2009 Volume 70 Issue 6 Pages 1712-1716
A 74-year-old woman was seen at the hospital because of upper abdominal pain. There was a previous history of undergoing laparotomy. When she was first seen, abdominal distension and mild degree of peritoneal irritation sign were noted. Following abdominal CT scan and ultrasonography, adhesive postoperative small bowel (strangulation) obstruction was diagnosed and an emergency operation was performed. After the obstruction was resolved, the patient developed intestinal obstruction again which needed re-operation. During the second operation, we recognized that more serious adhesions than those seen at the first operation developed. Considering a possible risk of causing intestinal obstruction again, a gastrostomy was created during the surgery and an intestinal splinting tube was induced and placed at the ileum about 30cm proximal to the ileum end. Despite resolution of the obstruction performed twice, intestinal obstruction recurred postoperatively, so that balloon dilatation method was conducted at the obstructing segment, which might cause the obstruction, through the gastrostomy using a guidewire. Non-operative resolution of the obstruction was thus done.
With this novel method using an intestinal splinting long tube and a balloon catheter that has not been reported so far, we have succeeded in conservative therapy of adhesive postoperative small bowel obstruction.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)
