An attempt has been made to investigate the rational
behind the use of suction in cases Of intestinal obstruction.
It would appear that the effect of distension with, or without
a compromisation of the blood supply, is the initial condition.
The effect of this distension leads to devitalisation and
circulatory embarrassment, resulting in conditions which are
conducive for the proliferation of bacteria and the production
of the clinical picture of toxaemia. The effect on the colon
is additionally complicated by the presence of the eaecum
which has a distinct tendency t® perforate under pressure
and lead to peritonitis.
Deaths occurring in any series are important to
analyse. Miller (1929) reported a mortality rate of 65%
at the Charity Hospital in Hew Orleans. Tendler and
Cartwright reported mortality rates of 51% from 1923/1932 ,
then 26% from 1933/46 and 8% from 1947/1953. Turner reported
100 consecutive cases from each of three decades and found
a mortality of 27% in 1929, 21% in 1939 and 4% in 1949.
Missed strangulated obstruction always led to death for
although suction will remove the toxic products from a
strangulated segment of gut, it will not do so in a closed
loop situation. Even in the simple strangulated case, suction
only acts to delay the inevitable operation. The question of
time is also of importance as regards the production of
complications from the mechanical effects of the suction tub®.
It should be noted however, that there is one report of a
patient with an indwelling nasogastric tube for 47 days without
complication. This is exceptional and many complications arise
in the first 48 hours of use.
Post-operatively the picture is even more confused but
with observations of the stomach after vagotomy the position
is being resolved. Some consider that suction is absolutely
necessary after operation involving vagotomy, believing that
the stomach is flaccid and distends to a considerable size.
It is true that a reduction in the contractile force dees occur,
but intragastric pressure and aural tone is increased. Numerous
reports have been read about the advantages of tubeless
post-operative management and the remarkable degree of success