Adhesional small bowel obstruction in the absence of previous operations: management and outcomes.

Abstract:

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.

journal_name

World J Surg

journal_title

World journal of surgery

authors

Butt MU,Velmahos GC,Zacharias N,Alam HB,de Moya M,King DR

doi

10.1007/s00268-009-0200-6

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

2368-71

issue

11

eissn

0364-2313

issn

1432-2323

journal_volume

33

pub_type

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