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首页> 外文期刊>Surgical Endoscopy >Enteroscopic treatment of early postoperative small bowel obstruction.
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Enteroscopic treatment of early postoperative small bowel obstruction.

机译：肠镜治疗术后早期小肠梗阻。

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BACKGROUND: Early postoperative small bowel obstruction (EPSBO) occurs in 1% of patients undergoing laparotomy and has a mortality rate exceeding 17%. Nasogastric (NG) decompression is successful in avoiding reoperation in 73% of patients. Repeat laparotomy has been recommended when obstruction does not resolve after 14 days of NG decompression. We report four patients with EPSBO treated successfully with push enteroscopy after failed NG decompression. METHODS: Four patients who failed NG decompression underwent push enteroscopy instead of repeat laparotomy. EPSBO was diagnosed if obstruction lasting more than 14 days developed after initial resolution of postoperative ileus, high NG output persisted postoperatively for 21 days in the absence of sepsis, or radiographic signs of obstruction persisted. Small bowel series or computed tomography were utilized when radiographic assessment was necessary. The Olympus SIF 100 push enteroscope was introduced with an overtube using topical anesthesia and intravenous sedation. After maximal insertion, the enteroscope was withdrawn without evacuation of insufflated air. NG tubes were placed after enteroscopy and patients were followed clinically. Flatus, defecation, and tolerance of a general diet defined resolution of EPSBO. RESULTS: EPSBO resolved 24 to 36 h following enteroscopy, and all patients were discharged on general diets 48 h after return of bowel function. Readmission has not been necessary during 18- to 30-month follow-up. CONCLUSIONS: Our experience suggests that push enteroscopy is successful in treating EPSBO and should be considered prior to reoperation. Push enteroscopy may eliminate the hazards of repeat laparotomy and reduce the morbidity, treatment cost, and lengthy hospital stays associated with this uncommon surgical complication.
机译：背景：剖腹手术患者中有1％发生早期术后小肠梗阻（EPSBO），死亡率超过17％。鼻胃（NG）减压成功避免了73％的患者再次手术。当NG减压14天后阻塞仍未解决时，建议重复剖腹手术。我们报告了4例NGBO减压失败后采用推式肠镜成功治疗的EPSBO患者。方法：四名NG减压失败的患者接受了肠镜检查，而不是重复剖腹手术。初步诊断术后肠梗阻后，如果梗阻持续超过14天，在没有败血症的情况下，术后NG持续高输出持续21天，或者影像学发现梗阻持续，则诊断为EPSBO。当需要射线照相评估时，应采用小肠检查或计算机断层扫描。 Olympus SIF 100推入式肠镜通过局部麻醉和静脉镇静作用与套管一起引入。在最大程度地插入后，将肠镜撤回而未排入吹入的空气。肠镜检查后放置NG管，并对患者进行临床随访。肠胃胀气，排便和一般饮食的耐受性定义了EPSBO的分辨率。结果：肠镜检查后24到36 h，EPSBO消失，所有患者在肠功能恢复后48 h按常规饮食出院。在18到30个月的随访期间，无需重新入院。结论：我们的经验表明，推式肠镜检查可成功治疗EPSBO，因此应在再次手术之前予以考虑。推入式肠镜检查可以消除再次开腹手术的危险，并降低发病率，治疗成本以及与这种罕见的手术并发症相关的长期住院时间。

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