Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: A randomized controlled trial
Journal
CMAJ
Journal Volume
173
Journal Issue
10
Pages
1165-1169
Date Issued
2005
Author(s)
Abstract
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. Interpretation: 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. ? 2005 CMA Media Inc. or its licensors.
SDGs
Other Subjects
antifoaming agent; digestant; laxative; magnesium oxide; prebiotic agent; simethicone; adult; aged; article; aspiration pneumonia; clinical trial; confidence interval; controlled clinical trial; controlled study; decompression; disease activity; disease severity; female; hospitalization; human; intestine resection; intravenous administration; Lactobacillus acidophilus; length of stay; major clinical study; male; nasogastric tube; nose injury; partial adhesive small bowel obstruction; pneumonia; randomized controlled trial; recurrent disease; side effect; small intestine obstruction; statistical significance; treatment indication; treatment outcome; urinary tract infection; Administration, Oral; Adult; Aged; Antacids; Antifoaming Agents; Female; Fluid Therapy; Humans; Intestinal Obstruction; Intubation, Gastrointestinal; Lactobacillus acidophilus; Length of Stay; Magnesium Oxide; Male; Middle Aged; Simethicone; Treatment Outcome
Type
journal article