Improved Transnasal Ileus Tube Technique for Intractable Adhesive Small Bowel Obstruction

Abstract

Background: Although up to 90% of patients experienced full recovery following long-tube decompression, without the need for surgical intervention, the remaining patients do not yield any benefit from the use of long nasointestinal tubes and require surgical intervention. Aim: To introduce an improved transnasal ileus tube technique for intractable adhesive small bowel obstruction (ASBO), and evaluated its efficacy in the management of intractable ASBO. Methods: 54 patients with intractable ASBO were treated with the improved transnasal ileus tube technique. The obstructions were passed through by balloon relay, and the adhesions were resolved by repeated to-and-fro movements of the ileus tube. Enterographic results were categorized as complete or incomplete resolution of the obstructions. Data on the technical success, final enterographic results, mortality, morbidity, and the final clinical outcome were collected, and follow up was performed at 1, 3, 6, and 12 months, and then yearly after the procedure. Results: Transnasal ileus tube placement was successful in all patients. Navigation and passage of the ileus tube through the obstructions to the colon were successful in 87% of the attempted tubes (47/54) and failure in 7 patients (4 patients due to severe obstruction and 3 patients due to the presence of a true stricture in the small bowel). Follow-up enterograms over 3-38 months indicated smooth passage of the contrast medium through the small bowel, without any difficulty, in 48 patients. Full recovery from ASBO was achieved in 48 patients (mean duration, 20.16 ± 10.04 months; range, 6-45 months). Six patients died of multiple organ failure without recurrent ASBO, and the clinical symptoms of small bowel obstruction recurred 2 patients. Conclusion: The improved transnasal ileus tube technique is a novel, safe, and effective technique that enables intractable ASBO resolution.