A new method for insertion of long intestinal tube for small bowel obstruction: Nonendoscopic over-the-wire method via short nasogastric tube

Clinical application of super-low-positioned intestinal decompression tube in the treatment of intestinal obstruction: a pilot study

OBJECTIVE

This study aimed to evaluate the clinical application and efficacy of a super-low-positioned intestinal decompression tube in the treatment of intestinal obstruction.

METHODS

A total of 130 patients with postoperative small bowel obstruction were included in this study. The patients were divided into a super-low-positioned intestinal decompression group and a conventional intestinal decompression group. The clinical data, treatment outcomes, and complications were compared between the two groups.

RESULTS

The technical success rate of placing the super-low-positioned intestinal decompression tube was 100%, with no intraoperative complications. The patients in the super-low-positioned intestinal decompression group had a significantly shorter hospital stay (8.3 ± 5.2 vs 17.7 ± 13.3, P < 0.001) and a higher non-operative treatment success rate (83.6% vs 57.9%, P = 0.001) compared to the conventional intestinal decompression group. Multivariate logistic regression analysis showed that the placement of a super-low-positioned intestinal decompression tube was an independent protective factor for treatment outcomes (P = 0.001). The hospital stay was significantly shorter in the super-low-positioned intestinal decompression group compared to the conventional group in both successful non-operative treatment patients (6.9 ± 3.0 vs 11.2 ± 7.5, P < 0.001) and failed non-operative treatment patients (16.2 ± 7.4 vs 26.6 ± 14.4, P < 0.001). The super-low-positioned intestinal decompression tube effectively relieved the "Self-strangulation" phenomenon in patients with intestinal obstruction.

CONCLUSION

The super-low-positioned intestinal decompression tube is a safe and effective method for the treatment of intestinal obstruction, with better treatment outcomes and shorter hospital stays compared to conventional intestinal decompression. Further prospective studies are needed to validate these findings.

Spiral Computed Tomography with Phytocomposition as a Diagnostic Tool for Adhesive Intestinal Obstruction

BACKGROUND

Adhesive intestinal obstruction is a common and potentially lethal complication after surgical interventions in the abdomen. Radiologic imaging is the main diagnostic method.

OBJECTIVE

This study aims to analyse the diagnostic value of spiral computed tomography with a novel method (n = 54).

MATERIAL AND METHODS

In this multidirectional cohort study, we present the data with non-parallel (historical) control. This study included the analysis of results of patients with a diagnosis of intestinal obstruction (n = 54) who were admitted to the surgical departments of the City Clinical Hospitals (Ufa city) from 2013 to 2019; the patients' examination methods included computed tomography with conventional enhancement. The proposed novel enhancement method was implemented by ingesting a mixture containing 50 ml of the contrast Unigexol (300 mg) in 1.0 L cold mineral carbonated water, and Computed tomography (CT) was performed during 40 min after ingesting the contrast meal. Further, the patients with suspected obstruction in the colon were administered a pre-prepared contrast enema with a decoction of leaves of smoke-tree (100 g), chamomile flowers (100 g) and calendula flowers (100 g). Additionally, CT was performed.

RESULTS

Obstruction was conservatively stopped in 24 (44.4%) patients of the main group. Remaining 30 (55.6%) patients from the main group were operated with minimal surgical access in the early stages.

CONCLUSION

Owing to early diagnosis of intestinal obstruction and application of the phytocomposition during the examination, exerting various effects such as antispasmodic, analgesic, disinfectant, bactericidal, cicatrising, choleretic, tanning and decongestant, unnecessary surgical interventions were prevented.

Adhesive small bowel obstruction - an update

Small bowel obstruction (SBO) accounts for 12-16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra-abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non-adhesive etiologies as adhesive SBO (ASBO) can be managed non-operatively in 70-90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed-loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non-operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.

Fluoroscopy-guided long intestinal tube placement for the treatment of malignant bowel obstruction

The aim of the present study was to investigate the safety and efficacy of long intestinal tube placement under fluoroscopic guidance for the treatment of malignant bowel obstruction (MBO). The cases of 74 patients with MBO who underwent long intestinal tube placement under fluoroscopic guidance during the period between June 2015 and October 2017 were reviewed. The clinical characteristics were retrospectively analysed with respect to efficacy, safety and outcome. Long intestinal tube placement was successfully completed in all 74 patients. The mean time required for tube placement was 31.09±16.25 min and the mean insertion depth of the tube was 153±39 cm. In 58 cases, the symptoms of abdominal pain, abdominal bloating and vomiting were greatly improved following 1-3 days of tube decompression. The symptoms of the remaining 16 patients were not effectively relieved following decompression. No serious complications were observed in any patients. Overall, for patients with severe MBO, long intestinal tube placement under fluoroscopic guidance appears to be an effective and safe treatment, and it may improve quality of life.