Adhesional small bowel obstruction in the absence of previous operations: management and outcomes. World J Surg 2009 Nov;33(11):2368-71
Date
09/17/2009Pubmed ID
19756860DOI
10.1007/s00268-009-0200-6Scopus ID
2-s2.0-70350029254 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
BACKGROUND: The majority of small bowel obstructions (SBO) are the result of adhesions caused by a previous abdominal operation. On rare occasions, adhesional SBO occurs in the absence of such an operation. Our objective was to describe the management, findings, and outcomes of unexplained adhesional SBO (UA-SBO) and examine whether preoperative diagnostic uncertainty leads to delays in therapy and complications.
METHODS: The medical records of all adhesional SBO patients admitted to the Massachusetts General Hospital between January 1, 1997 and December 31, 2007 were screened. UA-SBO records were reviewed in detail. Each UA-SBO patient was matched with an adhesional SBO patient with abdominal surgical history (SH-SBO) according to gender, age (+/-7 years), white blood cell count (+/-3000/mm3), time interval from the onset of symptoms to the time of admission (+/-24 h), and year of admission (+/-4 years). Outcomes included time from admission to operation, morbidity, mortality, and length of hospital stay.
RESULTS: Of 1,036 patients with adhesional SBO, 34 (3.3%) had UA-SBO. Adhesiolysis was sufficient in 31 patients, whereas 3 required an enterectomy. UA-SBO patients were similar in terms of demographics, clinical presentation, and initial laboratory tests with SH-SBO patients. There was no difference in any of the outcomes between the two groups.
CONCLUSIONS: In this study of UA-SBO, diagnostic delays were not found and patient outcomes were similar to those of patients with SH-SBO.
Author List
Butt MU, Velmahos GC, Zacharias N, Alam HB, de Moya M, King DRAuthor
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Digestive System Surgical Procedures
Female
Humans
Incidence
Intestinal Obstruction
Intestine, Small
Male
Middle Aged
Postoperative Complications
Tissue Adhesions
Treatment Outcome
Young Adult