Conservative treatment of early postoperative small bowel obstruction with obliterative peritonitis

Table 1 Demographic data and clinical features n (%)

	T group (n = 34)	TDS group (n = 36)	P value
Age (yr)	43.9 ± 10.2 (26-64)	45.4 ± 13.2 (20-78)	0.597
Sex ratio (M/F)	24/10	18/18	0.079
Symptoms onset
≤ 1 POW	12 (35.3)	13 (36.1)	0.943
1-2 POW	19 (55.9)	21 (58.3)	0.836
2-3 POW	3 (8.8)	1 (2.8)	0.276
3-4 POW	0	1 (2.8)
Mean POD of symptom onset	9.8 ± 3.4 (5-19)	9.1 ± 3.5 (5-23)	0.412
Symptoms
Nausea and vomiting	32 (94.1)	33 (91.7)	0.691
Abdominal distension	23 (67.6)	20 (55.6)	0.299
Colic pain	0	0
Obstipation	34 (100)	36 (100)
Hyperthermia (> 37.5 °C)1	1 (2.9)	1 (2.6)	0.967
Maximum WBC (× 109/L)	7.0 ± 2.3 (3.7-12.3)	8.0 ± 3.0 (4.8-17.1)	0.148
Neutrophil (%)	71.2 ± 10.4 (48-88)	75.1 ± 8.4 (59-91)	0.084
Nutrition status on admission
Mean BMI (kg/m2)	20.4 ± 2.2 (16.8-26.4)	21.2 ± 2.8 (17.3-28.0)	0.248
Hypoalbuminemia (< 35g/L)	13 (38.2)	8 (22.2)	0.144
Anemia (Hb < 120g/L)	10 (29.4)	4 (11.1)	0.056
Comorbidity	3 (8.8)	4 (11.1)	0.750

¹One due to pneumonia, and one due to epiglottis. POW: Postoperative week; POD: Postoperative day; BMI: Body mass index.

Table 2 Previous laparotomies n (%)

	T group (n = 34)	TDS group (n = 36)	P value
No. of laparotomies
1	3 (8.8)	4 (11.1)	0.750
2	7 (20.6)	11 (30.6)	0.340
3	15 (44.1)	11 (30.6)	0.241
4	6 (17.6)	4 (11.1)	0.435
≥ 5	3 (8.8)	6 (16.7)	0.327
Mean No. (range)	3.0 ± 1.0 (1-5)	2.9 ± 1.3 (1-6)	0.927
Type of last operation
Bowel obstruction	12 (35.3)	18 (50.0)	0.214
Enterocutaneous fistula	15 (44.1)	10 (27.8)	0.154
Enterectomy/colectomy	2 (5.9)	1 (2.8)	0.522
Gastroduodenal surgery	0	1 (2.8)	0.328
Hematoma removal	2 (5.9)	1 (2.8)	0.522
Appendectomy1	0	2 (5.6)	0.163
Laparotomy after trauma	1 (2.9)	1 (2.8)	0.967
Others	2 (5.9)	2 (5.6)	0.953
Patients with history of malignancy	5 (14.7)	10 (27.8)	0.183
At last operation
with extensive enterolysis2	24 (70.6)	30 (83.4)	0.204
with diffuse peritonitis	4 (11.8)	2 (5.6)	0.354
< 2 wk from previous surgery	3 (8.8)	3 (8.3)	0.971
Last operation time (h)	4.8 ± 1.1 (2.0-6.5)	4.1 ± 1.3 (1.5-7)	0.041

¹All are perforated appendicitis with diffuse peritonitis;

²Including with intestinal splinting.

Table 3 Outcomes of patients receiving total parenteral nutrition alone or in combination with somatostatin and dexamethasone

	TPN (n = 34)	TDS (n = 36)	P value
Time to obstruction resolution (d)	29.9 ± 10.1 (17-60)	22.4 ± 9.1 (13-52)	0.002
Length of hospital stay (d)	34.7 ± 11.2 (21-69)	25.8 ± 9.9 (16-57)	0.001
Daily NG output (mL)1	922 ± 399 (400-1825)	583 ± 208 (150-1050)	< 0.001
Mean NG duration (d)	27.7 ± 9.9 (7-54)	16.7 ± 8.8 (3-42)	< 0.001
Relapse of obstruction
1 yr after operation (n/N)2	3/32	2/34	0.668
2 yr after operation (n/N)3	6/29	5/31	0.745
3 yr after operation (n/N)4	8/27	6/28	0.547
Postoperative satisfaction ≥ 35
1 yr after operation (n/N)2	22/32	20/34	0.451
2 yr after operation (n/N)3	15/29	14/31	0.796
3 yr after operation (n/N)4	11/27	10/28	0.785

¹Mean value of the first 2 d after NG tube placement;

²TPN (n = 32, 1 patient was lost to follow-up, and 1 died of malignancy); TDS (n = 34, 2 patients were lost to follow-up);

³TPN (n = 29, 2 patients were lost to follow-up, and 1 died of malignancy); TDS (n = 31, 3 patients were lost to follow-up);

⁴TPN (n = 27, 2 patients were lost to follow-up); TDS (n = 28, 2 patients were lost to follow-up and 1 died of cardiovascular disease);

⁵Patients with satisfaction ≥ 3 were satisfied (3) or very satisfied (4). TDS: TPN + DM + SS; TPN: Total parenteral nutrition; DM: Dexamethasone; SS: Somatostatin; NG: Nasogastric.

Table 4 Treatment-related complications n (%)

	TPN (n = 34)	TDS (n = 36)	P value
Morbidity
Cholestasis	5 (14.7)	8 (22.2)	0.419
Patients requiring PTC	2 (5.9)	5 (13.9)	0.264
Infectious complications	8 (23.5)	7 (19.4)	0.677
Catheter-related infections	5 (14.7)	4 (11.1)	0.653
Wound infection	2 (5.9)	1 (2.8)	0.522
Pneumonia	1 (2.9)1	0	0.300
Pneumothorax	0	2 (5.5)	0.163
Overall complications	13 (38.2)	15 (41.7)	0.770

¹Patient had tracheostomy. TDS: TPN + DM + SS; TPN: Total parenteral nutrition; DM: Dexamethasone; SS: Somatostatin; PTC: Percutaneous transhepatic cholecystostomy.