An Acupuncture Case

A Case of acupuncture on postoperative adhesive intestinal obstruction

A 49-year-old housewife arrived at our clinic in January 2006 complaining of nausea, vomiting, cramping abdominal pain and obstipation. Initial examination showed a distended abdomen that was tender and tympanic on percussion. Hyperactive and high-pitched bowel sounds were audible on auscultation. A midline laparotomy scar and gridiron scar were present on her abdomen.

The patient had undergone an open appendicectomy for acute appendicitis in 1995 and had experienced intermittent diffuse abdominal pain, nausea, vomiting and constipation after the operation, requiring several attendances at the emergency department. In March 1999 she was readmitted to the hospital to undergo surgical adhesiolysis after an episode of AIO. Between March 2003 and September 2004, she experienced five more episodes of AIO and was given intravenous fluid treatment and nasogastric tube decompression at the hospital.

In December 2005 she was readmitted after presenting with vomiting and severe abdominal pain. A small bowel X-ray series showed marked dilatation of the jejunum with partial obstruction of barium flow. CT showed disproportional dilatation of the small intestine with fluid retention at the gastric level, suggesting intestinal obstruction from postoperative adhesions, for which surgical intervention was required. Unfortunately, she continued to experience nausea, constipation, bloating and abdominal pain after discharge from the hospital. Her pain persisted throughout the night, affecting her sleep and overall quality of life.

Further treatment with laxatives, prokinetics, barbiturates, antidepressants and analgesics only led to temporary relief of the patient's symptoms so she decided to pursue alternative treatments.

Acupuncture treatment

Acupuncture needles (0.30×25 mm) were inserted at ST36 (Zusanli) and ST25 (Tianshu) to the depth required for the production of the de qi sensation. The acupuncture needles were stimulated by rotation bidirectionally for 1 min. During needling at ST36 the patient experienced a strong warm sensation propagating from her lower leg to above her abdomen. The needles were then left in place for 20 min.

The patient underwent 12 sessions of treatment, three times a week for 4 weeks. During each session, changes in pain intensity were measured using an 11-point numeric rating Visual Analogue Scale (VAS). 1 At the first session her VAS score for abdominal pain was 9 out of 11. Immediately after the first session the patient noted a significant improvement of her abdominal pain. At the second session, 1 day later, her abdominal pain rating was 3 out of 11 on the VAS scale. Because she had experienced no adverse effects, she decided to continue with the treatment. On the third visit she reported that she no longer felt nauseous. She was able to sleep undisturbed and had normal bowel movements.

As the treatments continued her condition steadily improved. After 4 weeks of treatment she appeared to be symptom free and had been able to return to a normal diet. In a follow-up session 8 years after the final acupuncture treatment in February 2006 she reported that the symptoms had never returned. 

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