Acute adhesive obstruction of the small intestine

A review of the management of adhesive small bowel obstruction revealed many hazards of long intestinal intubation therapy. When compared with those patients treated by fluid and electrolyte repletion and laparotomy within 24 hours, patients treated by prolonged tube suction had a longer hospital course, 22.6 versus 15.3 days; longer postoperative ileus, 7.4 versus 6.5 days, and greater technical problems at operation. This latter group also had a greater incidence of extensive postoperative complications and erroneous diagnoses. Long tubes were successful in only 21 patients and were most ineffective in those with complete obstruction as observed on roentgenograms. Patients with a prior abdominal surgical procedure, absence of any signs of strangulation and partial small bowel obstruction on roentgenograms, may be treated initially by long tube decompression and careful monitoring. Lack of definite improvement in 24 hours demands laparotomy. The value of intraoperative intestinal decompression is questionable.