Significance of Selective Small Bowel Intraluminal Pressure for the Management of Adhesive Small Bowel Obstruction

Hajime Sasabe, Masahiko Onda, Noritake Tanaka and Shigehiko Yokoyama

First Department of Surgery Nippon Medical School

To evaluate the degree of adhensive small-bowel obstruction (ASBO), we devised a method to measure the intraluminal pressure of the small bowel using CO₂ gas. The measuring point is set at the oral side of the obstruction. The pressure of this point is defined as the selective intraluminal pressure of the small bowel (SIPS). SIPS was measured a few times during conservative treatment in 50 patients who were managed by a long tube for ASBO. All ASBO patients were also examined as a selective small intestinal series (SSIS). Three patteerns of pressure curves were observed in SIPS (type I, II, III). The mean pressure, which is the average of the integration in the pressure curve during the measuring time, is used as the index of obstruction degree. From SSIS, ASBO were divided into four groups. The mean pressure (non-obstructive group, flexed group, stenotic group and obstructive group) were 5. 2±2. 5, 6. 8±3. 9, 13. 2±7. 4, and 14. 9±7. 1 cmH₂O (mean±SD), respectively. Twenty patients were operated on. All patients who showed a type III pressure pattern underwent surgical treatment. The pressure curve pattern in the non-operative group was type I, whereas none of operative group showed this pattern. In the non-operative group, the mean presssure (6. 9±4. 4 cmH₂O) was significantly lower than in the operative group (15. 5±7. 0 cmH₂O) (p<0. 01). These findings suggest that SIPS measurement and analysis of the pressure pattern are useful techniques to determine further treatment of ASBO patients.

Key words
adhesive small bowel obstruction, long tube, intraluminal pressure of the small bowel, cobservative treatment for small bowel obstruction, selective intraluminal pressure of the small intestine

Reprint requests
Hajime Sasabe First Department of Surgery, Nippon Medical School 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603 JAPAN

Accepted
April 26, 2000

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