Successful Management of Early Postoperative Small Bowel Obstruction Using Steroid: A Case Report
DOI:
https://doi.org/10.24871/253202475-83Keywords:
Corticosteroids, non-operative intervention, small bowel obstructionAbstract
Background: Early Postoperative Small Bowel Obstruction (EPSBO) is a primary factor contributing to death and morbidity after pelvic and abdominal surgery. Although it is frequently regarded as a surgical emergency, the most recent research indicates that non-operative management is always preferable unless there are complications.
Case: A 53-year-old woman came with symptoms of small bowel obstruction and a history of hysterectomy three weeks earlier. The patient refused surgical intervention, so a conservative approach was taken. She was given methylprednisolone 500 mg/day in two doses daily for three consecutive days, in addition to nasogastric tube insertion and symptomatic therapy. After three days of follow-up, the patient showed symptoms improvement, and the abdominal X-Ray and CT Scan showed no abnormal findings.
Discussion: The majority of Early Postoperative Small Bowel Obstruction (EPSBO) cases, according to the most recent research, may be managed without surgery. Additionally, due to their anti-inflammatory properties, some medications, like corticosteroids, have been found to be beneficial and effective for EPSBO. This is because they may help resolve the obstruction and lessen the edema and fibrin deposition associated with EPSBO following abdominal surgery.
Conclusion: Conservative therapy with steroids appears promising due to its lower risk profile and greater patient comfort. However, the exact mechanism and its efficacy in treating EPSBO have yet to be fully concluded, so further research is still needed.
References
Kang WS, Park YC, Jo YG, Kim JC. Early postoperative small bowel obstruction after laparotomy for trauma: incidence and risk factors. Ann Surg Treat Res. 2018;94(2):94–101.
Goussous N, Kemp KM, Bannon MP, Kendrick ML, Srvantstyan B, Khasawneh MA, et al. Early postoperative small bowel obstruction: open vs laparoscopic. Am J Surg. 2015;209(2):385–90.
Broek RPG, Krielen P, Di Saverio S, Coccolini F, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO). World J Emerg Surg [Internet]. 2018;13(1):13–24. Available from: https://doi.org/10.1186/s13017-018-0185-2
Sheyn D, Bretschneider CE, Mahajan ST, Ridgeway B, Davenport A, Pollard R. Incidence and risk factors of early postoperative small bowel obstruction in patients undergoing hysterectomy for benign indications. Am J Obstet Gynecol [Internet]. 2019;220(3):251.e1-251.e9. Available from: https://doi.org/10.1016/j.ajog.2018.11.1095
Gong JF, Zhu WM, Yu WK, Li N, Li JS. Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis. World J Gastroenterol. 2013;19(46):8722–30.
Taylor MR, Lalani N. Adult small bowel obstruction. Acad Emerg Med. 2013;20(6):527–44.
Long B, Robertson J, Koyfman A. Emergency Medicine Evaluation and Management of Small Bowel Obstruction: Evidence-Based Recommendations. J Emerg Med [Internet]. 2019;56(2):166–76. Available from: https://doi.org/10.1016/j.jemermed.2018.10.024
Tong JWV, Lingam P, Shelat VG. Adhesive small bowel obstruction – an update. Acute Med Surg. 2020;7(1).
Rami Reddy SR, Cappell MS. A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017;19(6).
Nevitt PC. The string of pearls sign. Radiology. 2000;214(1):157–8.
Bauer J, Keeley B, Krieger B, Deliz J, Wallace K, Kruse D, et al. Adhesive small bowel obstruction: Early operative versus observational management. Am Surg. 2015;81(6):614–20.
Demessence R, Lyoubi Y, Feuerstoss F, Hamy A, Aubé C, Paisant A, et al. Surgical management of adhesive small bowel obstruction: Is it still mandatory to wait? – An update. J Visc Surg. 2022;159(4):309–19.
Victory Srinivasan N, Khan AI, Mashat GD, Hazique M, Khan KI, Ramesh P, et al. Recurrence of Small Bowel Obstruction in Adults After Operative Management of Adhesive Small Bowel Obstruction: A Systematic Review. Cureus. 2022;14(9):1–10.
Wu Z, Wang S, Yuan S, Lin M. Clinical efficacy and safety of somatostatin in the treatment of early postoperative inflammatory small bowel obstruction. 2020;0(April):1–6.
Shohei M, Hiroyuki O. A case of adhesive intestinal obstruction in which steroid administration was effective. J Japanese Soc Pediatr Surg. 2021;57(2):473.
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