Small bowel obstruction in a virgin abdomen

Strajina, Veljko; Kim, Brian D.; Zielinski, Martin D.

doi:10.1016/j.amjsurg.2019.02.011

Cited by 18 publications

(57 citation statements)

References 12 publications

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“…1). Ultimately, six studies met the inclusion criteria and were selected for the final assessment 6–11 . (Table 1) Among a total of 416 patients included in the studies, 205 (49.3%) had NOM and 211 (51.7%) underwent exploratory surgery.…”

Section: Resultsmentioning

confidence: 99%

“…All the studies were retrospective observational case series, 6–11 including one which utilized a prospectively collected database 10 . All studies scored 6 or more on the Newcastle‐Ottawa Scale and were therefore deemed good quality studies.…”

Section: Resultsmentioning

confidence: 99%

“…In four studies, the diagnosis of SBO was based on the combination of radiological findings and clinical symptoms 6,8–10 . Radiological investigations included either abdominal X‐rays 6,8–10 or CT imaging of the abdomen 6–11 . Radiographical appearances suggestive of SBO included dilated loops of small bowels, 6,8–10 air fluid levels, 6,8 visible valvulae conniventes 8 and a possible transition point with distended small bowels proximally and collapsed small bowels distally 6,8 …”

Section: Resultsmentioning

confidence: 99%

“…Exclusion criteria were mostly similar with most studies excluding patients with colonic obstruction, 6,8 incarcerated hernias, 6,8,11 inflammatory bowel disease, 7,11 abdominal malignancy 7,9,11 and urgent indicators for emergency exploratory surgery including haemodynamic compromise, diffuse peritonism and radiological features of closed‐loop obstruction 9–11 (Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…Conventionally, explorative surgery has been advocated in this group of patients with a virgin abdomen presenting with SBO due to concerns regarding malignancy or an obstructing lesion 5,6 . However, in the past decade with the improved diagnostic capability of a computed tomography (CT) scan, there have been numerous studies challenging this surgical dogma 6–11 …”

Section: Introductionmentioning

confidence: 99%

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

Yang

Prabhakaran

Bell

et al. 2020

ANZ Journal of Surgery

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Yang

Prabhakaran

Bell

et al. 2020

ANZ Journal of Surgery

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Diagnosis and Management of Acute Small Bowel Obstruction

Krielen

Broek

2023

Textbook of Emergency General Surgery

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Non‐operative Management of Small Bowel Obstruction in Patients with No Previous Abdominal Surgery: A Systematic Review and Meta‐analysis

et al. 2021

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While the contemporary management of adhesive small bowel obstruction (SBO) often includes a trial of non-operative management (NOM), surgical dogma dictates urgent operative exploration in patients without previous abdominal surgery. This dogma has been challenged by recent evidence suggesting most obstructions in this population are adhesive in nature. The objectives of this review were to evaluate the feasibility of NOM in patients with SBO and no history of previous abdominal surgery, to examine the etiologies of SBO in this population, and to explore the rate of adverse events seen following NOM. Embase, Medline, Cochrane, and Google Scholar were searched from inception to September 24, 2019. Articles reporting on NOM for SBO in patients without previous abdominal surgery and without clinical or radiographic features necessitating an emergent operation were included. Data were combined to obtain a pooled proportion of patients discharged without operation following a trial of NOM. 6 studies reporting on a total of 272 patients were included. The pooled proportion of patients discharged following NOM was 49.5% (95% CI 23.7-75.3%). Adhesions were found to be the predominant cause of obstruction. NOM did not appear to increase short-term complications. Most SBOs in patients without previous abdominal surgery are adhesive in nature and many patients can be discharged from hospital without surgery. While the short-term outcomes of NOM are acceptable, future studies are needed to address the long-term outcomes and safety of NOM as a treatment strategy for SBO in patients without previous abdominal surgery.

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Small bowel obstruction in a virgin abdomen

Cited by 18 publications

References 12 publications

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

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

Diagnosis and Management of Acute Small Bowel Obstruction

Non‐operative Management of Small Bowel Obstruction in Patients with No Previous Abdominal Surgery: A Systematic Review and Meta‐analysis

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