Enteroscopic treatment of early postoperative small bowel obstruction

Abstract

Background: Early postoperative small bowel obstruction (EPSBO) occurs in 1% of patients undergoing laparotomy and has a mortality rate exceeding 17%. Nasogastric (NG) decompression is successful in avoiding reoperation in 73% of patients. Repeat laparotomy has been recommended when obstruction does not resolve after 14 days of NG decompression. We report four patients with EPSBO treated successfully with push enteroscopy after failed NG decompression. Methods: Four patients who failed NG decompression underwent push enteroscopy instead of repeat laparotomy. EPSBO was diagnosed if obstruction lasting more than 14 days developed after initial resolution of postoperative ileus, high NG output persisted postoperatively for 21 days in the absence of sepsis, or radiographic signs of obstruction persisted. Small bowel series or computed tomography were utilized when radiographic assessment was necessary. The Olympus SIF 100 push enteroscope was introduced with an overtube using topical anesthesia and intravenous sedation. After maximal insertion, the enteroscope was withdrawn without evacuation of insufflated air. NG tubes were placed after enteroscopy and patients were followed clinically. Flatus, defecation, and tolerance of a general diet defined resolution of EPSBO. Results: EPSBO resolved 24 to 36 h following enteroscopy, and all patients were discharged on general diets 48 h after return of bowel function. Readmission has not been necessary during 18- to 30-month follow-up. Conclusions: Our experience suggests that push enteroscopy is successful in treating EPSBO and should be considered prior to reoperation. Push enteroscopy may eliminate the hazards of repeat laparotomy and reduce the morbidity, treatment cost, and lengthy hospital stays associated with this uncommon surgical complication.