Obstruction of the Small Intestine

Davis, Scott E.; Sperling, Louis

doi:10.1001/archsurg.1969.01340160004002

Cited by 40 publications

(4 citation statements)

References 3 publications

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“…Mortality associated with SBO has ranged from 5% to 15%, and there have been an estimated 9000 deaths annually. [8][9][10] Hence; the present study was undertaken for assessing the 48 patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome.…”

Section: Discussionmentioning

confidence: 99%

A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

Gupta¹

2020

Int Surg J

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Background: Intestinal obstruction is defined as obstruction of the passage of the intestine for its contents. Successful conservative treatment may leave adhesions that could cause recurrence; on the other hand, surgery may be the source of new adhesions like any other abdominal surgery. Hence, the present study was undertaken for assessing the 48 patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome.Methods: Of a total of 48 patients with ilecoceacal masses who presented with intestinal obstruction and underwent surgical intervention for the same. Surgical management outcome was classified as “favorable” or “unfavorable” outcome according to the retrospective secondary data extracted from their medical records. Unfavorable outcome was considered if the patient died or has one or more postoperative complications. Favorable outcome was considered if the patient was discharged alive and does not have any history of postoperative complications.Results: Abdominal pain, abdominal distension, vomiting and failure to pass faeces were the prominent presenting symptoms among intestinal obstruction patients. Favourable outcome was seen in 76 percent of the patients while unfavourable outcome was seen in 24 percent of the patients. Mortality occurred in 6 patients. Prolonged ileus was found to be present in 1 patient. Failure to wean from ventilator for more than 48 hours was seen in 2 patients. Conclusions: Surgical management had high efficacy of more than 75 percent in managing patients with intestinal obstructions. With precise technique and adequate care, complication rate can be reduced.

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Section: Discussionmentioning

confidence: 99%

A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

Gupta¹

2020

Int Surg J

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“…17–20 Concern about increased morbidity and mortality due to delay in treatment of intestinal ischemia associated with obstruction led surgeons to adopt the maxim of “never let the sun rise and set on a bowel obstruction”. 6,21 However, this practice of routine early surgery may have been most appropriate in an era when it was difficult to identify obstructions due to hernia, closed bowel loops, tumor, or with possible bowel strangulation.…”

Section: Discussionmentioning

confidence: 99%

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Thornblade

Truitt

Davidson

et al. 2017

Journal of Surgical Research

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INTRODUCTION Historical training instructs surgeons to, “never let the sun set on a small bowel obstruction (SBO)” due to concern for bowel ischemia. However, the routine use of CT scans for ruling out ischemia provides the opportunity for trial of non-operative management, allowing time for resolution of adhesive SBO. In light of advances in practice, little is known about how surgeons manage these patients, in particular, whether there is consistency in the stated duration for safe non-operative management. MATERIAL & METHODS Using a case vignette (a patient with CT-scan diagnosed complete SBO without bowel ischemia), we interviewed a purposive sample of general surgeons practicing in Washington State to understand stated approaches to clinical management. Interview questions addressed typical practice, preferred timing of surgery, and approach. We conducted a content analysis to understand current practice and attitudes. RESULTS We interviewed 15 surgeons practicing across Washington State. Surgical practice patterns for patients with SBO vary widely. The period of time that surgeons were willing to manage patients non-operatively ranged from 1–7 days. Interviews revealed insight into surgical decision making, the importance of patient preferences, variation in practice, and evidence gaps. All surgeons acknowledged a lack of evidence to support appropriate management of patients with SBO. CONCLUSIONS Interviews with practicing surgeons highlight a changing paradigm away from routine early surgery for patients with adhesive SBO. However, there is lack of consensus in the appropriate duration of non-operative management and practices vary considerably. These revealed attitudes inform the feasibility and design of future randomized studies of patients with adhesive SBO.

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“…Treatment is straightforward, if an incarcerated external hernia is diagnosed, but is complex otherwise. Unnecessary surgery can cause recurrent ileus due to adhesions, while delayed surgical treatment increases morbidity and mortality [8][9][10]. In order to arrive at the correct management decision, one must differentiate be tween paralytic or mechanical ileus, complete or partial.…”

Section: Discussionmentioning

confidence: 99%

Role of Gastrografin in the Management of Small Bowel Obstruction: A Study of 355 Cases

Avrahami¹,

Kalish²,

Wattemberg³

et al. 1996

Dig Surg

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The effect of Gastrografin on the management of small bowel obstruction was evaluated retrospectively. A total of 355 patients with small bowel obstruction (excluding those with abdominal wall hernia) formed the study population: 219 (61.7%) were treated conservatively without Gastrografin, and 136 (38.3%) were treated conservatively with Gastrografin. Of the first group, 26.0% required surgery as compared with 9.5% of the second group (p < 0.05). After exclusion of those patients who underwent surgery during the first 24 h because of complete obstruction or progressive deterioration in their condition (15 and 3, respectively), surgical treatment was needed in 19% of those who were treated without Gastrografin versus only 7.3% in those who received Gastrografin (p < 0.05). The use of Gastrografin may reduce the need for surgery in patients with small bowel obstruction, without increasing complication rates.

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Obstruction of the Small Intestine

Cited by 40 publications

References 3 publications

A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

A study of forty eight patients with ilecoceacal mass presenting as intestinal obstruction requires surgical intervention and their outcome

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Role of Gastrografin in the Management of Small Bowel Obstruction: A Study of 355 Cases

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