Occurrence of Intestinal Pseudo-obstruction in a Brainstem Hemorrhage Patient

Intestinal pseudo-obstruction is a massive colonic dilation with signs and symptoms of colonic obstruction, but without a mechanical cause. A 49-year-old female patient complained of nausea, vomiting, and abdominal distension 1 month after a massive brainstem hemorrhage. No improvement was seen with conservative treatments. An extended-length rectal tube was inserted to perform glycerin enema. In addition, bethanechol (35 mg per day) was administered to stimulate colonic motility. The patient's condition gradually improved over a 2-month period without any surgical intervention. Extended length rectal tube enema and bethanechol can be used to improve intestinal pseudo-obstruction in stroke patients.

The advantage and disadvantage of rectal tube retenton in patient with diarrhea.

The objective of this study was to determine the advantage and disadvantage of rectal tube retention by evaluating patient’s satisfaction (feeling) and complications that may occur. Subjects were divided into two groups. Rectal tube was not retained in the control groups and retrained in treatment groups. There are 30 patients in each group. 63 percent of subjects were female and mean age for control group was 51 years. 53 percent of subjects were male and mean age for treatment group was 57 years and mean duration of rectal tube retention was 4 days. Their results were as follows. 1. In the rectal tube retention group, 14.3 percent had moderate abdominal distention, 7.1 percent moderate tenesmus, 7.1 percent moderate rectal pain and 14.3 percent moderate anxiety regarding rectal tube retention. 2. Sigmoidoscopy after remove rectal tube in 24-48 hour showed 13 percent of patient in treatment group had erythematous rectal mucosa. 3. There were no perianal ulceration in the treatment group while ulceration were present in the control (10 percent). 4. The number of time for anal cleansing and the amount of pad used was much less in the treatment group than in the control group (p<0.01).

Effectiveness of a Rectal Tube for Relief of Pain after Colonoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: Abdominal distension from the insufflation of air can create more troublesome discomfort after colonoscopy (CFS) than after upper endoscopy. Many patients report difficulty in expelling insufflated air after CFS. One previous study demonstrated that insertion of rectal tube at the conclusion of CFS significantly improves patient satisfaction with the procedure. The aim of this study was to compare the effectiveness of rectal tube placement for abdominal decompression after CFS in an effort to limit patient discomfort by carefully applying air suction during CFS. METHODS: We conducted a prospective trial in 103 consecutive patients undergoing elective CFS. Patients were randomized to receive rectal tube placement at the end of the procedure or simple air suction during the procedure. Patients were evaluated by clinical symptoms and signs 10 minutes after completion of CFS. RESULTS: All 103 patients had a complete examination of the colon to the cecum. No specific complications occurred during and a day after examination. The two groups were well matched with respect to age, sex, height, weight, chief complaints. There were no significant differences between the two groups for bowel preparation, duration of examination, abdominal pain during procedure, abdominal disten-sion 10 minutes after CFS, and abdominal pain 10 minutes after CFS (p >0.05). CONCLUSIONS: Meticulous air suction during CFS reduces abdominal discomfort and distension after CFS and is as effectively as the placement of a rectal tube at the con-clusion of CFS.