Nonsurgical Management of Partial Adhesive Small Bowel Obstruction with Bisacodyl Suppository Combine Intravenous Metoclopramide Therapy: A Randomized Control Trial
Keywords:
Adhesive small bowel obstruction, Bisacodyl suppository and metoclopramide, Randomized controlled trial, Nonsurgical managementAbstract
Background and objective: Patients with clinical feature of small bowel obstruction and present of previous abdominal surgery should be suspected of adhesive small bowel obstruction especially midline incision. Previous study of oral laxative drug with digestive agent was a conservative treatment that this approach is associated with the hospital stays and risk of delayed surgery. The aims of the present randomized controlled trial study were to investigate a combining standard conservative treatment using Bisacodyl suppository with intravenous metoclopramide for partial adhesive small bowel obstruction comparing with the control group which nothing by mouth, intravenous hydration and nasogastric tube decompression.
Materials and Methods: 120 patients admitted between January 2019 - December 2020 with symptom and sign suggestive of partial adhesive small bowel obstruction were randomized to receive either the control group (nothing by mouth, intravenous hydration and nasogastric tube decompression) or treatment group (Bisacodyl suppository and intravenous metoclopramide). The primary outcome included time to first flatus and defecation, number of successfully treatment without surgery, and length of hospital stay were recorded.
Results: A total of 120 patients were included in this study, 60 patients in each treatment group and control group. The treatment group was more effective than the control group in the time of flatus and defecation (p < 0.001), and lower number surgical need than another group with statistic significantly (p < 0.05). Also, average length of hospital stay in the treatment group was shorter than the control group with statistically significant at p < 0.001. There were no statistically significant differences between patients in both groups in terms of age, gender, and type of previous surgical incision as baseline.
Conclusion: Bisacodyl suppository and metoclopramide intravenous injection was safe and effective without complication to use in patients. It was effective in hastening the resolution of conservatively treated partial adhesive small bowel obstruction and shortening the hospital stay.
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