Small Bowel Obstruction: A Population-Based Appraisal

Foster, Nova; McGory, Marcia L.; Zingmond, David S.; Ko, Clifford Y.

doi:10.1016/j.jamcollsurg.2006.04.020

Cited by 230 publications

(168 citation statements)

References 12 publications

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“…[13][14][15][16] Similar findings were noted in present study as well. Out of the 34 operated cases 23 had to be performed by open method (66%).…”

Section: Discussionsupporting

confidence: 92%

Small bowel obstruction: need for surgery based on history and radiology

Meena¹,

Bhatt²,

Jain³

2018

Int Surg J

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INTRODUCTIONBowel obstruction continues to be one of the most common intra-abdominal conditions encountered by general surgeons in their practice. It remains a major cause of morbidity and mortality, accounting for 15% of hospital admissions for acute abdomen and up to 30% of these needs operative intervention.1,2 Patients may present acutely or as a chronic and relapsing problem with symptoms ranging from modest discomfort to extreme illness and shock. Small Bowel Obstruction (SBO) has been and continues to be a common clinical challenge. This is so because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognize the presence of strangulationobstruction and hence the need for urgent operative intervention; and on the other hand can avoid a nontherapeutic laparotomy along with its associated ABSTRACT Background: Small bowel obstruction is a common clinical challenge because the proper management of small bowel obstruction requires a methodology which on one hand can promptly recognise the presence of strangulationobstruction and hence the need for urgent operative intervention; and on the other hand, can avoid a non-therapeutic laparotomy along with its associated morbidities and further adhesion formation with its potential sequelae. The study was done to identify relevant features in the patient's clinical and CT abdomen findings which when present would be highly predictive of the requirement of an operative intervention in a patient with small bowel obstruction. Methods: The study was a hospital based analytical observational study on patients admitted from March 2013 to May 2014 with a diagnosis of small bowel obstruction and who underwent a concurrent CT abdomen. Correlation of line of management was done with respect to the three chosen parameters, obstipation (history), mesenteric edema (CT imaging) and lack of small bowel feces Sign (CT imaging). Results: A total of 74 patients were included with Male:Female ratio being 3.1:1. Forty patients were managed conservatively and remaining underwent surgery with adhesions being the most frequent etiology. The most common operative procedure performed was adhesiolysis with or without band release. Twenty-three cases were performed by open method and remaining laparoscopically. Evaluation of the three parameters revealed that these variables, when present independently or in combination, are predictive for need for operative intervention (p-value <0.001). The sensitivity and specificity to predict the need for exploration when all 3 features were present concurrently was 38.24% and 100%, respectively. Conclusions: Small-bowel obstruction is a common surgical dilemma, the management of which is dealt on a daily basis by surgeons and non-surgeons. The management using variables based on history and radiology may help classify patients into those requiring conservative management and those in need of early exploration.

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“…[13][14][15][16] Similar findings were noted in present study as well. Out of the 34 operated cases 23 had to be performed by open method (66%).…”

Section: Discussionsupporting

confidence: 92%

Small bowel obstruction: need for surgery based on history and radiology

Meena¹,

Bhatt²,

Jain³

2018

Int Surg J

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“…[1] According to two studies by Miller et al and Foster et al, hernia caused less than 10% to intestinal obstruction. [5,6] But statistics in this part shows that hernia contributed approximately 29% of cases to intestinal obstruction. As per majority of the available studies, adhesions, incarcerated hernias, and large bowel cancers constitute the most frequent causes for bowel obstruction.…”

Section: Resultsmentioning

confidence: 99%

A Pattern of Intestinal Obstruction Cases – A Tertiary Care Centre Study

Pillai¹,

Benjamin²,

Chisthi³

2017

AIMDR

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Background: Bowel obstruction is a surgical emergency that causes confusion both in the diagnosis and the management. Decision on whether to operate on the patient or to continue with conservative management as well as the timing of intervention often rests upon the treating surgeon and his competence. Objectives: Primary objective of the study was to describe the etiological profile in patients with intestinal obstruction in our institution. Secondary objectives were to study the demographic pattern and the mode of management in these patients. Material & Methods: This was a hospital based Cross sectional study conducted at the General Surgery department, Government Medical College Hospital, Trivandrum. The study period was for 18 months, from April 2014 to September 2015. Study subjects included patients admitted in the Surgical wards with intestinal obstruction. Sample size was calculated to be 204 based on reference study. All values are presented as means and percentages. Results: Males were found to be affected much more than females. In 70% of patients, small bowel was the bowel predominantly involved. Adhesions were the commonest etiological factor followed by obstructed hernias. Most of the patients underwent operative management. Conclusions: Small bowel was the most commonly obstructed part of the bowel while adhesions and hernia form the commonest reasons for intestinal obstruction in our setting. Appendicectomy and laparotomy for perforation peritonitis caused the most postoperative adhesions.

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“…The former alone accounts for approximately 20% of admissions in this category [1][2][3] . Intestinal ischemia is uncommon but still carries a mortality in excess of 70% 4 .…”

Section: Introductionmentioning

confidence: 99%