Deconstructing dogma: Nonoperative management of small bowel obstruction in the virgin abdomen

Abstract

Therapeutic, level IV.

Non‐operative management for small bowel obstruction in a virgin abdomen: a systematic review

“…1). Ultimately, six studies met the inclusion criteria and were selected for the final assessment 6–11 . (Table 1) Among a total of 416 patients included in the studies, 205 (49.3%) had NOM and 211 (51.7%) underwent exploratory surgery.…”

“…All the studies were retrospective observational case series, 6–11 including one which utilized a prospectively collected database 10 . All studies scored 6 or more on the Newcastle‐Ottawa Scale and were therefore deemed good quality studies.…”

“…All studies incorporated radiological findings in the diagnosis of SBO. In four studies, the diagnosis of SBO was based on the combination of radiological findings and clinical symptoms 6,8–10 . Radiological investigations included either abdominal X‐rays 6,8–10 or CT imaging of the abdomen 6–11 .…”

“…In four studies, the diagnosis of SBO was based on the combination of radiological findings and clinical symptoms 6,8–10 . Radiological investigations included either abdominal X‐rays 6,8–10 or CT imaging of the abdomen 6–11 . Radiographical appearances suggestive of SBO included dilated loops of small bowels, 6,8–10 air fluid levels, 6,8 visible valvulae conniventes 8 and a possible transition point with distended small bowels proximally and collapsed small bowels distally 6,8 …”

“…Conventionally, explorative surgery has been advocated in this group of patients with a virgin abdomen presenting with SBO due to concerns regarding malignancy or an obstructing lesion 5,6 . However, in the past decade with the improved diagnostic capability of a computed tomography (CT) scan, there have been numerous studies challenging this surgical dogma 6–11 …”