Corticosteroid Therapy in Early Postoperative Small Bowel Anastomotic Strictures: A Case Report and Literature Review.

Abstract

For early anastomotic strictures, conservative approaches involve parenteral nutrition and bowel rest, with most obstructions relieving spontaneously. Conservative approaches involve parenteral nutrition and bowel rest, with most obstructions relieving spontaneously. However, reoperation may be required for refractory cases. Corticosteroids may be effective in reducing inflammatory edema and restoring luminal patency. We report a case of a 50-year-old woman who developed small bowel obstruction following laparoscopic small bowel resection and anastomosis due to a strangulated femoral hernia. CT with oral and intravenous contrast suggested peri-anastomotic edema without evidence of leak or peritonitis. Conservative interventions in the form of nil per mouth, intravenous fluids, and nasogastric (NG) tube failed, and intravenous hydrocortisone, tapered over five days, was administered. This resulted in rapid improvement of bowel function without recurrence and avoidance of reoperation. This case highlights the potential role of short-term corticosteroid therapy as an adjunct to other conservative measures in carefully selected patients, particularly in the setting of partial obstruction without evidence of leak, to avoid the need for resurgery.