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World Journal of Surgery

, Volume 9, Issue 6, pp 868–875 | Cite as

Recurrent adhesive small bowel obstruction

  • Peter F. Jones
  • Alexander Munro
Article

Abstract

Adhesive obstruction of the small bowel complicates about 5% of laparotomies; of these, 5–10% have recurrent attacks. The etiology of adhesions is incompletely understood and attempts to prevent their formation are of unproven value. Patients with recurrent acute obstruction that threatens strangulation, or that fails to subside, require laparotomy. If numerous adhesions have to be divided, it is worth considering a procedure to encourage fresh adhesions to form in a favorable pattern. Suture plication of the bowel by Noble's technique has a high incidence of complications and recurrent obstruction, and transmesenteric plication cannot be used in the presence of sepsis. Splinting of the entire small bowel by intraoperative passage of a long tube, which is left indwelling for 2–3 weeks, appears to be effective and safe. We have used this method in 140 patients without associated complications; of these, 17 had recurrent intestinal obstruction after 1–5 previous laparotomies for adhesions. A meticulous adhesiolysis followed by transluminal splinting through a jejunostomy has been followed by freedom from recurrence during 103 patient-years of follow-up.

Keywords

Small Bowel Intestinal Obstruction Small Bowel Obstruction Cual Recurrent Attack 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

L'occlusion de l'intestin grÊle secondaire à des adhérences complique environ 5% des laparotomies et récidive dans 5–10% des cas. L'étiologie précise des adhérences n'est pas parfaitement connue et toutes les méthodes de prévention qui ont été tentées n'ont pas fait leur preuve. Tous les malades qui présentent des attaques répétées et des menaces d'étranglement intestinal doivent Être opérés. Si les adhérences à lever sont très nombreuses il est nécessaire d'avoir recours à une méthode thérapeutique qui favorise la reconstitution en bon ordre de nouvelles adhérences. La plicature ordonnée des anses intestinales selon la technique de Noble est suivie de nombreuses complications et de récidive, la plicature transmésentérique selon la technique de Child ne peut Être employée en cas d'infection. C'est la raison pour laquelle il convient de substituer à ces modes de plicature, celle qui fait appel à un long tube intradigestif qui est laissé en place 2–3 semaines. La méthode est dénuée de danger et efficace. Elle a été employée chez 140 malades sans aucune complication alors mÊme que 17 d'entre eux présentaient des occlusions à répétition, et avaient subi de l à 5 laparotomies. Cette technique de libération des adhérences suivie de la plicature ordonnée des anses intestinales sur un tube introduit dans le grÊle par la voie d'une petite jéjunostomie a permis d'enregistrer l'absence de récidives de l'occlusion chez 103 malades qui ont été attentivement suivis.

Resumen

La obstrucción por adherencias es una complicación que ocurre en alrededor del 5% de las laparotomías, y de los pacientes que la desarrollan 5–10% sufren episodios recurrentes. La etiología de las adherencia no es totalmente conocida, y los intentos orientados a prevenir su formación han probado ser de utilidad no comprobada. Los pacientes con obstrucción aguda que presagia estrangulación o que no cede con un manejo de unos días de reposo intestinal y líquidos parenterales, requieren laparotomía. Cuando es necesario dividir numerosas adherencias, es Útil considerar la realización de un procedimiento que promueva la formación de adherencias frescas en un patrón ordenado y favorable. La plicación mediante suturas segÚn la técnica de Noble se acompaña de una elevada tasa de complicaciones y de obstrucción recurrente, y la plicación transmesentérica está contraindicada en presencia de sepsis. La fijación de la totalidad del intestino delgado mediante la colocación intraoperatoria de un tubo intestinal largo, el cual es dejado por 2–3 semanas, parece ser un método efectivo y seguro. Hemos utilizado tal método en 140 pacientes sin complicaciones; de éstos, 17 presentaban obstrucción recurrente después de 1–5 laparotomías previas por adherencias. La meticulosa lisis de las adherencias seguida de la fijación transluminal mediante tubo colocado a través de una yeyunostomía a 10–15 cm del ángulo duodenoyeyunal ha resultado en ausencia de recurrencia en 103 pacientes-año de seguimiento.

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Copyright information

© Société Internationale de Chirurgie 1985

Authors and Affiliations

  • Peter F. Jones
    • 1
    • 2
    • 3
  • Alexander Munro
    • 1
    • 2
    • 3
  1. 1.Department of Surgery, Woodend General HospitalUniversity of AberdeenUK
  2. 2.Department of Surgery, Royal Aberdeen Children's HospitalUniversity of AberdeenUK
  3. 3.Raigmore HospitalInvernessUK

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