Specific oral medications decrease the need for surgery in adhesive partial small-bowel obstruction.
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.
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7 Chung-Shan South Road, Taipei 100, Taiwan. scc@ha.mc.ntu.edu.tw
Shyr-Chyr
SC
Chen
Chien-Chang
CC
Lee
Zui-Shen
ZS
Yen
Geng-Shiau
GS
Lin
Wen-Jone
WJ
Chen
Po-Huang
PH
Lee
Hong-Shiee
HS
Lai
Fang-Yue
FY
Lin
Wei-Jao
WJ
Chen
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000934:Antifoaming Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002400:Cathartics / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
D000934:Antifoaming Agents; D002400:Cathartics; D005765:Gastrointestinal Agents