Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial.
BACKGROUND
Patients with partial adhesive small-bowel obstruction are usually managed conservatively, receiving intravenous hydration and nothing by mouth. Previous studies have suggested that this approach is associated with longer hospital stays and an increased risk of delayed surgery. We conducted a randomized controlled trial to see if combining standard conservative treatment with oral administration of a laxative, a digestant and a defoaming agent would reduce the frequency of subsequent surgical intervention and reduce the length of hospital stay.


METHODS
We identified 144 consecutive patients admitted between February 2000 and July 2001 with adhesive partial small-bowel obstruction and randomly assigned 128 who met the inclusion criteria to either the control group (intravenous hydration, nasogastric-tube decompression and nothing by mouth) or the intervention group (intravenous hydration, nasogastric-tube decompression and oral therapy with magnesium oxide, Lactobacillus acidophilus and simethicone). The primary outcome measures were the number of patients whose obstruction was successfully treated without surgery and the length of hospital stay. We also monitored rates of complications and recurring obstructions.


RESULTS
Of the 128 patients, 63 were in the control group and 65 in the intervention group; the mean ages were 54.4 (standard deviation [SD] 15.9) years and 53.9 (SD 16.3) years respectively. Most of the patients were male. More patients in the intervention group than in the control group had successful treatment without surgery (59 [91%] v. 48 [76%], p = 0.03; relative risk 1.19, 95% confidence interval 1.03-1.40). The mean hospital stay was significantly longer among patients in the control group than among those in the intervention group (4.2 [SD 2.7] v. 1.0 [SD 0.7] days, p < 0.001). The complication and recurrence rates did not differ significantly between the 2 groups.


CONCLUSIONS
Oral therapy with magnesium oxide, L. acidophilus and simethicone was effective in hastening the resolution of conservatively treated partial adhesive small-bowel obstruction and shortening the hospital stay.
Chen
Shyr-Chyr
SC
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Yen
Zui-Shen
ZS
Lee
Chien-Chang
CC
Liu
Yueh-Ping
YP
Chen
Wen-Jone
WJ
Lai
Hong-Shiee
HS
Lin
Fang-Yue
FY
Chen
Wei-Jao
WJ
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000863:Antacids / Q000627:therapeutic use*; D000934:Antifoaming Agents / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy*; D007441:Intubation, Gastrointestinal; D007779:Lactobacillus acidophilus; D007902:Length of Stay; D008277:Magnesium Oxide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012841:Simethicone / Q000627:therapeutic use*; D016896:Treatment Outcome
D000863:Antacids; D000934:Antifoaming Agents; D008277:Magnesium Oxide; D012841:Simethicone