Bowel obstruction Non-operative management

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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:
  • 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

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
• 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

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