Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored

Abstract

Adhesions are by far the most likely cause of SBO in patients without previous abdominal surgery followed by a small number of newly diagnosed malignancies. Both prevalences are in equal proportion to patients with previous abdominal surgery. A trial of nonoperative management may therefore be justified.

Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence

“…While the diagnosis of complete versus incomplete SBO has traditionally stemmed from clinical examination and plain film radiography, this has been aided by CT in recent years. Our study showed a 76% accuracy of CT diagnosis for the underlying aetiology, compared with earlier studies reporting between 27% and 53% . Besides helping to elucidate the aetiology of SBO, improved CT resolution also aids in assessing the extent of obstruction and complications such as strangulation, ischaemia and pneumoperitoneum.…”

“…As SBO is classically presumed to be unlikely due to adhesions in patients without a prior abdominal surgery, many centres routinely advocate emergent operative management, although there is little evidence to support such indiscriminate practice . Taking into account contemporary studies that show a rising incidence of adhesions causing SBO, there is likely a role for non‐operative management in these patients as they can potentially be treated successfully with bowel decompression and serial assessment …”

“…However, such an approach may sometimes result in benign findings, hence subjecting patients who might have resolved with conservative management to unnecessary surgery and the possibility of future intestinal adhesions. Emerging evidence appears to challenge such a dogmatic approach as adhesions remain the most common cause of obstruction in patients despite the absence of prior abdominal surgery, and conservative management using nasogastric decompression and fluid resuscitation have demonstrated success in carefully selected patients . Additionally, there is a little evidence on the aetiology of SBO in patients with a virgin abdomen to validate an appropriate management pathway.…”

Hernia transmesentérica. Revisión del tema a raíz de un caso exótico de infarto intestinal en un adulto

“…Una laparotomía temprana evitará serias complicaciones. Una conducta de "mirar para ver" (look and see), ante la sospecha de una HI, siempre será preferible a una de "esperar para ver" (wait and see) (53).…”

Bowel obstruction without history of laparotomy: Clinical analysis of 70 patients

“…A few reports have been published on the etiology of BO without HL in adults, [2][3][4] but, to our knowledge, there has been no report on BO without HL in children. Therefore the detailed etiology and the appropriate interval to avoid resecting strangulated bowel in BO without HL in children remains unknown.…”