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
- 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 relief 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.