Background
Nothing by mouth (NPO) is the standard treatment for small-bowel obstruction. Whether
oral medications should be prohibited during treatment of adhesive, partial small-bowel
obstruction is unclear. The goal of this study was to determine whether a combination
of specific oral medications in adhesive, partial small-bowel obstruction will decrease
the need for operative intervention.
Methods
Of 266 consecutive adult patients with partial small-bowel obstruction admitted at
a tertiary medical center, 236 were randomized into 2 groups. Group I patients were
treated with intravenous hydration, nasogastric tube decompression, and NPO. Group
II patients were placed on intravenous hydration, nasogastric tube decompression,
and oral fluids incorporating an oral laxative, a digestant, and a defoaming agent.
We compared differences between the groups in (1) the number of patients having a
successful nonoperative treatment, (2) complications, and (3) recurrence of symptoms.
Results
A total of 116 and 120 patients comprised groups I and II, respectively. The number
of patients treated successfully by a nonoperative approach was less in group I than
in group II (77% vs 90%, P < .01). The complications and recurrence rate for groups I and II did not differ
(4% vs 5% and 5% vs 4%, respectively).
Conclusions
The NPO status for patients with adhesive, partial small-bowel obstruction may not
be necessary. This cocktail of oral medications can decrease the need for operative
intervention in patients with presumed adhesive, partial small-bowel obstruction.
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Article info
Publication history
Accepted:
August 29,
2005
Identification
Copyright
© 2006 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
