cellulase and Intestinal-Obstruction

Postoperative adhesion is a frequent problem in patients undergoing surgery. In particular, gastrectomy is associated with a high risk of bowel obstruction. However, there are few reports of small bowel obstruction (SBO) after gastrectomy in the English-language literature. We reviewed the literature to assess the effectiveness of various techniques for preventing adhesion in patients treated with gastrectomy. We assumed that strategies used to prevent postoperative adhesion associated with colorectal surgery, cholecystectomy, appendectomy and gynecologic procedures are similar to those used in gastrectomy. We therefore reviewed reports on the prevention of postoperative SBO in any abdominal surgical procedure, focusing especially on gastrectomy. General intraoperative preventive techniques, such as the use of starch-free gloves, saline irrigation at a temperature below 37 °C and laparoscopic techniques whenever possible, may reduce the incidence of SBO in patients with gastric cancer who undergo gastrectomy. If preserving the omentum is unrelated to the survival rate of patients with gastric cancer, this technique should be recommended for preventing postoperative SBO. The use of hyaluronic acid/carboxymethylcellulose bioabsorbable membranes should also be considered in patients undergoing gastrectomy. However, demonstrating the advantages of bioabsorbable membranes would require larger randomized studies with a longer follow-up period.

Topics: Biocompatible Materials; Cellulase; Gastrectomy; Gloves, Surgical; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Intraoperative Care; Laparoscopy; Membranes, Artificial; Omentum; Postoperative Complications; Sodium Chloride; Starch; Stomach Neoplasms; Temperature; Therapeutic Irrigation

A 66-year-old woman had a sudden onset of small-bowel obstruction during enzymatic treatment for gastric persimmon bezoar. Oral enzymatic therapy is the most effective method of treatment for large phytobezoars when endoscopic extraction is not possible. However, this report suggests that a further endoscopic intervention may be necessary in case the dissolved bezoars cause small-bowel obstruction during this form of therapy.

Topics: Aged; Bezoars; Cellulase; Female; Fruit; Gastrointestinal Agents; Humans; Intestinal Obstruction; Jejunal Diseases; Pancreatin; Pepsin A; Stomach; Ursodeoxycholic Acid

Topics: Bezoars; Cellulase; Humans; Ileal Diseases; Intestinal Obstruction; Male; Middle Aged; Stomach