Endoscopic decompression in partial small bowel obstruction.

Abstract

Upper gastrointestinal endoscopy has been applied successfully in the management of patients with small bowel obstruction. In one group of patients after gastrectomy with a Roux-Y limb obstructed at the level of the transverse mesocolon, the endoscope was manipulated into this segment, and the tip was deflected in four directions with release of the kink. Conventional wisdom depends heavily on the interpretation of the upper gastrointestinal series, which in all five patients in this report proved to be incorrect. It was only through the endoscopic examination that the anastomoses were found to be patent, and the kinked segment of jejunum, once identified, could be released by endoscopic manipulation. Two patients required repeat endoscopy, and at last follow-up, all patients were eating well with no recurrence of symptoms. In the second group of patients with distal small bowel obstruction who normally would be considered for Miller-Abbott tube management, it was possible to decompress the stomach, duodenum, and upper jejunum endoscopically with immediate clinical and radiographic improvement. In addition, it was also possible to place the Miller-Abbott tube into the small bowel at the same time and thus avoid the 2 to 3 days of delay in advancing the tube beyond the pylorus. All patients had improvement and there were no complications. Although two required laparotomy several weeks later, they too were improved by the endoscopic procedures. The immediate decompression and rapid intubation represent significant advances in the management of patients with small bowel obstruction.