Conservative Management of Adhesive Small Bowel Obstructions in Patients Previously Operated on for Primary Colorectal Cancer

Abstract

This study aimed to determine the incidence of adhesive small bowel obstruction (SBO) after primary colorectal cancer surgery and the outcomes of conservative management using gastrointestinal tubes in such cases. Between October 2000 and December 2005, 2,586 primary colorectal cancer patients underwent consecutive operations and were followed up completely for a median of 38 months. During the follow-up periods, 119 patients with 130 consecutive cases of adhesive SBO underwent conservative management using nasogastric tubes and long intestinal tubes. The overall adhesive SBO rate was 5.0% in 38 months of follow-up, and the observed incidence rate was 0.0013 per patient-month. Of the 130 cases, 104 cases (80%) were successfully treated by conservative management, and the symptoms of SBO were resolved by the sixth day (range 1 to 22). Twenty-six cases (20%) underwent surgery because of lack of clinical improvement (17) or signs of strangulation (9). The high success rate indicates that initial conservative management with intestinal decompression using gastrointestinal tubes is recommended for patients with adhesive SBO after primary colorectal cancer surgery.

Risk factors for post-colectomy adhesive small bowel obstruction

“…In our study, postoperative small bowel obstruction caused by adhesions after colectomy for colorectal cancer was determined in 13.7% of patients, and in similar studies, the percentage of postoperative adhesions after surgery colon tumors ranged from 5.5% (13) to 9.5% (14)(15)(16)(17).…”

Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction

“…code 560.81 or 560.9. Exclusion criteria for our analysis (and the rationale for these exclusions) included the following: (1) operation on day of hospital admission (to exclude patients who presented with initial signs of intestinal strangulation and thus received emergency operation without initial delay in operative management); (2) clinical evidence of preoperative sepsis and/or septic shock (to exclude patients in whom nonoperative management may have been attempted but then aborted because of the development of signs of intestinal ischemia); (3) operation more than 10 days after admission (to exclude patients in whom bowel obstruction may have occurred during the course of hospitalization for some other indication); (4) previous operation within 30 days of index operation (to exclude patients who may have sustained early obstruction after previous abdominal surgery); (5) transfer from another acute hospital, intermediate care facility, or emergency department (to exclude patients in whom the length of preoperative hospitalization at the treating institution could not be known); (6) index operation performed by a nongeneral surgeon (to exclude patients in whom bowel obstruction may not have been the primary surgical indication); (7) classification as ''outpatient'' in the postoperative period; (8) American Society of Anesthesiology (ASA) physical status classification of 5 (''moribund''); and/or (9) pregnancy. An a priori decision was also made to include patients for analysis without regards to whether their operation was performed as an elective versus emergency procedure.…”

Manual physical therapy clears adhesive bowel obstruction and strictures in a patient with Crohn’s disease

“…[14] In the setting of adhesive partial SBO, a conservative approach has been shown to be successful in 65 to 80% of cases, with a relatively low overall incidence of ischemia ranging from 3 to 6%. [15][16][17][18][19] While this approach is more tenuous in patients with complete SBO, some studies still report nonoperative management to be successful in 41 to 73% of these cases. [20] In all cases, failure of non-operative management quickly portends surgical intervention per current guidelines.…”