Percutaneous needle decompression in treatment of malignant small bowel obstruction

Table 1 Patient and tumor characteristics n (%)

Characteristic	Value
Age (yr), median (range)	62 (27-86)
Gender (male/female)	18 (34.6)/34 (65.4)
Weight loss > 5 kg in 90 d	37 (71.2)
ECOG status, median ± SD	2.84 ± 0.91
Albumin (g/L), median ± SD	30.24 ± 4.96
Hemoglobin (g/L), median ± SD	90.01 ± 22.99
Bloody ascites	11 (21.1)
Alimentary system malignancy (n = 27)
Gastric	13
Colorectal	9
Pancreas	2
Small bowel carcinoma	1
Hepatic	2
Gynecologic malignancy (n = 21)
Ovarian	14
Uterine and cervical	7
Lymphoma	1
Peritoneal metastatic carcinoma of unknown primary origin	3
Prior therapy
Chemotherapy	39 (75.0)
Radiotherapy	20 (38.5)
Surgery	37 (71.2)

ECOG: The Eastern Cooperative Oncology Group; SD: Standard deviation.

Table 2 Computed tomography imaging n (%)

Findings	n (%)
Dilation of the small intestine	52 (100.0)
Small intestinal fluid level	52 (100.0)
Wall thickening	15 (28.8)
Mesenteric edema and congestion	36 (69.2)
Ascites	19 (36.5)
Closed loop	28 (53.8)
Extensive adhesions	14 (26.9)
Large masses	6 (11.5)
Peritoneal metastasis	28 (53.8)
Intestinal fecal signs	7 (13.5)
Multiple small bowel obstructions	39 (75.0)

Table 3 Relief of symptoms after needle decompression n (%)

Symptom	Before treatment(n = 49)	After treatment(n = 49)
Vomiting	40 (81.6)	13 (26.5)a
Abdominal distention	49 (100)	4 (8.2)a
Abdominal pain	42 (85.7)	23 (46.9)a
Inability to eat	49 (100)	45 (91.8)a

^aP < 0.05 vs before.

Table 4 Complications after percutaneous intestinal puncture in seven patients

Patient No.	Primary malignancy	Complication	Postoperative time to complication (d)	Outcome
1	Pancreas	Death	5	Died of tumor progression, no autopsy was performed
2	Gastric	Peritonitis	3	Intravenous systemic antibiotics therapy, ascites culture found growing Klebsiella pneumoniae; discharged 3 wk after surgery, palliative care was continued
3	Ovarian	Abdominal pain, intestinal contents leak	Intraoperative	Anti-analgesic treatment, complete extraction of the intestinal contents, abdominal flush with metronidazole; after 14 d, patient was voluntarily discharged
4	Gastric	Puncture site metastases	17	No obvious symptoms at metastatic sites, postoperative local arterial infusion of chemotherapy was delivered; discharged after 4 wk for palliative care
5	Ovarian	Intestinal contents leak, sepsis	< 1	Persistent abdominal flush with metronidazole and abdominal percutaneous catheter drainage, systemic antibiotics, nasal intestinal drainage tube was placed postoperatively; discharged after 1 wk for rehabilitation
6	Ovarian	Ascites extravasation	< 1	Closed drainage with abdominal decompression, ascites smears showed tumor cells; discharged after 28 d following peritoneal local chemotherapy
7	Cervical	Exudates at puncture sites	< 1	Exudates disappeared following local pressure dressing, intravenous albumin and intensified nutrition therapy for 2 d; discharged 10 d after surgery