise surgery may be considered. | *If [[gastrograffin]] is seen to reach the [[colon]], then this is a good indication of success of non-operative management, otherwise [[surgery]] may be considered. | ||
**Dosage: 7.5 mL over 30 minutes, up to 22.5 mL over 2 hours | **Dosage: 7.5 mL over 30 minutes, up to 22.5 mL over 2 hours | ||
***Dosing can be repeated if ineffective initially, up to 100ml | ***Dosing can be repeated if ineffective initially, up to 100ml | ||
*Water-soluble contrast study has been found to predict resolution of bowel obstruction upon non-operative management with a sensitivity of 92% and a specificity of 93%. | *Water-soluble [[contrast]] study has been found to predict resolution of [[bowel obstruction]] upon non-operative management with a [[sensitivity]] of 92% and a [[specificity]] of 93%. | ||
==Observation== | ==Observation== | ||
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==Failure of non-operative management== | ==Failure of non-operative management== | ||
*A failure is categorised as an obstruction that persists for more than 5 days. | *A failure is categorised as an [[obstruction]] that persists for more than 5 days. | ||
*The decision to move forward with surgery is based upon individual clinical status. | *The decision to move forward with [[surgery]] is based upon individual clinical status. | ||
Revision as of 22:01, 7 February 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Many patients without indications for surgery may initially undergo non-operative management of bowel obstruction. Non-operative treatment includes gastrointestinal decompression and water-soluble contrast. Success rates vary by etiology of bowel obstruction. Bowel obstruction caused by adhesion has a high success rate of resolving non-surgical, where as complete obstruction have low success rates.
Indications
- Non-operative management indications include:[1][2][3][4][5]
- Early postoperative bowel obstruction
- Bowel obstructions that occur early on post-operatively are less likely to be strangulations
- Inflammatory bowel disease
- Must not be fulminant or having a history of refractory strictures
- Gallstone ileus
- The stone may pass during a period of observation
- Infectious small bowel disease
- Such as those caused by tuberculosis and Crohn's disease
- Colonic diverticular disease
- May benefit from lone antibiotic therapy
- Early postoperative bowel obstruction
Non-operative management
Gastrointestinal decompression
- Patients with excessive distension and severe symptoms of nausea and vomiting, nasogastric decompression may be carried out to relieve symptoms.
- Patients with chronic or recurrent bowel obstruction, long tube decompression may be useful in conservative management.
Water-soluble contrast
- Gastrograffin is introduced into the bowel in an attempt to relieve partial small bowel obstruction.
- Gastrograffin is hypertonic drawing fluid to it in order to relieve edema of the bowel wall and to stimulate peristalsis.
- Plain x-rays of the abdomen are taken within a 24 hour period of administration.
- If gastrograffin is seen to reach the colon, then this is a good indication of success of non-operative management, otherwise surgery may be considered.
- Dosage: 7.5 mL over 30 minutes, up to 22.5 mL over 2 hours
- Dosing can be repeated if ineffective initially, up to 100ml
- Dosage: 7.5 mL over 30 minutes, up to 22.5 mL over 2 hours
- Water-soluble contrast study has been found to predict resolution of bowel obstruction upon non-operative management with a sensitivity of 92% and a specificity of 93%.
Observation
- Patients are observed for a period not exceeding 12 - 24 hours after non-operative management has taken place.
- If no improvement is noted, then the patient is recommended to be explored surgically.
Failure of non-operative management
- A failure is categorised as an obstruction that persists for more than 5 days.
- The decision to move forward with surgery is based upon individual clinical status.
References
- ↑ Oyasiji T, Angelo S, Kyriakides TC, Helton SW (2010). "Small bowel obstruction: outcome and cost implications of admitting service". Am Surg. 76 (7): 687–91. PMID 20698371.
- ↑ Brolin RE, Krasna MJ, Mast BA (1987). "Use of tubes and radiographs in the management of small bowel obstruction". Ann. Surg. 206 (2): 126–33. PMC 1493109. PMID 3606237.
- ↑ Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD (2008). "Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial". World J Surg. 32 (10): 2293–304. doi:10.1007/s00268-008-9694-6. PMID 18688562.
- ↑ Catena F, Di Saverio S, Coccolini F, Ansaloni L, De Simone B, Sartelli M, Van Goor H (2016). "Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention". World J Gastrointest Surg. 8 (3): 222–31. doi:10.4240/wjgs.v8.i3.222. PMC 4807323. PMID 27022449.
- ↑ Azagury D, Liu RC, Morgan A, Spain DA (2015). "Small bowel obstruction: A practical step-by-step evidence-based approach to evaluation, decision making, and management". J Trauma Acute Care Surg. 79 (4): 661–8. doi:10.1097/TA.0000000000000824. PMID 26402543.