Significance of Long Tube Management and Timing of Surgical Operation for Conservative Treatment of Adhesion Ileus

Takumi Sakakibara, Akio Harada, Tadao Ishikawa, Yoshinao Komatsu, Hajime Nakamura, Toyohisa Yaguchi and Hiroya Murakami

Department of Surgery, Aichi Koseiren Kainan Hospital

Purpose: In treating many cases of postoperative adhesion ileus, we have found that if a long tube is not effective in conservative treatment, surgical timing requires discussion. Most of our patients showed recurrence of adhesion ileus in conservative treatment after removal of the long tube. We clarified the limits of conservative treatment, long tube management, and surgical timing. Patients and Methods: Of 234 patients with adhesion ileus admitted from April 1998 to September 2001, 155 cases were excluded (135 who recovered in conservative treatment within 2 days and 20 who required surgery due to suspended strangulation). Leaving 79 subjects, whom we divided 2 groups i.e. group A, 23 who recovered from ileus in conservative treatment after 3 days and group B, 56 who underwent surgery after 3 days. We compared groups, interval from the onset of symptoms to long tube insertion, the type of bowel stenosis contrasted through the long tube, location of the long tube tip, and drainage volume through the long tube. Results: In bowel stenosis, surgery tended to be selected in the group with occlusion or retention of gastrografin. A significant difference was found in interval from the onset of symptoms to long tube insertion (35 hours vs. 44 hours), long tube tip location, and drainage volume on day 3 (more or less than 500 ml) through the long tube. During follow-up, two-thirds of patients in group A showed recurrent adhesion ileus recurrence, and half underwent surgery within 3 years. Discussion: In conservative treatment in challenging cases of ileus, the long tube should be enplace as soon as possible and observe the change of the volume from the long tube. If ileus persists more than 3 days and drainage volume on day 3 is over 500 ml, we should recommend surgery for adhesion ileus.

Key words
adhesion ileus, ileus surgery, long tube

Reprint requests
Takumi Sakakibara Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine
65 Tsurumai-machi, Showa-ku, Nagoya, 466-8560 JAPAN

Accepted
March 30, 2005

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