Strategy to small intestine obstruction caused by Crohn's disease on the basis of transnasal ileus tube insertion

Abstract

Background: Previous studies reported that transnasal ileus tube was a new and useful method for rapid relief of small intestinal obstruction. However, no study reported the impacts of the transnasal ileus tube for Crohn's disease combined with intestinal obstruction. We aimed to describe the strategy to the small intestine obstruction caused by Crohn's disease on the basis of transnasal ileus tube insertion.

Methods: From November 2019 to November 2021, the data of 6 hospitalized patients with CD, diagnosed and conservatively treated in The Second Hospital of Nanjing, were not relived and retrospectively collected. After the insertion of transnasal ileus tube, demographic information, clinical features and treatment data were extracted from medical records.

Results: Six Crohn's disease patients with intestinal obstruction were included. Half of them were male. The patients aged from 29 to 70 years. Five patients had chronic intestinal obstruction more than one year. Three patients had intestinal surgery history. One patient had colonic abdominal fistula and anastomotic fistula, when she took intermittent usage of sulfsalazine and steroid. On admission, all the patients had abdominal pain, distention and mass. Five patients had anemia, low albumin and cholinesterase. All CDAI scores were more than 400. Compared to 19 patients with incomplete intestinal obstruction improved by nasogastric decompression tube, 6 patients with intestinal obstruction catheter had significant difference in time for relieving abdominal pain and distension (p = 0.003), time for alleviating abnormal mass (p ≤ 0.01), drainage volume (p = 0.004), and preoperative CDAI score (p = 0.001). Compared with X-ray image before insertion, complete remission of obstruction of 5 patients were observed in intestinal cavity after insertion. After 1-2 months nutrition, all the patients had small intestine resection and ileostomy, half of them underwent colectomy and fistula repair, and 4 patients were performed enterolysis at the same time, the residual small intestine length ranging from 250 to 400 cm. 1 patient had permanent ileostomy;1 patient had abdominal infection after operation. The typical manifestations of acute and chronic inflammation, transmural inflammation, pseudopolyps and serous fiber hyperplasia could be seen in pathological findings of patients 1 to 5. All the patients continued enteral nutrition after surgery. Four patients were treated with infliximab or vedolizumab.

Conclusion: The current intestinal obstruction catheter which is used to treat patients with Crohn's combined obstruction can afford quick clinical remission, longer nutrition time, and suitable preoperative CDAI score for operation, which is worthy of wildly being used.

Keywords: Crohn’s disease; Obstructions; Transnasal ileus tube.

Fig. 1

Process of cases screening

Fig. 2

Abdominal X-Ray and CT at the beginning of obstruction confirmation. A1 and A2 showed the obstruction sign before tube insertion of patient 1; B1 and B2 showed the showed the obstruction sign before tube insertion of patient 2; C1 and C2 showed the obstruction sign before tube insertion of patient 3; D1 and D2 showed the obstruction sign before tube insertion of patient 4; E1 and E2 showed the obstruction sign before tube insertion of patient 5; F1 and F2 showed the obstruction sign before tube insertion of patient 6

Fig. 3

Parameters comparison of 6 patients before catheter insertion, 1W after insertion and before surgery

Fig. 4

Relief after 2w-4w transnasal ileum tube insertion by X-ray. A image of X-RAY after transnasal ileum tube insertion of patient 1; B image of X-RAY after X-RAY of patient 2; C image of X-AY after transnasal ileum tube insertion of patient 3; D image of X-AY after transnasal ileum tube insertion of patient 4; E image of X-AY after transnasal ileum tube insertion of patient 5; F image of X-AY after transnasal ileum tube insertion of patient 6. B–F indicated fully relieved; A indicated partially relieved

Fig. 5

Gastrointestinal radiological findings of stricture location of before surgery. From left to right: Patient 1, Patient 3, Patient 4, Patient 5. P1: segmental ileal stenosis, P3: multiple dilatation and segmental stenosis of small bowel, P4: ileal stenosis above ileocecal region, P5: stricture of ileocolic anastomosis, dilated ileum

Fig. 6

Macroscopic and microscopic findings of excisional intestinal specimen of 6 patients. A1 and A2 macroscopic and microscopic findings of patient 1; B1 and B2 macroscopic and microscopic findings of patient 2; C1 and C2 macroscopic and microscopic findings of patient 3; D1 and D2 macroscopic and microscopic findings of patient 4; E1 and E2 macroscopic and microscopic findings of patient 5; F1 and F2 macroscopic and microscopic findings of patient 6