Skip to main content
SpringerLink
Log in

Small Bowel Obstructions in the Elderly

  • Chapter
  • First Online:
Emergency General Surgery in Geriatrics

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

  • 759 Accesses

Abstract

According to the World Health Organization, old age is defined as 60 years of age or older, although in poorer countries with lower life expectancy than in developed countries, an age range between 50 and 55 is also taken into account. Small bowel obstruction (SBO) is a frequent emergency diagnosis in elderly patients and its occurrence tends to increase with the increasing number of elderly patients thus requiring sometimes acute medical care and emergency surgery. About 10–12% of patients above 65 years of age presenting with abdominal pain at the emergency department (ED) is diagnosed with small bowel obstruction (Spangler et al. Int J Emerg Med. 7:43, 2014; Ozturk et al. World J Emerg Surg. 13:48, 2018). The three most frequent causes of SBO are postoperative adhesions, hernias, and neoplasms. A correct diagnosis may be difficult in the elderly population, due to a lack of detailed studies on symptoms. In fact, they seem to present later and to be less profound in the elderly compared to younger patients thus resulting in a higher rate of misdiagnosis (Bugliosi et al. Ann Emerg Med. 19:1383–1386, 1990; Leuthauser and McVane. Emerg Med Clin North Am. 34:363–375, 2016). A tailored surgical approach should be done for elderly patients with SBO due to frailty.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55–68.

    PubMed  PubMed Central  Google Scholar 

  2. Wiseman DM. Adhesion prevention: past the future. In: Di Zerega GS, editor. Peritoneal surgery. New York: Springer; 2000. p. 401.

    Chapter  Google Scholar 

  3. Hayanga AJ, Bass-Wilkins K, Bulkley GB. Current management of small-bowel obstruction. Adv Surg. 2005;39:1–33.

    Article  Google Scholar 

  4. Long B, Ms JR, Koyfman A. Clinical Reviews emergency medicine evaluation and management of small bowel. J Emerg Med. 2018;(October):1–11. https://doi.org/10.1016/j.jemermed.2018.10.024

  5. Maung AA, Johnson DC, Piper GL, et al. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5):362–9. https://doi.org/10.1097/TA.0b013e31827019de.

    Article  Google Scholar 

  6. Spangler R, Van Pham T, Khoujah D, Martinez JP. Abdominal emergencies in the geriatric patient. Int J Emerg Med. 2014;7:43. https://doi.org/10.1186/s12245-014-0043-2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ozturk E, Van Iersel M, Stommel MMWJ, Schoon Y, Rpg R, Van Goor H. Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World J Emerg Surg. 2018;13:48.

    Article  Google Scholar 

  8. Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med. 1990;19:1383–6. https://doi.org/10.1016/S0196-0644(05)82602-2.

    Article  CAS  PubMed  Google Scholar 

  9. Roos J. A case of small-bowel obstruction after insertion of a percutaneous endoscopic gastrostomy tube due to mesenteric penetration. Ann R Coll Surg Engl. 2015;97(5):e79–80. https://doi.org/10.1308/003588415X14181254790365.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Marmo R, Rea M, Pecora A, Sansone S, Rotondano G. Small bowel obstruction due to penetrating migrated biliary stent: removal with a clip applicator via double balloon enteroscopy. Dig Liver Dis. 2013;45(9):783–5. https://doi.org/10.1016/j.dld.2013.02.013.

    Article  PubMed  Google Scholar 

  11. Kendrick ML. Partial small bowel obstruction: clinical issues and recent technical advances. Abdom Imaging. 2008;34(3):329–34. https://doi.org/10.1007/s00261-008-9436-0.

    Article  Google Scholar 

  12. Broek RPG, Krielen P, Di Saverio S, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018;13:24.

    Article  Google Scholar 

  13. Duron JJ. Postoperative intraperitoneal adhesion pathophysiology. Color Dis. 2007;9(s2):14–24. https://doi.org/10.1111/j.1463-1318.2007.01343.x.

    Article  Google Scholar 

  14. Richard PG, Issa Y, Van Santbrink EJP, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and meta-analysis. BMJ. 2013;347:f5588. https://doi.org/10.1136/bmj.f5588.

