Brief Article
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World J Gastroenterol. Dec 14, 2013; 19(46): 8722-8730
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8722
Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis
Jian-Feng Gong, Wei-Ming Zhu, Wen-Kui Yu, Ning Li, Jie-Shou Li
Jian-Feng Gong, Wei-Ming Zhu, Wen-Kui Yu, Ning Li, Jie-Shou Li, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Gong JF, Zhu WM, Li N and Li JS designed the study; Gong JF, Zhu WM and Yu WK performed the study; Gong JF and Zhu WM analyzed the data; and Gong JF and Zhu WM wrote the paper.
Correspondence to: Wei-Ming Zhu, MD, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Gulou District, Nanjing 210002, Jiangsu Province, China. zhuwmjlh@163.com
Telephone: +86-25-80863736 Fax: +86-25-80860220
Received: July 20, 2013
Revised: October 5, 2013
Accepted: November 2, 2013
Published online: December 14, 2013
Processing time: 150 Days and 10.2 Hours
Abstract

AIM: To investigate the effect of somatostatin and dexamethasone on early postoperative small bowel obstruction with obliterative peritonitis (EPSBO-OP).

METHODS: This prospective randomized study included 70 patients diagnosed with EPSBO-OP from June 2002 to January 2009. Patients were randomized into two groups: a control group received total parenteral nutrition and nasogastric (NG) tube feeding; and an intervention group received, in addition, somatostatin and dexamethasone treatment. The primary endpoints were time to resolution of bowel obstruction and length of hospital stay, and the secondary endpoints were daily NG output and NG feeding duration, treatment-related complications, postoperative obstruction relapse, and patient satisfaction.

RESULTS: Thirty-six patients were allocated to the intervention group and 34 to the control group. No patient needed to undergo surgery. Patients in the intervention group had an earlier resolution of bowel obstruction (22.4 ± 9.1 vs 29.9 ± 10.1 d, P = 0.002). Lower daily NG output (583 ± 208 vs 922 ± 399 mL/d, P < 0.001), shorter duration of NG tube use (16.7 ± 8.8 vs 27.7 ± 9.9 d, P < 0.001), and shorter length of hospital stay (25.8 vs 34.9 d, P = 0.001) were observed in the intervention group. The rate of treatment-related complications (P = 0.770) and relapse of obstruction (P = 0.357) were comparable between the two groups. There were no significant differences in postoperative satisfaction at 1, 2 and 3 years between the two groups.

CONCLUSION: Somatostatin and dexamethasone for EPSBO-OP promote resolution of obstruction and shorten hospital stay, and are safe for symptom control without increasing obstruction relapse.

Keywords: Dexamethasone; Intestinal obstruction; Parenteral nutrition; Postoperative period; Somatostatin

Core tip: This prospective study revealed that somatostatin and dexamethasone, when used in combination, promoted the resolution of small bowel obstruction and shortened length of hospital stay in patients with early postoperative small bowel obstruction due to obliterative peritonitis. Somatostatin and dexamethasone were effective in symptom control in this population.