Nonoperative management of small-bowel obstruction with endoscopic long intestinal tube placement

Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%...

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Bibliographic Details
Published inThe American surgeon Vol. 56; no. 10; p. 587
Main Authors Snyder, C L, Ferrell, K L, Goodale, R L, Leonard, A S
Format Journal Article
LanguageEnglish
Published United States 01.10.1990
Subjects
Duodenal Obstruction - therapy
Duodenoscopy
Female
Follow-Up Studies
Humans
Intestinal Obstruction - therapy
Intubation, Gastrointestinal - adverse effects
Intubation, Gastrointestinal - instrumentation
Intubation, Gastrointestinal - methods
Jejunal Diseases - therapy
Length of Stay
Male
Middle Aged
Retrospective Studies
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Summary:Intestinal obstruction remains a major cause of morbidity and mortality in surgical patients. We reviewed the records of 77 patients with mechanical small-bowel obstruction who were treated with endoscopically and fluoroscopically placed Leonard long intestinal tube decompression. Most patients (59%) had failed a trial of nasogastric tube or Miller-Abbott tube decompression. Overall, 29 per cent of patients were able to resolve their obstruction with Leonard tube decompression alone. Subdivision of patients on the basis of the etiology of their obstruction demonstrated a much higher rate of success for tube decompression in adhesive obstruction (37%) versus malignant obstruction (12%) or inflammatory obstruction (no successes). Patients with radiographic and clinical evidence of complete intestinal obstruction were significantly less likely to respond to long intestinal tube treatment (13%). The long intestinal tube was easily passed in all patients. There were no complications of the intubation procedure in our series, and the incidence of tube-related complications was four per cent. We conclude that an initial period of long intestinal tube decompression allows a significant percentage of patients with mechanical small-bowel obstruction to be treated nonoperatively, particularly if a partial obstruction from postoperative adhesions is present. Patients who have failed a trial of nasogastric tube decompression and are poor operative risks should also be considered for long intestinal tube placement.
ISSN:0003-1348