From the Research
When nasogastric (NG) tube suctioning is stopped in a patient with small bowel obstruction (SBO), it is crucial to closely monitor the patient for signs of increased abdominal distension, nausea, vomiting, and abdominal pain, as these can indicate worsening of the obstruction. The most recent and highest quality study on this topic is from 2023 1, which suggests that the management of SBO has evolved, and the use of nasogastric tube decompression is being reevaluated. According to this study, some patients with adhesive small bowel obstruction (aSBO) can be managed successfully without NGT decompression, with no significant differences in operative rates, mortality, or rates of bowel resection compared to those who received NGT decompression. However, the decision to stop NG tube suctioning should be made on a case-by-case basis, taking into account the individual patient's condition and the severity of the obstruction. Key factors to consider include:
- The presence of signs of strangulation or ischemia, which would necessitate urgent surgical intervention 2
- The patient's ability to tolerate oral intake and the presence of nausea and vomiting 3
- The results of imaging studies, such as computed tomography (CT) scans, which can help assess the severity of the obstruction and guide management decisions 4
- The patient's overall clinical condition, including the presence of comorbidities and the risk of complications 5 In general, NG tube suctioning should be maintained until there is clear evidence of obstruction resolution, such as passage of flatus or stool, decreased abdominal distension, or radiographic improvement of the obstruction. This approach can help minimize the risk of complications and improve patient outcomes. It is also important to note that the use of water-soluble contrast (WSC) may stimulate bowel function and reduce hospital length of stay, and its administration should be considered in the management of aSBO 1.