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BMJ Case Reports 2018; doi:10.1136/bcr-2017-223965
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)
  • CASE REPORT

Intraoperative intraluminal injection of N-acetylcysteine allowing treatment of distal intestinal obstruction syndrome without the need for enterotomy

  1. James Wheeler
  1. Department of Surgery, Addenbrooke’s Hospital, Cambridge, UK
  1. Correspondence to Dr Nicholas JS Chilvers, n.chilvers{at}nhs.net, nickchilvers{at}gmail.com
  • Accepted 23 April 2018
  • Published 16 May 2018

Summary

We describe a case of an 18-year-old man who suffers from cystic fibrosis and developed distal intestinal obstruction syndrome while being treated as an inpatient. Following failed medical management, we proceeded to laparotomy where the small bowel was decompressed with retrograde milking into the stomach, leaving a section of impacted stool in the distal ileum. N-acetylcysteine was injected into the bowel lumen proximal to the obstruction. This resulted in dissolution of the stool without the need for enterotomy and is, to our knowledge, the first successful example of this technique in the literature.

Footnotes

  • Contributors Both authors contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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