Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care

Abstract

Small bowel obstruction is one of the most frequent emergencies in general surgery, commonly affecting elderly patients. Morbidity and mortality from small bowel obstruction in elderly is high. Significant progress has been made in the diagnosis and management of bowel obstruction in recent years. But little is known whether this progress has benefitted outcomes in elderly patients, particularly those who are frail or have a malignancy as cause of the obstruction, and when considering quality of life and functioning as outcomes. In this review, we discuss the specific challenges and needs of elderly in diagnosis and treatment of small bowel obstruction. We address quality of life aspects and explore how the concept of geriatric assessment can be utilized to improve decision-making and outcomes for elderly patients with a small bowel obstruction.

Jejunal Adenocarcinoma as a Rare Cause of Small Bowel Obstruction: A Case Report

“…Postoperative adhesions (60%) are the most common cause of small bowel obstruction, followed by hernias, Crohn's disease, malignancy, and volvulus. Other less frequent causes of bowel obstruction differ between young adults and elderly patients; gallstone ileus is more frequent in elderly patients while Crohn’s disease in young adults [ 1 ]. Rarely small bowel obstruction may occur as a result of strictures secondary to small bowel adenocarcinoma (SBA) that accounts for about 3-5% of all gastrointestinal malignancies [ 2 ].…”

Surgical Recovery of Intestinal Obstructions: Pre- and Postoperative Care and How Could it Be Prevented?

“…An ongoing debate in the management of small bowel obstruction is the duration of nonoperative treatment that is deemed mandatory to resolve the bowel obstruction before the decision to operate. Most authors apply the 72-h safe-time rule for duration of initial nonoperative therapy irrespective of age [26][27][28][29].…”

Surgical Abdomen

“…Tachycardia, fever, marked leukocytosis, acidosis, and localized abdominal tenderness are signs of possible strangulation requiring early surgical intervention. It is more difficult to recognize strangulation or ischemia of bowel in the elderly based on physical findings and laboratory tests (Ozturk et al 2018). The sensitivity of detecting strangulation, even in experienced hands is only 48% (ten Broek et al 2018).…”

“…Groin hernia, malignant etiology, and malnutrition have also been demonstrated to be associated with higher rates of death (Lee et al 2019). Furthermore, frailty, patient's wishes, and quality of life issues should have important roles in decision making (Ozturk et al 2018;ten Broek et al 2018).…”