No abstract

Introduction Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively. Method We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t. Results 118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p < 0.001). Conclusions Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.

A 60 year old male presented with sudden onset of pain in right lower limb, difficulty in standing and antalgic gait since 3 days. There was no history of trauma. Examination showed a non-tender, compressible, pulsatile 10 x 6 cm swelling in the right popliteal fossa. His blood investigations were within normal range. Arterial duplex ultrasonography of right lower limb showed right sided popliteal artery aneurysm (PAA) with foci of thrombus in it. CT-angiography confirmed the findings. He underwent popliteal artery aneurysmectomy and interposition of graft. He was discharged on postoperative day 5. We will be describing a case of spontaneous giant PAA and discuss the protocol that we follow.