Case Report of International Journal of Case Reports
Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease
1 Leonard B Weinstock, 2Janey S A Pratt, 3Lawrence Wurn, 4 Sharon Hepburn,
1Associate Professor of Clinical Medicine and Surgery, Washington University School of Medicine; Specialists in Gastroenterology, LLC, St. Louis, MO 63141, United States;
2Clinical Associate Professor of Surgery, Stanford University School of Medicine, Palo Alto, CA 94035, United States;
3Director of Clinical Research, Clear Passage Therapies, Gainesville, FL;
4Clinical Director, Clear Passage Therapies, St. Louis, MO
A woman with Crohn’s disease with prior resection presented with a one-year history of persistent abdominal pain. The small bowel follow-through radiograph demonstrated the presence of two strictures in the small intestine due to adhesive scarring. Opting for conservative management, the patient underwent a specialized manual physical therapy regimen. Following treatment, the patient experienced significant decrease of abdominal pain and improved biomechanical function. Radiologic imaging revealed complete resolution of both strictures. Manual physical therapy may be a viable non-operative option to manage small bowel strictures or obstruction.
Keywords: Manual physical therapy, adhesive bowel obstruction and strictures, Crohn’s disease
How to cite this article:
Leonard B Weinstock, Janey S A Pratt, Lawrence Wurn, Sharon Hepburn. Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease. International Journal of Case Reports, 2018 2:19. DOI: 10.28933/ijcr-2018-04-2801.
1. Duron JJ. Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis. 2007;9 Suppl 2:14-24.
2. Arung W, Michel M, Olivier D. Pathophysiology and prevention of postoperative peritoneal adhesions. World J of Gastroenterol. 2011;17:4545-4553.
3. Beck DE, Ferguson MA, Opelka FG, et al. Effect of previous surgery on abdominal opening time. Dis Colon Rectum. 2000;43:1749-1753.
4. Coleman MG, McLain AD, Moran BJ. Impact of previous surgery on time taken for incision and division of adhesions during laparotomy. Dis Colon Rectum. 2000;43:1297-1299.
5. Parker MC. Epidemiology of adhesions: the burden. Hosp Med. 2004;65:330-336.
6. Tirumani H, Vassa R, Fasih N, et al. Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes. Clin Imaging. 2014;38:580-588.
7. Osada H, Watanabe W, Ohno H, et al. Multidetector CT appearance of adhesion-induced small bowel obstructions: matted adhesions versus single adhesive bands. Jpn J Radiol. 2012;30:706-712.
8. Mucha P. Small intestinal obstruction. Surg Clin North Am. 1987;67:597-620.
9. Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl. 1997;577:5-9.
10. Miller G, Boman J, Shirier I, et al. Natural history of patients with adhesive small bowel obstruction. Br J Surg. 2000;87:1240-1247.
11. Takeuchi K, Yasushi T, Tetsu A, et al. Clinical studies of strangulating small bowel obstruction. The American Surgeon. 2004;70:40-44.
12. Catena F, Di Saverio S, Kelly MD, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2010 evidence-based guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2011;6:5
13. Diaz JJ, Bokhari F, Mowery NT, et al. Guidelines for management of small bowel obstruction. J Trauma. 2008;64:1651-1664.
14. Kendrick ML. Partial small bowel obstruction: clinical issues and recent technical advances. Abdom Imaging. 2009;34:329-334.
15. Seror D, Feigin, E, Szold, A, et al. How conservatively can postoperative small bowel obstruction be treated? Am J Surg. 1993;165:121-125.
16. Tanaka S, Yamamoto T, Kobuto D, et al. Predictive factors for surgical indication in adhesive small bowel obstruction. Am J Surg. 2008;196:23-27.
17. Jeong WK, Lim SB, Choi HS, et al. Conservative management of adhesive small bowel obstructions in patients previously operated on for primary colorectal cancer. J Gastointest Surg. 2008;12:926-932.
18. Cox MR, Gunn IF, Eastman MC, et al. The safety and duration of non-operative treatment for adhesive small bowel obstruction. Aust N Z J Surg. 1993;63:367-371.
19. Fevang BT, Jensen D, Svanes K, et al. Early operation or conservative management of patients with small bowel obstruction? Eur J Surg Suppl. 2002;168:475-481.
20. Fevang BT, Fevang J, Lie SA, et al. Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg. 2004;240:193-201.
21. HCUPnet: A tool for identifying, tracking, and analyzing national hospital statistics, 2012.
22. Strik C, Stommel MWJ, Schipper LJ, et al. Risk factors for future repeat abdominal surgery. Langenbeck’s Archives of Surgery. 2016;401:829-837.
23. Peters AA, Trimbos-Kemper GC, Admiraal C. A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain. Br J Obstet Gynaecol. 1992;99:59-62.
24. Chan CL, Wood C. Pelvic adhesiolysis – the assessment of symptom relief by 100 patients. Aust N Z J Obstet Gynaecol. 1985;25:295-298.
25. Steege JF, Stout AL. Resolution of chronic pelvic pain after laparoscopic lysis of adhesions. Am J Obstet Gynecol. 1991;165:278-281.
26. Sampson S, Meng M, Schulte A, et al. Management of Dupuytren contracture with ultrasound-guided lidocaine injection and needle aponeurotomy coupled with osteopathic manipulative treatment. J Am Osteopat Assoc. 2011;111:113-116.
27. Boyles R, Toy P, Mellon J, et al. Effectiveness of manual physical therapy in the treatment of cervical radiculopathy: a systematic review. J Man Manip Ther. 2011;19:135-142.
28. Şenbursa G, Baltaci G, Atay ÖA. The effectiveness of manual therapy in supraspinatus tendinopathy. Acta Orthop Traumatol. 2011;45:162-167.
29. Gaspar PD, Willis FB. Adhesive capsulitis and dynamic splinting: a controlled, cohort study. BMC Musculoskelet Disord. 2009;10:111.
30. Wurn BF, Wurn LJ, Patterson K, et al. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual physical therapy: Results from two independent studies. J Endometr. 2011;3:188-196.
31. Wurn BF, Wurn LJ, King CR, et al. Treating fallopian tube occlusion with a manual pelvic physical therapy. Altern Ther Heal Med. 2008;14:18-23.
32. Wurn BF, Wurn LJ, King CR, et al. Treating female infertility and improving IVF pregnancy rates with a manual physical therapy technique. Med Gen Med. 2004;6(2):51.
33. Kramp ME. Combined manual therapy techniques for the treatment of women with infertility: a case series. J Am Osteopath Assoc. 2012;112:680-684.
34. Rice AD, Reed ED, Patterson K, et al. Clearing bowel obstruction and decreasing pain in a terminally ill patient via manual physical therapy. J Palliat Med. 2013;16:222-223.
35. Rice AD, Wakefield LB, Patterson K, et al. Decreasing adhesions and avoiding further surgery in a pediatric patient involved in a severe pedestrian versus motor vehicle accident. Pediatr Rep. 2014;6(1):5126.
36. Rice A, King R, Reed E, et al. Manual physical therapy for non-surgical treatment of adhesion-related small bowel obstructions: two case reports. J Clin Med. 2013;2:1-12.
37. Rice AD, Patterson K, Reed ED,et al. Treating small bowel obstruction with a manual physical therapy: a prospective efficacy study. Biomed Res Int. 2016;1:8.
38. 2011 GoOT. http://www.aacom.org/resources/bookstore/Documents/GOT2011ed.pdf