Efficacy of Dexamethasone in Adhesive Small Bowel Obstruction

Small bowel obstruction (SBO) is a common long-term complication following abdominal surgery and a frequent cause of inpatient admissions. The most common cause of SBO is adhesions, followed by hernias and malignancy. Non-operative management strategies include bowel rest, nasogastric decompression, and Gastrografin administration, each with their own advantages and risks. Intravenous (IV) corticosteroids (Dexamethasone) have demonstrated benefit in malignant SBO but remain unexamined in adhesive SBO. The aim of this study is to evaluate the role of Dexamethasone in adhesive SBO.

A retrospective review of all patients admitted with adhesive SBO to a tertiary Colorectal Unit between 2020 and 2024 was performed. Demographics, patient results and interventional data were collected. All patients received nasogastric decompression, and IV Dexamethasone was used based on surgeon preference. For analysis, the cohort was divided into two: those who received Dexamethasone (Dex) and those who didn't (Control).

A total of 105 patients were included with a mean age of 63.5 years and 54% male. There was no significant difference in baseline characteristics between the two groups. In the Dex group, 92% (46/50) resolved with non-operative management, compared to 75% (41/55) in the Control group, which was statistically significant (p = 0.018). There was no difference in Gastrografin use or the length of stay between the two groups.

IV Dexamethasone was safe and significantly reduced the need for surgical intervention in adhesive SBO. This is the first study which evaluates the use of IV Dexamethasone in non-malignant SBO and a randomised clinical trial is warranted.