The indicator for surgery in adhesive small bowel obstruction patient managed with long tube.

Background/aims: In treating many cases of postoperative adhesive small bowel obstruction (ASBO), we have found that if a long tube is not effective in conservative treatment, the surgical timing requires careful consideration. The aim of this study was to clarify the limits of conservative treatment, long tube management, and surgical timing.

Methodology: A retrospective chart review was conducted of 234 patients with ASBO from April 1998 to September 2002, and 155 cases were excluded (135 who recovered in conservative treatment within 2 days and 20 who required surgery due to suspended strangulation). We divided the remaining 79 subjects into 2 groups, a conservative improvement group of 23 patients who recovered from ASBO following conservative treatment after 3 days, and a surgery group of 56 patients who underwent surgery after 3 days. We examined the baseline characteristics, interval from the onset of symptoms, duration of long tube placement, and change in drainage volume through the long tube.

Results: A significant difference in interval was found from the onset of symptoms to long tube insertion (35 hours vs. 44 hours). In bowel stenosis, surgery tended to be selected in the group with occlusion or retention of gastrografin. A significant difference was found in the change in drainage volume through long tube on day 3 (more or less than 500mL) between the conservative improvement group and surgery group.

Conclusions: In conservative treatment for challenging cases of ASBO, the long tube should be placed as soon as possible. The drainage volume through the long tube on day 3 (cut-off value; 500mL) was the indicator for surgery in ASBO.