Recurrence of Small Bowel Obstruction in Adults After Operative Management of Adhesive Small Bowel Obstruction: A Systematic Review

Srinivasan, Nishok Victory; Khan, Aujala Irfan; Mashat, Ghadi D; Hazique, Mohammad; Khan, Kokab Irfan; Ramesh, Prasana; Kanagalingam, Suthasenthuran; Haq, FNU Zargham Ul; Penumetcha, Sai Sri

doi:10.7759/cureus.29141

Cited by 4 publications

(7 citation statements)

References 23 publications

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“…As shown in our study, the risk of developing NI-SBO was higher in patients with a history of SBR. This is consistent with previous studies that have examined adhesive SBOs and found that the number of previous laparotomies, bowel injuries, operative times, perioperative bleeding, and diffuse adhesions (or matted adhesions) were all significantly associated with recurrent hospitalizations for SBO [ 22 - 24 ]. The results of this study suggest that while the probability of developing NI-SBO after a first resection is low, prevention of CD recurrence after a first resection is critical, and clinicians should likely start/optimize therapy to avoid the need for repeat resection.…”

Section: Discussionsupporting

confidence: 91%

“…On the other hand, although laparoscopy has been shown to be associated with decreased adhesion formation, it has not been associated with a lower incidence of SBO in colorectal surgery [ 16 ]. Two other meta-analyses found no benefit with regard to reoperation for adhesion in patients undergoing laparoscopic procedures compared to those undergoing open procedures [ 24 , 26 ]. Furthermore, no significant benefits were found between the two approaches in the “conventional vs. laparoscopic-assisted surgery in colorectal cancer” trial, which compared the incidence of adhesion-related complications, particularly SBO, after laparoscopic and open colorectal surgery [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn’s Patients

Zulqarnain,

Jaber,

Jahagirdar

et al. 2024

Gastroenterol Res

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Background The aim of the study was to investigate the risk factors associated with the development of small bowel obstruction (SBO) in Crohn’s disease (CD) after small bowel resection (SBR) that are not due to active/recurrent inflammation. Methods We conducted a retrospective cohort study of patients who had SBR for active or complicated CD. Abstracted data included demographics, phenotype, therapies for CD, endoscopic disease recurrence, and several surgical variables. The primary outcome was the development of non-inflammatory SBO (NI-SBO) within 5 years after SBR. Results A total of 335 patients were included. The cumulative rates of NI-SBO at 6 months, 1 year, and 5 years were 5 (1.5%), 8 (2.4%), and 29 (8.9%), respectively. Variables associated with the development of NI-SBO were active macroscopic or microscopic inflammation in the surgical margins (13 (56%) vs. 65 (27%), P = 0.004), open resection (vs. laparoscopic resection) (12 (41.4%) vs. 60 (19.5%), P = 0.0006) and a higher median number of previous resections (2 (interquartile range (IQR) 2 - 3) vs. 1 (IQR 1 - 2), P = 0.0002). Only 21% of patients who developed NI-SBO required surgical intervention. Conclusions The incidence of NI-SBO after SBR in CD is low and associated with inflammation at the margins of the resected bowel, previous bowel resections, and an open laparotomy approach. Most NI-SBOs resolve with medical management.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn’s Patients

Zulqarnain,

Jaber,

Jahagirdar

et al. 2024

Gastroenterol Res

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“…Conservative management is still the treatment of choice for managing adhesive SBO with high success rates. In non-responding cases, surgical dense adhesiolysis might by followed with recurrent severe adhesions [ 6 ]. This fact supports the consideration of conservative treatment as the first line of therapy for mildly symptomatic ACS.…”

Section: Discussionmentioning

confidence: 99%

“…The thickened fibrotic membrane encapsulating the bowel with the dense adhesions prevent the vascular pedicle from twisting [ 8 ]. Therefore, the necessity for bowel resection in such a case is less common compared with when a band is the cause of intestinal obstruction [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Abdominal cocoon syndrome, a diagnostic challenge affecting the treatment. A rare case report from Somalia

Mahmoud¹,

Salad²,

Abdullahi³

2023

Journal of Surgical Case Reports

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Abdominal cocoon syndrome is defined as idiopathic encapsulation of the bowel within a fibrocollagenous membrane and is considered as a rare cause of small bowel obstruction. A 15-year-old female presented complaining of right lower abdominal pain, distension and vomiting for 24 hours with previous similar attacks in the last four years. She had no another significant medical or surgical history. Computed tomography study revealed matted mildly distended bowel loops centrally with a suspicion of acute appendicitis. Next day, abdominal pain was the only clinical finding and acute appendicitis was the primary diagnosis. During surgery, most of the small bowel was found to be encapsulated within a cocoon-like fibrous membrane. The appendix was congested. Appendectomy, full resection of the membrane and dense adhesiolysis were performed. Herein, we will present the first reported case from Somalia and discuss the radiological findings affecting the management for such a rare disease.

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“…Surgical intervention poses the concern of creating new adhesions, while pursuing a non-operative treatment leaves the adhesions in place. 12 However, two studies found that delaying surgical intervention was associated with increased mortality, morbidity, and length of stay (LOS). 7,11 Several other studies have investigated the differences in patient care and outcomes when a patient is admitted to MS vs SS.…”

Section: Introductionmentioning

confidence: 99%

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission

Sturm,

Van Horn,

Sternick

et al. 2024

The American Surgeon™

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Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO ( P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

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Recurrence of Small Bowel Obstruction in Adults After Operative Management of Adhesive Small Bowel Obstruction: A Systematic Review

Cited by 4 publications

References 23 publications

Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn’s Patients

Predictive Factors of Non-Inflammatory Small Bowel Obstruction After Bowel Resection in Crohn’s Patients

Abdominal cocoon syndrome, a diagnostic challenge affecting the treatment. A rare case report from Somalia

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission

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