Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy

Obstruction of the intestines due to adhesions resulting from previous abdominal surgery is painful, results in vomiting and dehydration and requires urgent medical and often surgical intervention.

Typical management requires placement of a nasogastric tube (a small plastic tube inserted to drain the contents of the stomach and its gastric juices), intravenous rehydration and prolonged observation to see if the obstruction will spontaneously resolve. Often surgical intervention is necessary to relieve the obstruction. Although the practice of giving patients nothing by mouth might appear intuitive, there is little evidence to support it.

In this randomized controlled trial, Chen and coauthors assigned consecutive patients with partial small-bowel obstruction to receive either standard care and nothing by mouth (control group) or standard care plus oral therapy with a laxative, a digestant and a defoaming agent (intervention group).

Compared with patients in the control group, patients receiving oral therapy were more likely to have successful treatment without surgery (91% v. 76%); relative risk of avoiding surgery 1.19 (95% confidence interval 1.03 to 1.40). They also had shorter lengths of stay in hospital. Follow-up of all patients showed that there were no longer-term adverse events resulting from the new management strategy.

This study has important implications for clinical practice. Although further studies are needed to confirm and further explore these findings, clinicians and surgeons can apply the results to the management of similar patients and expect to see fewer patients requiring surgery and shorter stays in hospital.