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

Abstract

Background Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non‐operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Results Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). Conclusion NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed‐loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large‐scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long‐term follow‐up data are warranted to allow for quantitative analysis to reinforce this evidence.

Trans‐omental internal hernia containing Meckel's diverticulum – a rare type of Littre's hernia causing small bowel obstruction

“…Although small bowel obstruction in a virgin abdomen has traditionally been thought to be a surgical emergency with requirement for surgical intervention, recent reports in the literature have shown increasing evidence for non‐operative management in a selected group of patients with no features of closed loop small bowel obstruction 10 . This case highlights the significance of Meckel's diverticulum as a potential cause of small bowel obstruction, and the possibility of this being associated with rare internal omental defects.…”

The Angers CT Score is a Risk Factor for the Failure of the Conservative Management of Adhesive Small Bowel Obstruction: A Prospective Observational Multicentric Study

“…Indeed, the literature reports a high rate of surgery for these patients (39–83%), while their management should be the same as in managing aSBO with other causes [24]. Recent literature reports that previous surgery was an independent predictor of the success of non‐operative management (OR = 0.47; p = 0.03) [25], while conservative management seems feasible and safe in cases of aSBO in a previously un‐operated abdomen [26, 27]. Conservative management in such patients should, however, be pursued with caution because reviews include patients with aSBO in a virgin abdomen owing to indications other than aSBO.…”

Ileal Tubulo-Villous Adenoma Causing Small Bowel Obstruction in a Virgin Abdomen

“…Small bowel obstruction in patients with a virgin abdomen (SBO-VA) have historically been operative situations due to the belief that more sinister etiologies are behind the obstruction [8,9]. Compared to the roughly 30% operative rate for adhesive SBO, SBO-VA have a reported operative rate of between 40-100% [8,9]. Recent systematic reviews have demonstrated mandatory operation may no longer be the case [10][11][12][13][14].…”