Outcome of decompression using a transnasal ileus tube in malignant adhesive bowel obstruction: A retrospective study

Abstract

Malignant adhesive bowel obstruction caused by peritoneal carcinomatosis is a common complication of advanced abdominal malignancies, and surgical treatment provides little benefit. The present study was undertaken to evaluate the decompression efficacy of a transnasal ileus tube under X-ray guidance, with benign adhesive bowel obstruction patients serving as the control group. A total of 21 patients with malignant adhesive bowel obstruction and 60 patients with benign conditions were enrolled between February 2011 and March 2015. All the patients were treated with transnasal ileus intubation under X-ray guidance. A total of 9 of the 21 malignant cases and 44 of the 60 benign cases were successfully treated with transnasal ileus intubation (42.9 vs. 73.3%, respectively; P=0.01). Treatment in 8 malignant and 4 benign cases failed due to death, tube discharge, and/or therapy abandonment, all of which contributed to a significant difference between the two groups (38.1 vs. 6.7%, respectively; P=0.01). A total of 4 malignant cases and 12 benign adhesion cases received further surgical treatment, the success rate of which was 50 vs. 91.7%, respectively. The rate of successfully treated intubation cases in all resolution patients was similar between the two groups (81.8% in the malignant group and 80% in the benign group; P=0.89). In conclusion, ileus tube decompression in patients with malignant conditions was associated with a lower success rate and lower further surgical intervention success rate compared with that observed in patients with benign conditions. However, insertion of an ileus tube may successfully cure ~80% of all resolution patients in both groups; thus, it may be used as a feasible therapy in malignant adhesive bowel obstruction patients, similar to patients with benign obstruction.

Keywords: adhesive bowel obstruction; ileus tube; intestinal decompression; malignant bowel obstruction; peritoneal carcinomatosis.

Figure 1.

Transnasal ileus tube insertion in malignant adhesive bowel obstruction. (A and B) The patient had undergone surgical treatment for ovarian cancer 3 years prior to presenting with bowel obstruction caused by peritoneal carcinomatosis (arrow). (C) A transnasal ileus tube was inserted under X-ray guidance. The bowel obstruction symptoms resolved after 5 days of continuous decompression.

Figure 2.

Flow diagram showing the treatment and outcome of 81 patients. A total of 21 malignant and 60 benign cases underwent intubation therapy, with a success rate of 42.9 and 73.3%, respectively.