Current status of diagnosis and management of strangulation obstruction of the small bowel

Shatila, Ahmad H.; Chamberlain, Bruce E.; Webb, Watts R.

doi:10.1016/0002-9610(76)90379-2

Cited by 97 publications

(42 citation statements)

References 13 publications

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“…3,4 Current CT resolution has reached a point that allows clinicians to visualize details never before imagined. 5 These details, when combined with the patient's history and physical examination, can appropriately direct the clinical course of a patient with SBO and should be incorporated into a treatment algorithm. [6][7][8][9][10] With the new knowledge gained in the era of CT scan and its use in management of small bowel obstruction, author wanted to apply the original definition of complete bowel obstruction to the modern day and determine features on CT scan that can be used to further discriminate the need for operative exploration.…”

Section: Discussionmentioning

confidence: 99%

Small bowel obstruction: need for surgery based on history and radiology

Meena¹,

Bhatt²,

Jain³

2018

Int Surg J

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INTRODUCTIONBowel obstruction continues to be one of the most common intra-abdominal conditions encountered by general surgeons in their practice. It remains a major cause of morbidity and mortality, accounting for 15% of hospital admissions for acute abdomen and up to 30% of these needs operative intervention.1,2 Patients may present acutely or as a chronic and relapsing problem with symptoms ranging from modest discomfort to extreme illness and shock. Small Bowel Obstruction (SBO) has been and continues to be a common clinical challenge. This is so because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognize the presence of strangulationobstruction and hence the need for urgent operative intervention; and on the other hand can avoid a nontherapeutic laparotomy along with its associated ABSTRACT Background: Small bowel obstruction is a common clinical challenge because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognise the presence of strangulationobstruction and hence the need for urgent operative intervention; and on the other hand, can avoid a non-therapeutic laparotomy along with its associated morbidities and further adhesion formation with its potential sequelae. The study was done to identify relevant features in the patient's clinical and CT abdomen findings which when present would be highly predictive of the requirement of an operative intervention in a patient with small bowel obstruction. Methods: The study was a hospital based analytical observational study on patients admitted from March 2013 to May 2014 with a diagnosis of small bowel obstruction and who underwent a concurrent CT abdomen. Correlation of line of management was done with respect to the three chosen parameters, obstipation (history), mesenteric edema (CT imaging) and lack of small bowel feces Sign (CT imaging). Results: A total of 74 patients were included with Male:Female ratio being 3.1:1. Forty patients were managed conservatively and remaining underwent surgery with adhesions being the most frequent etiology. The most common operative procedure performed was adhesiolysis with or without band release. Twenty-three cases were performed by open method and remaining laparoscopically. Evaluation of the three parameters revealed that these variables, when present independently or in combination, are predictive for need for operative intervention (p-value <0.001). The sensitivity and specificity to predict the need for exploration when all 3 features were present concurrently was 38.24% and 100%, respectively. Conclusions: Small-bowel obstruction is a common surgical dilemma, the management of which is dealt on a daily basis by surgeons and non-surgeons. The management using variables based on history and radiology may help classify patients into those requiring conservative management and those in need of early exploration.

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Section: Discussionmentioning

confidence: 99%

Small bowel obstruction: need for surgery based on history and radiology

Meena¹,

Bhatt²,

Jain³

2018

Int Surg J

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“…Patients were also excluded if there was the potential for favouring nonoperative man agement owing to other medical circumstances, such as in patients with incurable intraabdominal malignancy, inflammatory bowel disease, recent abdominal surgery, prior abdominal or pelvic radiation, or severe comorbid illnesses. 18,19 By using 2 expert radiologists blinded to each other's interpretations and to patient outcomes, only CT findings with good interobserver correlation were included in the multivariable logistic regression model. Our study was specifically designed to achieve results that may be more readily extrapolated to the sur gical management of patients with nonstrangulating SBO at other centres.…”

Section: Discussionmentioning

confidence: 99%

986 Computed Tomography Features Associated With Operative Management for Nonstrangulating Small Bowel Obstruction

Suri¹,

Vora²,

Kirby³

et al. 2010

Gastroenterology

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“…Strangulation obstruction of the small bowel continues to be a majar diagnostic and therapeutic problem in surgery [16]. However, when analyzed retrospectively many series have shown that the presence of strangulation was not diagnosed preoperatively in 50-85% of patients with strangulation obstruction who underwent laparotomy [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…However, when analyzed retrospectively many series have shown that the presence of strangulation was not diagnosed preoperatively in 50-85% of patients with strangulation obstruction who underwent laparotomy [15][16][17]. The overall mortality of strangulation obstruction is 14.6-30% [4,12,14].…”

Section: Introductionmentioning

confidence: 99%

“…The main cause of this high mortality is anoxia of the involved segment due to inadequate blood supply of the closed loop. The fluid which collects in the lumen of the closed loop leaks into the peritoneal cavity as a transudate before actual perforation of the bowel wall occurs [1,16]. This transudate is rich in bacteria and their toxic products which may cause endotoxemia and death after absorption by the systemic circulation [1,2,6,14,18].…”

Section: Introductionmentioning

confidence: 99%

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Liver glycogen in gangrenous intestinal obstruction

et al. 1988

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Considerable drops in liver glycogen contents of guinea pigs suffering from gangrenous intestinal obstruction were recorded in regard to control values (P less than 0.001). An additional experiment was conducted by using carbontetrachloride (CT) to determine whether or not the shortening of survival related to liver glycogen content in animals with strangulation obstruction. The mean tissue glycogen content in the sham-operated group was 816.2 +/- 13.3 micrograms/g, w. wt., whereas in the CT-treated group it was 73.5 +/- 11.0 micrograms/g w. wt. This difference is highly significant (P less than 0.001). The mean survival was 54.4 +/- 5.8 h and 21.9 +/- 5.5 h in animals with gangrenous intestinal obstruction before and after CT treatment, respectively. These results suggested that the liver glycogen depletion was a significant factor in decreasing the survival time of guinea pigs with strangulation obstruction.

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Current status of diagnosis and management of strangulation obstruction of the small bowel

Cited by 97 publications

References 13 publications

Small bowel obstruction: need for surgery based on history and radiology

Small bowel obstruction: need for surgery based on history and radiology

986 Computed Tomography Features Associated With Operative Management for Nonstrangulating Small Bowel Obstruction

Liver glycogen in gangrenous intestinal obstruction

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