A multidisciplinary approach to diagnosis and management of bowel obstruction

Sarani, Babak; Paspulati, Raj Mohan; Hambley, Jana; Efron, David T.; Martı́nez, José M.; Perez, Armando; Bowles-Cintron, Robert J.; Yi, Fia; Hill, Susanna S.; Meyer, David C.; Maykel, Justin A.; Attalla, Sara; Kochman, Michael L.; Steele, Scott R.

doi:10.1067/j.cpsurg.2018.09.001

Cited by 7 publications

(9 citation statements)

References 182 publications

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“…A broad range of pathologies can result in duodenal obstruction, from benign to malignant, intraluminal or extraluminal. Despite many benign etiologies, periampullary tumors remain the most common cause of duodenal obstruction [25]. As such, an adult presenting with duodenal obstruction has cancer until proven otherwise.…”

Section: Discussionmentioning

confidence: 99%

Malignant Duodenal Obstruction Caused by Urothelial Carcinoma

Johnson¹

2020

AJBSR

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Section: Discussionmentioning

confidence: 99%

Malignant Duodenal Obstruction Caused by Urothelial Carcinoma

Johnson¹

2020

AJBSR

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“…In this systematic review, ultrasound was found to be 92.4% sensitive and 96.6% specific for SBO. Recent studies demonstrated that there is not a significant difference in the accuracy of detecting SBO between ultrasound and CT. Ultrasound may help the emergency physician to answer rapidly the following questions: the presence or absence of SBO, the grade of bowel involvement, the patient’s needs of emergency surgery and the clinical progress in patients treated conservatively [8,14,15,18,20,27]. Ultrasound criteria for the diagnosis of SBO are related to morphological and functional findings [27].…”

Section: Discussionmentioning

confidence: 99%

“…Previous abdominal surgery does not represent a dominant risk factor for SBO caused by solitary band adhesions, unlike SBO caused by matted adhesions; while in patients with no history of previous abdominal surgery (virgin abdomen) the risk for bowel obstruction is usually due to a solitary band [1,2]. The diagnosis of SBO in the Emergency Department (ED) has been estimated to be around 2% of all patients who presented with abdominal pain and 15% of all patients who ultimately get admitted to the surgical unit from the ED [3,4,5,6,7,8]. The clinical suspicion of SBO is usually made based on patient’s history, symptoms and physical sign (crampy abdominal pain, abdominal distension, nausea and vomiting).…”

Section: Introductionmentioning

confidence: 99%

“…The indications for and timing of surgical intervention for SBO have changed over the past decades. There is a widespread assumption that most of those conditions may resolve spontaneously if parietal vascular damage is absent with nonsurgical treatment, namely nasointestinal decompression (nasogastric tube insertion, bowel rest, intravenous fluids) [6,8,11]. The real dilemma that surgeons and radiologists face when confronted with a possible SBO is to confirm or exclude the pathology.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasound in the Diagnosis of Small Bowel Obstruction

Tamburrini¹,

Lugarà²,

Iaselli³

et al. 2019

Diagnostics

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Introduction: Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). This study aimed to analyze the accuracy of ultrasound (US) in diagnosing and staging SBO. Objectives: The main object of this study was to analyze the accuracy of ultrasound in diagnosing and staging SBO compared to CT. Methods: Retrospectively, stable patients with an ultrasonographic diagnosis of SBO who underwent abdominal CT immediately after US and before receiving naso-intestinal decompression, were included. US criteria for the diagnosis of SBO were related to morphological and functional findings. US diagnosis of obstruction was made if fluid-filled dilated small bowel loops were detected, peristalsis was abnormal and parietal abnormalities were present. Morphologic and functional sonographic findings were assigned to three categories: simple SBO, compensated SBO and decompensated SBO. US findings were compared with the results of CT examinations: Morphologic CT findings (divided into loop, vascular, mesenteric and peritoneal signs) allowed the classification of SBO in simple, decompensated and complicated. Results: US diagnostic accuracy rates in relation to CT results were calculated: ultrasound compared to CT imaging, had a sensitivity of 92.31% (95% CI, 74.87% to 99.05%) and a specificity of 94.12% (95% CI, 71.31% to 99.85%) in the diagnosis of SBO. Conclusions: This study, similarly to the existing literature, suggests that ultrasound is highly accurate in the diagnosis of SBO, and that the most valuable sonographic signs are the presence of dilated bowel loops ad abnormal peristalsis.

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“…4 Further, contributing to the number of Hartmann's procedures, up to 29% of colon cancer patients can present with obstructing left-sided tumors. 5,6 Reversal of Hartmann's procedure, however, can be technically difficult secondary to dense adhesions, pelvic infection, anatomic limitations of the pelvis, and colonic conduit reach, which can be further compounded by patient comorbidities and frailty. 7 To further complicate the risk/benefit analysis, most surgeons consider reversal purely elective and for lifestyle or cosmetic reasons.…”

Section: Introductionmentioning

confidence: 99%

Use of a 5-Item Modified Frailty Index for Assessing Outcomes After Hartmann’s Reversal: An ACS-NSQIP Study

Ottaviano,

Palange,

Hill

et al. 2023

The American Surgeon™

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Background Half of all patients with an end colostomy after sigmoid colectomy (Hartmann’s procedure) never undergo Hartmann’s reversal, frequently secondary to frailty. This retrospective cohort study evaluates the utility of a five-item modified frailty index (mFI-5) in predicting post-operative outcomes after Hartmann’s reversal. Methods The National Surgery Quality Improvement Program (NSQIP) database captured patients with elective Hartmann’s reversals from 2011 to 2020. Clinical covariates were evaluated with univariate analysis and modified Poisson regression to determine association with overall morbidity, overall mortality, and extended length of stay (eLOS) when categorized by mFI-5 score. Results 15,172 patients underwent elective Hartmann’s reversal (91.6% open and 8.4% laparoscopic). Patients were grouped by mFI-5 score (0: 48.7%, 1: 38.2%, ≥ 2: 13.1%). Adjusted multivariable analysis showed frail patients (mFI-5≥2) had increased overall mortality (OR 2.23, 95% CI 1.21-4.11), morbidity (OR 1.23, 95% CI 1.12-1.35), and eLOS (OR 1.12, 95% 1.02-1.23). Among frail patients, a laparoscopic approach was associated with decreased overall morbidity (OR .64, 95% CI 0.56-.73) and decreased eLOS (OR .46, 95% CI 0.39-.54) when compared to open approach. Discussion An mFI-5 of ≥2 was associated with greater morbidity, mortality, and eLOS following Hartmann’s reversal. However, there were no mortality or eLOS differences in patients with an mFI-5 of 1 and only a 14% increase in any morbidity, making these patients potentially good candidates for Hartmann’s reversal. Furthermore, laparoscopic surgery was associated with a protective effect for overall morbidity and eLOS, potentially mitigating some of the risk associated with higher frailty scores.

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A multidisciplinary approach to diagnosis and management of bowel obstruction

Cited by 7 publications

References 182 publications

Malignant Duodenal Obstruction Caused by Urothelial Carcinoma

Malignant Duodenal Obstruction Caused by Urothelial Carcinoma

Diagnostic Accuracy of Ultrasound in the Diagnosis of Small Bowel Obstruction

Use of a 5-Item Modified Frailty Index for Assessing Outcomes After Hartmann’s Reversal: An ACS-NSQIP Study

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