    Article  Google Scholar 

  15. Krielen P, Van Den Beukel BA, Stommel MWJ, Van Goor H, Strik C, Broek RPG. In-hospital costs of an admission for adhesive small bowel obstruction. World J Emerg Surg. 2016;11:49. https://doi.org/10.1186/s13017-016-0109-y.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Duron JJ, Pitie-salpetriere GH. Foreign material in postoperative adhesions. Ann Surg. 1996;223(3):242–8. https://doi.org/10.1016/j.amjsurg.2014.04.009.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Richard PG, Joyce B, Van Goor H. Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection. Surg Endosc. 2011;25:1827–34. https://doi.org/10.1007/s00464-010-1474-3.

    Article  Google Scholar 

  18. Bakker FC, Persoon A, Bredie SJH, et al. The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: results of a before-after study with focus on surgical patients. Am J Surg. 2014;208(5):735–46.

    Article  Google Scholar 

  19. Karamanos E, Dulchavsky S, Beale E, Inaba K, Demetriades D. Diabetes mellitus in patients presenting with adhesive small bowel obstruction: delaying surgical intervention results in worse outcomes. World J Surg. 2016;40(4):863–9. https://doi.org/10.1007/s00268-015-3338-4.

    Article  PubMed  Google Scholar 

  20. Eagon C. Small bowel obstruction in the elderly. In: Rosenthal RA, Zenilman ME, Katlic MR, editors. Principles and practice of geriatric surgery. New York: Springer; 2001. p. 569–79.

    Chapter  Google Scholar 

  21. Gul M, Aliosmanoglu I, Kapan M, et al. Patients who underwent emergency operation for incarcerated abdominal wall hernia. 2012;2488001:305–309.

    Google Scholar 

  22. Durgakeri P, Strauss P, Jones B. Obturator hernia: the “little old lady’s hernia”. ANZ J Surg. 2017;87(5):412–4. https://doi.org/10.1111/ans.12903.

    Article  PubMed  Google Scholar 

  23. Chen D, Fei Z, Wang X. Bowel obstruction secondary to incarcerated obturator hernia. Asian J Surg. 2017;40(3):193–6. https://doi.org/10.1016/j.asjsur.2015.08.003.

    Article  PubMed  Google Scholar 

  24. Prost À la Denise J, Douard R, Malamut G, Mecheri F, Wind P. Small bowel obstruction in patients with a prior history of cancer: predictive findings of malignant origins. World J Surg. 2014;38(2):363–9. https://doi.org/10.1007/s00268-013-2303-3.

    Article  PubMed  Google Scholar 

  25. Leuthauser A, McVane B. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(2):363–75. https://doi.org/10.1016/j.emc.2015.12.009.

    Article  PubMed  Google Scholar 

  26. Liang SY. Sepsis and other infectious disease emergencies in the elderly. Emerg Med Clin North Am. 2017;34(3):501–22. https://doi.org/10.1016/j.emc.2016.04.005.Sepsis.

    Article  Google Scholar 

  27. Norman DC. Fever in the elderly. Clin Infect Dis. 2000;31(1):148–51. https://doi.org/10.1086/313896.

    Article  CAS  PubMed  Google Scholar 

  28. Gardner CS, Jaffe TA, Nelson RC. Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. Abdom Imaging. 2015;40(7):2877–82. https://doi.org/10.1007/s00261-015-0419-7.

    Article  PubMed  Google Scholar 

  29. Reginelli A, Russo A, Pinto A, et al. Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. Int J Surg. 2014;12(s2):s181–6. https://doi.org/10.1016/j.ijsu.2014.08.345.

    Article  PubMed  Google Scholar 

  30. Zhang Y, Gao Y, Ma Q, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis. 2006;38(3):188–94. https://doi.org/10.1016/j.dld.2005.10.010.

    Article  CAS  PubMed  Google Scholar 

  31. Hefny AF, Corr P, Abu-Zidan FM. The role of ultrasound in the management of intestinal obstruction. J Emerg Trauma Shock. 2012;5(1):84–6. https://doi.org/10.4103/0974-2700.93109.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Joseph B, Zangbar B, Pandit V, et al. Emergency general Surgery in the elderly: too old or too frail? J Am Coll Surg. 2016;222(5):805–13. https://doi.org/10.1016/j.jamcollsurg.2016.01.063.

    Article  PubMed  Google Scholar 

  33. Springer JE, Bailey JG, Davis PJB, Johnson PM. Management and outcomes of small bowel obstruction in older adult patients: a prospective cohort study. Can J Surg. 2014;57(6):379–84. https://doi.org/10.1503/cjs.029513.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fleshner PR, Siegman MG, Slater GI, Brolin RE, Chandler JCJ, Aufses AH. A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction. Am J Surg. 1995;170(4):366–70.

