Shinya Urakawa, MD, Yohei Kono, MD, Kota Momose, MD, Talal Alzghari, MD, Jeffrey Milsom, MD
Weill Cornell Medical College, New York, NY
Introduction: Small bowel obstruction (SBO) is a common disease in the gastrointestinal surgery field. Although causes of SBO are highly variable, surgical management is usually selected for adhesive obstruction if nasogastric tube decompression has failed. There have been no reports of endoscopic cure for SBO, despite several reports of endoscopic management of colonic voluvulus or malignant colonic obstruction. Here we report three cases in which endoscopic reduction was safely performed for SBO.
Case Description/Methods: Case1: An 86-year-old woman developed obstruction one month after right hemicolectomy for colorectal cancer. Preprocedural CT scan imaging detected a lumen caliber change near the ileocolonic anastomosis, and no recovery sign was acquired even after decompression treatment by nasogastric tube for 3 days. Colonoscopy with fluoroscopy showed ileum kinking at 10 cm proximal from the anastomosis. Case2: A 68-year-old woman developed obstruction during hospitalization for myelodysplastic syndrome. She had past surgcal history of 7 caesarean sections. Preprocedural CT scan imaging showed terminal ileum with transition point at 20 cm from ileocecal valve. Colonoscopy was performed after one week of conservative management. Colonoscopy with fluoroscopy revealed strong angulation and stricture accompanied by ulcerations at the terminal ileum. Case3: A 79-year-old woman developed obstruction one year after cystectomy with Indiana pouch reconstruction for bladder cancer. There was no improvement sign after 5 days of nasogastric tube and supportive treatment. Colonoscopy with fluoroscopy revealed ileum kinking 20 cm proximal to the ileocolic anastomosis, consistent with preprocedural imaging.
In all 3 cases, the scope passed through the obstruction site following insertion of a guide wire and stiff catheter through above the obstruction area. All obstructions were successfully released. The passage of the contrast intraoperatively through the site was clearly observed. In Case 3 was added balloon dilation after the endoscope withdrawal. All patients were discharged without additional surgery or postprocedural complications, with 1.5-4months follow up.
Discussion: We report three cases in which endoscopic treatment safely treated for SBO likely due to adhesions. Endoscopic management could release the obstruction earlier than predictable course in these three cases. These cases show the potential for endoscopic treatment to replace surgical treatment in a certain type of SBO.
Citation: Shinya Urakawa, MD, Yohei Kono, MD, Kota Momose, MD, Talal Alzghari, MD, Jeffrey Milsom, MD. P0600 - ENDOSCOPIC MANAGEMENT CASES FOR SMALL BOWEL OBSTRUCTION. Program No. P0600. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.