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Long tube decompression is successful in 90% of patients with adhesive small bowel obstruction

      Abstract

      Background

      For patients with small bowel obstruction (SBO), who do not have strangulation obstruction or other contraindications, long tube decompression has been successful in 75% in two studies. In a 1995 prospective randomized study, comparing nasogastric suction (short tube) with long tube decompression, the short tube was successful in 51% and the long tube was successful in 75%. Using upper gastrointestinal endoscopy, a long tube can be advanced into the jejunum in 20 minutes, so the delay in function has been eliminated.

      Methods

      There were 35 patients with 37 episodes of SBO. From 1983 to 1988, three tubes then available were advanced endoscopically into the jejunum in 17 patients. From 1989 to 2002, an improved tube designed for endoscopic placement was used in 20 patients.

      Results

      From 1983 to 1988 using three tubes, long tube decompression was successful in 12 of 17 (70%); from 1989 to 2002 with the improved tube, decompression was successful in 18 of 20 (90%).

      Conclusions

      For patients with SBO due to adhesions, a trial with long tube decompression for 48 to 72 hours is recommended. For those who fail a trial with the long tube, laparotomy with enterolysis or bowel resection is indicated. If the operative findings indicate a high risk for recurrent obstruction, then long tube splinting of the small bowel should be considered.
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      References

        • Wangensteen O.H
        • Paine J.R
        Treatment of intestinal obstruction by suction with a duodenal tube.
        JAMA. 1933; 101: 1532-1539
        • Wangensteen O.H
        Historical aspects of the management of acute intestinal obstruction.
        Surgery. 1969; 65: 363-383
        • Wangensteen O.H
        Understanding the bowel obstruction problem.
        Am J Surg. 1978; 135: 131-149
        • Abbott W.O
        • Johnston C.G
        Intubation studies of the human small intestine.
        Surg Gynecol Obstet. 1938; 66: 691
        • Douglas D.D
        • Morrissey J.F
        A new technique for rapid endoscopic assisted intubation of the small intestine.
        Arch Surg. 1978; 113: 196-198
        • Gowen G.F
        • DeLaurentis D.A
        • Stefan N.M
        Immediate endoscopic placement of a long intestinal tube in partial small bowel obstruction.
        Surg Gynecol Obstet. 1987; 165: 456-457
        • Gowen G.F
        Decompression is essential in the management of small bowel obstruction.
        Am J Surg. 1997; 173: 459-460
        • Gowen G.F
        Long tube decompression in small bowel obstruction.
        J Pelvic Surg. 1997; 3: 43-47
        • Baker J.W
        A long jejunostomy tube for decompressing intestinal obstruction.
        Surg Gynecol Obstet. 1959; 109: 519-523
        • Baker J.W
        An historical overview of surgical decompression in advanced intestinal obstruction.
        Surg Gynesal Obstet. 1984; 158: 593
        • Gowen G.F
        • Malloy T.R
        Prevention of postoperative adhesive obstruction using the long tube to splint the small bowel.
        J Pelvic Surg. 1998; 4: 174-179
        • Quatramoni J.C
        • Rosoff L
        • Halls N.B
        • Yellin A.E
        Early postoperative small bowel obstruction.
        Am Surg. 1980; 191: 72-74
        • Wolfson P
        • Bauer J
        • Gelernt J.M
        • et al.
        Use of the long tube in the management of patients with small bowel obstruction due to adhesions.
        Arch Surg. 1985; 120: 1001-1006
        • Fleshner P.R
        • Seigman M.G
        • Slater G.I
        • et al.
        A prospective randomized trial of short versus long tubes in adhesive small bowel obstruction.
        Am J Surg. 1995; 170: 366-369
        • Welch J.P
        Bowel obstruction. Philadelphia, WB Saunders1990
        • Sarr M.G
        • Buckley B.V
        • Zuidema G.D
        Preoperative recognition of intestinal strangulation obstruction.
        Am J Surg. 1983; 145: 176-182
        • Pickelman J
        • Lee R.M
        Management of patients with early small bowel obstruction.
        Ann Surg. 1989; 201: 216-219
      1. Beck D, Becker J, Fazio V, Wexner S. Prevention and treatment of adhesive small bowel obstruction. A symposium, American Society of Colon and Rectal Surgeons, 1997