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Visceral Manipulation as a Non-Surgical Approach to Resolving Small Bowel Obstruction: A Case Report of a 77-Year-Old Male

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 14-15. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

case report [710]
geriatrics [117]
male [784]
small bowel obstruction [1]
visceral osteopathy [87]

Abstract:

Introduction/Background: Small bowel obstruction (SBO) is a significant cause of morbidity in elderly patients, often necessitating surgical intervention. Osteopathic manipulative treatment (OMT) offers a non-invasive alternative, promoting homeostasis. Literature on the use of OMT for SBO patients remains scarce. This case demonstrates the successful application of OMT as an adjunctive therapy in a patient with SBO. Case: A 77-year-old Caucasian male with a history of pulmonary embolism on anticoagulant therapy, chronic obstructive pulmonary disease, and recurrent diverticulitis presented with 48 hours of colicky abdominal pain, nausea, and vomiting. Physical examination revealed right lower quadrant tenderness and mild abdominal distention without guarding. Imaging confirmed SBO at the terminal ileum with colonic air-fluid levels. Initial conservative management and current standard of care included NPO status, IV fluids, NG decompression, antibiotics, and a trial of gastrograffin. Imaging studies indicated progression to high-grade SBO. OMT was initiated on hospital day 4, targeting the cecum and sigmoid colon with abdominal lifts and visceral techniques. After two OMT sessions, the patient passed a large bowel movement, experienced significant pain relief, and resolution of obstruction on imaging. The NG tube was removed, and the patient transitioned to a regular diet before discharge. Results: OMT resulted in rapid clinical improvement, allowing the patient to avoid surgical intervention. Post-treatment imaging confirmed obstruction resolution. The patient was discharged in stable condition. Discussion: This case highlights the potential role of OMT in managing SBO in patients with high surgical risks. By addressing mechanical dysfunction and promoting motility, OMT offers a safe, low-risk adjunct to traditional treatment. Further research is needed to validate its efficacy and establish standardized protocols for SBO management.


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