Safety of Foregoing Operation for Small Bowel Obstruction in the Virgin Abdomen: Systematic Review and Meta-Analysis

Adhesive small bowel obstruction in a virgin abdomen in an elderly: a case report

“…11 A systematic review and meta-analysis of 6 cohort studies involving 442 patients found that de novo adhesions (152/281, 54.1%) were the most common etiology of SBO in patients without abdominopelvic surgery history. 10 Any source of peritoneal irritation can result in local fibrin production which may lead to adhesion formation. 12 The process of adhesion development begins when damage to peritoneal surfaces from any source (operative trauma, infection, foreign bodies, desiccation, irradiation, allergic reaction, or chemical injury) induces a series of biochemical/molecular biologic cascades.…”

“…The term virgin abdomen predates widespread computed tomography (CT) imaging, which now elucidates most SBO etiologies. 10 The utility of the CT scan of the abdomen in guiding operative management is increasingly relevant as the technology becomes readily available and efficient. 11 CT has been shown to be useful in determining the site, level and cause of SBO.…”

“…5 Despite recent efforts to re-evaluate clinical management standards, the evidence of underlying etiologies of SBO in the virgin abdomen and the safety of foregoing surgery remains unclear. 10 Surgical exploration is still considered mandatory in the setting of SBO in a virgin abdomen by some large centers. 4 Successful non-operative SBO management in patients without abdominopelvic surgery history may risk missing a potentially malignant etiology.…”

“…1 The term virgin abdomen was coined before widespread use of computed tomography, which now elucidates many SBO etiologies. 10 Although adhesions account for more than 70% of SBO, they are thought to be less likely etiologies in patients without previous abdominal surgery, where a hernia or malignancy is frequently believed to be the underlying cause. 11 However emerging evidence appears to challenge such a dogmatic approach as adhesions remain most common cause of obstruction in patients despite absence of prior abdominal surgery.…”

Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

“…A recent systematic review and meta-analysis of six studies, analyzing the safety of foregoing surgery in patients without abdominal or pelvic surgery history presenting with small bowel obstruction, found a high prevalence of malignant etiologies (7.7%–13.4%), most of which were not suspected before surgery. In almost half of these patients, a trial of nonoperative management failed and patients required operative interventions (11). Moreover, a recent Cochrane review investigating the role of water-soluble contrast media (WSCM) in inoperable small bowel malignant obstructions reported limited evidence to determine the therapeutic effects and safety of conservative management with WSCM (12).…”