Partial small-bowel obstruction caused by adhesions usually is managed initially by decompressing the gastrointestinal tract with a nasogastric (NG) tube, administering intravenous fluids, prohibiting oral intake, and waiting for spontaneous resolution. Researchers in Taiwan examined a more proactive approach in 128 patients with partial small-bowel obstructions presumed to be caused by adhesions from previous abdominal surgery.
Patients were randomized to two groups: One group received standard treatment with NG tube decompression, IV fluids, and nothing by mouth. The other group received similar standard treatment plus an oral regimen, given thrice daily, that consisted of magnesium oxide to stimulate bowel movement, simethicone to accelerate gas passage, and Lactobacillus acidophilus to promote digestion of undigested food in the bowel lumen. The proportion of patients who did not require surgery was significantly higher in the intervention group than in the control group (91% vs. 76%). In addition, the mean duration of hospital stay was significantly shorter in the intervention group (1 vs. 4 days). No obvious complications from the intervention were noted.
These results seem almost too good to be true: A safe and simple regimen appeared to dramatically hasten the resolution of partial small-bowel obstruction. Limitations of the study include confirmation of the diagnosis by plain radiography only and lack of double-blinding. We need more research to confirm these results.
Reference:
Chen S-C et al. Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: A randomized controlled trial. CMAJ 2005 Nov 8; 173:1165-9.