Small Bowel Obstruction: Conservative vs. Surgical Management

Williams, Stephen B.; Greenspon, José; Young, Heather A.; Orkin, Bruce A.

doi:10.1007/s10350-004-0882-7

Cited by 175 publications

(143 citation statements)

References 19 publications

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“…There is wide variation in the reported rate of successful nonoperative management among patients with SBO, ranging from 43%-76%. [26][27][28][29][30][31][32][33][34] This likely reflects variation in the etiology of SBO among patients included in previous studies, different clinical thresholds for taking patients with SBO to the operating room and changing practice patterns over the past 3 decades. In the only study that specifically examined treatment of SBO among elderly patients, 19% of patients older than 70 years were treated nonoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…35 A downfall of nonoperative management is that it is associated with an increased risk of recurrent SBO compared with surgery. 26,29,34,36 In the largest study of recurrent SBO (n = 32 583), Foster and colleagues 34 reported recurrence after 5 years of follow-up in 20% of patients treated nonoperatively compared with 16% of patients treated surgically. Readmission for recurrence happened earlier in the patients managed nonoperatively than in those managed surgically (median 194 v. 354 d).…”

Section: Discussionmentioning

confidence: 99%

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Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

et al. 2014

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Background:The purpose of this research was to examine the morbidity, mortality and rate of recurrent bowel obstruction associated with the treatment of small bowel obstruction (SBO) in older adults. Methods:We prospectively enrolled all patients 70 years or older with an SBO who were admitted to a tertiary care teaching centre between Jul. 1, 2011, and Sept. 30, 2012. Data regarding presentation, investigations, treatment and outcomes were collected. Results:Of the 104 patients admitted with an SBO, 49% were managed nonoperatively and 51% underwent surgery. Patients who underwent surgery experienced more complications (64% v. 27%, p = 0.002) and stayed in hospital longer (10 v. 3 d, p < 0.001) than patients managed nonoperatively. Nonoperative management was associated with a high rate of recurrent SBO: 31% after a median follow-up of 17 months. Of the patients managed operatively, 60% underwent immediate surgery and 40% underwent surgery after attempted nonoperative management. Patients in whom nonoperative management failed underwent surgery after a median of 2 days, and 89% underwent surgery within 5 days. The rate of bowel resection was high (29%) among those who underwent delayed surgery. Surgery after failed nonoperative management was associated with a mortality of 14% versus 3% for those who underwent immediate surgery; however, this difference was not significant. Conclusion:These data suggest that some elderly patients with SBO may be waiting too long for surgery.Contexte : Le but de cette recherche était d'analyser la morbidité, la mortalité et le taux de récurrence de l'occlusion intestinale associés au traitement de l'occlusion intestinale grêle (OIG) chez des adultes âgés.Méthodes : Nous avons inscrit de manière prospective tous les patients de 70 ans ou plus présentant une OIG qui ont été admis dans un établissement de soins tertiaires entre le 1er juillet 2011 et le 30 septembre 2012. Nous avons recueilli les données concernant les tableaux cliniques, les épreuves diagnostiques, les traitements et leurs résultats. Résultats :Parmi les 104 patients admis pour OIG, 49 % ont été traités non chirurgicalement et 51 % ont subi une intervention chirurgicale. Les patients soumis à la chirurgie ont présenté davantage de complications (64 % c. 27 %, p = 0,002) et ont séjourné plus longtemps à l'hôpital (10 j. c. 3 j., p < 0,001) comparativement aux patients qui n'ont pas été opérés. La prise en charge non chirurgicale a été associée à un taux élevé de récurrences de l'OIG : 31 % après un suivi médian de 17 mois. Parmi les patients opérés, 60 % ont subi une chirurgie immédiate et 40 % ont subi leur chirurgie après une tentative de prise en charge non chirurgicale. Les patients chez qui la prise en charge non chirurgicale a échoué ont subi leur chirurgie après une période médiane de 2 jours et 89 % en l'espace de 5 jours. Le taux de résection intestinale a été élevé (29 %) chez ceux dont la chirurgie a été retardée. La chirurgie après une intervention non chirurgicale infructueuse a été associée à un taux d...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

et al. 2014

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“…Of these, over half will require operative management. 1,2 Moreover, recurrent episodes of adhesive obstruction may occur in 29-42% of patients. 3,4 In addition, the work-load and cost of treating adhesive small bowel obstruction is significant, thus impacting on the resources of a state-funded healthcare service.…”

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confidence: 99%

Long-Term Follow-Up of the Use of the Jones' Intestinal Tube in Adhesive Small Bowel Obstruction

Fazel

Jamieson

2009

annals

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INTRODUCTION Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive bstruction. This paper describes our experience of this technique. PATIENTS AND METHODS A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who re identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction. RESULTS Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and re thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube. CONCLUSION Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.

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“…Appendectomies, gynaecological operations, cholecystectomie, and large bowel cancer resections are supposed to be the commonest surgeries leading to adhesions. [19,20] Operative management was done in 125 patients (61.27%) while 79 patients (38.73%) were conservatively managed. 93% of hernias, 81% of malignancies and 80% of volvulus cases underwent emergency surgeries, while 24% of adhesions were released surgically.…”

Section: Resultsmentioning

confidence: 99%

A Pattern of Intestinal Obstruction Cases – A Tertiary Care Centre Study

Pillai¹,

Benjamin²,

Chisthi³

2017

AIMDR

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Background: Bowel obstruction is a surgical emergency that causes confusion both in the diagnosis and the management. Decision on whether to operate on the patient or to continue with conservative management as well as the timing of intervention often rests upon the treating surgeon and his competence. Objectives: Primary objective of the study was to describe the etiological profile in patients with intestinal obstruction in our institution. Secondary objectives were to study the demographic pattern and the mode of management in these patients. Material & Methods: This was a hospital based Cross sectional study conducted at the General Surgery department, Government Medical College Hospital, Trivandrum. The study period was for 18 months, from April 2014 to September 2015. Study subjects included patients admitted in the Surgical wards with intestinal obstruction. Sample size was calculated to be 204 based on reference study. All values are presented as means and percentages. Results: Males were found to be affected much more than females. In 70% of patients, small bowel was the bowel predominantly involved. Adhesions were the commonest etiological factor followed by obstructed hernias. Most of the patients underwent operative management. Conclusions: Small bowel was the most commonly obstructed part of the bowel while adhesions and hernia form the commonest reasons for intestinal obstruction in our setting. Appendicectomy and laparotomy for perforation peritonitis caused the most postoperative adhesions.

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Small Bowel Obstruction: Conservative vs. Surgical Management

Cited by 175 publications

References 19 publications

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study

Long-Term Follow-Up of the Use of the Jones' Intestinal Tube in Adhesive Small Bowel Obstruction

A Pattern of Intestinal Obstruction Cases – A Tertiary Care Centre Study

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