P2.26: Optimizing the Management of intestinal pseudo-obstruction with effective bowel decompression using a pan intestinal decompressive tube

Abstract

Children with intestinal psuedoobstruction are notoriously hard to manage. Refractory abdominal distension, small bowel bacterial overgrowth, inability to feed, frequent line infections, septic episodes and intestinal failure related liver damage are unfortunate realities in the management of these children. It’s also hard to determine how contributory adhesive bowel obstruction is to the ongoing abdominal distension. One of the central factors contributing to all this is the inability to effectively decompress the inherently poorly peristaltic long tubular length of the intestine. We devised a simple solution to effectively decompress the entire length of small bowel by passing a perforated decompresive tube all along its length that went from the DJ flexure to the caecum. Low profile devices at both ends ensured decompression into bags at both ends. The resulting decompressed bowel with reduced luminal calibre prevented stasis and promoted some peristalsis. In, addition it stented the bowel in a non-obstructive pattern in the abdomen. 8 children with intestinal pseudo obstruction had pan intestinal decompressive tubes placed. Ages ranged from 5 weeks to 16 years. All children had improvement in their abdominal distension, were able to take oral feeds and started stooling more frequently. 2 children with gastroschisis came off TPN after 4 and 6 months. Serum bilirubin improved initally in all children. In 2 children, after temporary relief, there was progression to liver failure and eventual death. In 3 children, additional procedures to reduce leakage around the tubes and skin excoriation were done. In 7 children, this reduced hospitalization significantly and allowed management to continue from home. In children with intestinal psuedoobstruction, the placement of a pan intestinal decompressive tube can mitigate several of the problems associated with this condition. In gastroschisis with hypomotilitiy, it has the potential to restore motility and avoid the need for a transplant.