Bowel decompression in the treatment of patients with acute colonic obstruction

According to literature data acute intestinal obstruction is characterized by a great number of neglected forms comprising 5–70% cases with the given pathology. A number of radiological signs in the way of Kloiber’s bowls and intestinal arches simply confirm this and testify of colon motor activity decompensation. To date there are no objective diagnostic criteria providing indications to intestinal decompression before the operation. Intestinal intubation, its types and indications to its fulfilment are based only on the experience and intuition of the operating surgeon. Aim — to define clinical efficiency of the intestinal wall impaired contractility diagnostics method in the treatment of patients with acute colonic obstruction. Medical histories analysis of 166 patients with obstructive intestinal obstruction was carried out. Assessment of intestinal motor activity compensation was carried out with the help of echographic criteria — the number of enlarged small bowel loops, intestinal lumen width, wall thickness, distance between Kerckring folds, number of peristaltic movements per minute. According to the suggested method 3 groups of patients were distinguished — with compensated motor activity (32 (19%) patients), with sub-compensated motor activity (61 (36.5%) patients) and with intestinal decompensated motor activity (73 (44.4%) patients). Wherein the greater number of patients with obstructive ileus (135 (81%) patients) got into the hospital with sub- and decompensated intestinal motor function. In the group of patients with compensated muscular tone intestinal decompression was not carried out, in the second group with sub-compensated intestinal tone decompression was carried out simultaneously in 13 (7.8%) patients, and in 9 (5.4%) a nasojunal probe was installed for 2–3 days, in the third group intestinal intubation was done in 63 (38%) patients. Post-operative mortality was 3.2%. Thus, echographic criteria allow establishing the degree of intestinal impaired motor function before the operation in patients with acute intestinal obstruction which decompression depends upon its state.

Long-Term Follow-Up of the Use of the Jones' Intestinal Tube in Adhesive Small Bowel Obstruction

INTRODUCTION Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive bstruction. This paper describes our experience of this technique. PATIENTS AND METHODS A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who re identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction. RESULTS Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and re thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube. CONCLUSION Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.