Spontaneous resolution of intestinal obstruction while receiving home parenteral nutrition.

Abstract:

:Six patients with intestinal obstruction secondary to benign adhesions so dense and vascular that the operating surgeon could not free them, were placed on a home total parenteral nutrition program. Four patients had enterocutaneous fistulas, and two had their bowels divided and stomas created to divert intestinal contents from distal enterotomies made during the attempt to free the intestine. The enterocutaneous fistulas closed in four patients within 2 weeks to 5 months and the obstructions spontaneously resolved in 2 to 3.5 months. At reoperation on the two patients whose intestinal tracts were purposely divided, the previously matted bowels with dense adhesions were easily freed. We believe complete gastrointestinal rest allows adhesions to mature into long avascular collagen fibers in the absence of a persistent inflammatory reaction that accompanies partial or total small bowel obstruction. We recommend that patients receive 3 months of home total parenteral nutrition before a second operation for persistent obstruction after recent enterolysis should be considered. Spontaneous resolution should occur, but if not, reoperation can be performed safely after the 3 month interval.

journal_name

Am J Surg

authors

Selby RR,Mertz GH,Gilsdorf RB

doi

10.1016/0002-9610(83)90331-8

subject

Has Abstract

pub_date

1983-12-01 00:00:00

pages

742-5

issue

6

eissn

0002-9610

issn

1879-1883

pii

0002-9610(83)90331-8

journal_volume

146

pub_type

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