A multi-institution prospective observational study of small bowel obstruction

Kulvatunyou, Narong; Pandit, Viraj; Sadoun, Moutamn; Inaba, Kenji; Chouliaras, Konstantinos; DeMoya, Marc; Naraghi, Leily; Kalb, Bobby; Arif, Hina; Reddy, Sravanthi; Joseph, Bellal; Gries, Lynn; Tang, Andrew; Rhee, Peter

doi:10.1097/ta.0000000000000759

Cited by 30 publications

(39 citation statements)

References 13 publications

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“…17,18,[20][21][22][23][24][25]28,30,[33][34][35][36][37][38][39][40][42][43][44][45][46][47][48][50][51][52][55][56][57][58][59]63,66,67 2. Time to resolution; 37,40,[44][45][46]48,[56][57][58][59][60]63 3. Time from admission to relief of obstruction 50 36 (71) 12 (24) 1 (2) Procedure specific measures 4.…”

Section: Resultsmentioning

confidence: 99%

“…Included studies were published between the years of 1988 2015. Twenty studies focussed on operative management of SBO (3 RCTs 20 21 22 , and 17 prospective cohort studies 2 23-38 ) 31 focussed on conservative management (21 RCTs , and 10 prospective cohort studies [60][61][62][63][64][65][66][67][68] ). Study characteristics presented in supplementary file 1.…”

Section: Searchmentioning

confidence: 99%

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A systematic review of outcomes reported in small bowel obstruction research

Mellor¹,

Hind²,

Lee

2018

Journal of Surgical Research

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Section: Resultsmentioning

confidence: 99%

Section: Searchmentioning

confidence: 99%

A systematic review of outcomes reported in small bowel obstruction research

Mellor¹,

Hind²,

Lee

2018

Journal of Surgical Research

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“…1a, b). A transition point in patients with nonstrangulated SBO may be a significant predictor of operative management [62], but this finding is controversial [63]. Complete obstruction shows severely discrepant luminal diameters between proximal and distal small bowel adjacent to the transition point, with collapse of the distal small bowel and colon, and no passage of air or fluid beyond the transition point.…”

Section: Common Ct Signsmentioning

confidence: 99%

“…Incomplete high-grade obstruction shows moderately discrepant luminal diameters between the proximal and distal small bowel adjacent to the transition point with minimal passage of air or fluid into the distal small bowel and ascending colon. High-grade obstruction is predictive of failure of nonoperative management [64] and a need for early surgery [63]. Low-grade obstruction shows mildly discrepant luminal diameters between proximal and distal small bowel adjacent to the transition point, with the passage of air or fluid into the distal small bowel and ascending colon [65].…”

Section: Common Ct Signsmentioning

confidence: 99%

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Reddy¹,

Cappell

2017

Curr Gastroenterol Rep

169

111

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SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks. Classical clinical tetrad is abdominal pain, nausea and emesis, abdominal distention, and constipation-to-obstipation. Physical exam may reveal restlessness, acute illness, and signs of dehydration and sepsis, including tachycardia, pyrexia, dry mucous membranes, hypotension/orthostasis, abdominal distention, and hypoactive bowel sounds. Severe direct tenderness, involuntary guarding, abdominal rigidity, and rebound tenderness suggest advanced SBO, as do marked leukocytosis, neutrophilia, bandemia, and lactic acidosis. Differential diagnosis includes postoperative ileus, narcotic bowel, colonic pseudo-obstruction, mesenteric ischemia, and large bowel obstruction. Medical resuscitation includes intravenous hydration, correcting electrolyte abnormalities, intravenous antibiotics, nil per os, and nasoenteral suction. Abdominal CT with oral and intravenous gastrografin contrast is highly sensitive and specific in detecting/characterizing SBO. SBO usually resolves with medical therapy but requires surgery, preferentially by laparoscopy, for unremitting total obstruction, bowel perforation, severe ischemia, or clinical deterioration with medical therapy. Overall mortality is 10% but increases to 30% with bowel necrosis/perforation. Key point in SBO is early diagnosis, emphasizing abdominal CT; aggressive medical therapy including rehydration, antibiotics, and nil per os; and surgery for failed medical therapy.

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“…6,21 However, this practice of routine early surgery may have been most appropriate in an era when it was difficult to identify obstructions due to hernia, closed bowel loops, tumor, or with possible bowel strangulation. CT scans have been shown to have high sensitivity for intestinal ischemia in the setting of SBO, 7,22,23 and given increases in the use of CT scans to support decision-making, a number of studies have demonstrated resolution of SBO in 28–75% of patients during a period of non-operative expectant management. 9–12,24–26 The use of enteral contrast studies (i.e.…”

Section: Discussionmentioning

confidence: 99%

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

Thornblade

Truitt

Davidson

et al. 2017

Journal of Surgical Research

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INTRODUCTION Historical training instructs surgeons to, “never let the sun set on a small bowel obstruction (SBO)” due to concern for bowel ischemia. However, the routine use of CT scans for ruling out ischemia provides the opportunity for trial of non-operative management, allowing time for resolution of adhesive SBO. In light of advances in practice, little is known about how surgeons manage these patients, in particular, whether there is consistency in the stated duration for safe non-operative management. MATERIAL & METHODS Using a case vignette (a patient with CT-scan diagnosed complete SBO without bowel ischemia), we interviewed a purposive sample of general surgeons practicing in Washington State to understand stated approaches to clinical management. Interview questions addressed typical practice, preferred timing of surgery, and approach. We conducted a content analysis to understand current practice and attitudes. RESULTS We interviewed 15 surgeons practicing across Washington State. Surgical practice patterns for patients with SBO vary widely. The period of time that surgeons were willing to manage patients non-operatively ranged from 1–7 days. Interviews revealed insight into surgical decision making, the importance of patient preferences, variation in practice, and evidence gaps. All surgeons acknowledged a lack of evidence to support appropriate management of patients with SBO. CONCLUSIONS Interviews with practicing surgeons highlight a changing paradigm away from routine early surgery for patients with adhesive SBO. However, there is lack of consensus in the appropriate duration of non-operative management and practices vary considerably. These revealed attitudes inform the feasibility and design of future randomized studies of patients with adhesive SBO.

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A multi-institution prospective observational study of small bowel obstruction

Abstract: Therapeutic study, level III; prognostic study, level II.

Cited by 30 publications

References 13 publications

A systematic review of outcomes reported in small bowel obstruction research

A systematic review of outcomes reported in small bowel obstruction research

A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction

Surgeon attitudes and practice patterns in managing small bowel obstruction: a qualitative analysis

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