    Article  CAS  Google Scholar 

  35. Young J, Murthy L, Westby M, Akunne A, O’Mahony R. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ. 2010;314:c3704.

    Article  Google Scholar 

  36. Costa G, Ruscelli P, Balducci G, et al. Clinical strategies for the management a Delphi consensus study of SICUT (Società Italiana di Chirurgia d ’ Urgenza e del Trauma). Ann Ital Chir. 2016;87:105–17.

    PubMed  Google Scholar 

  37. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the nationwide inpatient sample. J Trauma Acute Care Surg. 2013;74(1):181–9.

    Article  Google Scholar 

  38. Horwood J, Akbar F, Maw A. Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Ann R Coll Surg Engl. 2009;91(8):681–7. https://doi.org/10.1308/003588409X12486167520993.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101(1):e109–18. https://doi.org/10.1002/bjs.9360.

    Article  CAS  PubMed  Google Scholar 

  40. Ten Broek RPG, Stommel MWJ, Strik C, van Laarhoven CJHM, Keus F, van Goor H. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet. 2014;383(9911):48–59. https://doi.org/10.1016/S0140-6736(13)61687-6.

    Article  CAS  PubMed  Google Scholar 

  41. Sajid MS, Khawaja AH, Sains P, Singh KK, Baig MK. A systematic review comparing laparoscopic vs open adhesiolysis in patients with adhesional small bowel obstruction. Am J Surg. 2016;212(1):138–50. https://doi.org/10.1016/j.amjsurg.2016.01.030.

    Article  PubMed  Google Scholar 

  42. Woolfson RG, Jennings K, Whalen GF. Management of bowel obstruction in patients with abdominal cancer. Arch Surg. 1997;132(10):1093–7. https://doi.org/10.1001/archsurg.1997.01430340047006.

    Article  CAS  PubMed  Google Scholar 

  43. Blair SL, Chu DZ, Schwarz RE. Outcome of palliative operations for malignant bowel obstruction in patients with peritoneal carcinomatosis from nongynecological cancer. Ann Surg Oncol. 2001;8(8):632–7.

    Article  CAS  Google Scholar 

  44. Kim YJ, Yoon CJ, Seong NJ, Kang SG, An SW, Woo YN. Safety and efficacy of radiological percutaneous jejunostomy for decompression of malignant small bowel obstruction. Eur Radiol. 2013;23(10):2747–53. https://doi.org/10.1007/s00330-013-2883-1.

    Article  PubMed  Google Scholar 

  45. Olson TJP, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg. 2014;149(4):383–92. https://doi.org/10.1001/jamasurg.2013.4059.Palliative.

    Article  Google Scholar 

  46. Gallagher P, Clark K. The ethics of surgery in the elderly demented patient with bowel obstruction. J Med Ethics. 2002;28(2):105–8.

    Article  CAS  Google Scholar 

  47. van de Pol MH, Fluit CR, Lagro J, Slaats YH, Olde Rikkert MG, Lagro-Janssen AL. Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. Patient Educ Couns. 2016;99(6):1069–77. https://doi.org/10.1016/j.pec.2015.12.014.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Surgery, Maggiore Hospital, Parma, Italy

    Gennaro Perrone, Vittoria Pattonieri, Antonio Tarasconi & Fausto Catena

  2. Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy

    Vincenzo Papagni

  3. General Surgical Clinic, Maggiore Hospital, Parma, Italy

    Mario Giuffrida

Authors
  1. Gennaro Perrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vincenzo Papagni
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Giuffrida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vittoria Pattonieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Tarasconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fausto Catena
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, New York Medical College, School of Medicine and Westchester Medical Center, Valhalla, NY, USA

    Rifat Latifi

  2. Emergency Surgery Department, Parma University Hospital, Parma, Italy

    Fausto Catena

  3. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy

    Federico Coccolini

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Perrone, G., Papagni, V., Giuffrida, M., Pattonieri, V., Tarasconi, A., Catena, F. (2021). Small Bowel Obstructions in the Elderly. In: Latifi, R., Catena, F., Coccolini, F. (eds) Emergency General Surgery in Geriatrics . Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-62215-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-62215-2_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-62214-5

  • Online ISBN: 978-3-030-62215-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation