Skip to main content
SpringerLink
Log in

Adhesional Small Bowel Obstruction in the Absence of Previous Operations: Management and Outcomes

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The majority of small bowel obstructions (SBO) are the result of adhesions caused by a previous abdominal operation. On rare occasions, adhesional SBO occurs in the absence of such an operation. Our objective was to describe the management, findings, and outcomes of unexplained adhesional SBO (UA-SBO) and examine whether preoperative diagnostic uncertainty leads to delays in therapy and complications.

Methods

The medical records of all adhesional SBO patients admitted to the Massachusetts General Hospital between January 1, 1997 and December 31, 2007 were screened. UA-SBO records were reviewed in detail. Each UA-SBO patient was matched with an adhesional SBO patient with abdominal surgical history (SH-SBO) according to gender, age (±7 years), white blood cell count (±3000/mm3), time interval from the onset of symptoms to the time of admission (±24 h), and year of admission (±4 years). Outcomes included time from admission to operation, morbidity, mortality, and length of hospital stay.

Results

Of 1,036 patients with adhesional SBO, 34 (3.3%) had UA-SBO. Adhesiolysis was sufficient in 31 patients, whereas 3 required an enterectomy. UA-SBO patients were similar in terms of demographics, clinical presentation, and initial laboratory tests with SH-SBO patients. There was no difference in any of the outcomes between the two groups.

Conclusions

In this study of UA-SBO, diagnostic delays were not found and patient outcomes were similar to those of patients with SH-SBO.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480

    Article  PubMed  CAS  Google Scholar 

  2. Mucha P Jr (1987) Small intestinal obstruction. Surg Clin North Am 67:597–620

    PubMed  Google Scholar 

  3. Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180:33–36

    Article  PubMed  CAS  Google Scholar 

  4. Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 126:345–353

    Article  PubMed  CAS  Google Scholar 

  5. Gingalewski C, Lalikos J (2008) An unusual cause of small bowel obstruction: herniation through a defect in the falciform ligament. J Pediatr Surg 43:398–400

    Article  PubMed  Google Scholar 

  6. Agresta F, Michelet I, Candiotto E, Bedin N (2007) Incarcerated internal hernia of the small intestine through a breach of the broad ligament: two cases and a literature review. JSLS 11:255–257

    PubMed  CAS  Google Scholar 

  7. Smith GH, Skipworth RJ, Duff MD, Anderson DN (2006) Red herring: a rare cause of small bowel obstruction. Am Surg 4:107–110

    CAS  Google Scholar 

  8. Zissin R, Hertz M, Gayer G, Paran H, Osadchy A (2005) Congenital internal hernia as a cause of small bowel obstruction: CT findings in 11 adult patients. Br J Radiol 78:796–802

    Article  PubMed  CAS  Google Scholar 

  9. Maeda A, Yokoi S, Kunou T et al (2004) Intestinal obstruction in the terminal ileum caused by an anomalous congenital vascular band between the mesoappendix and the mesentery: report of a case. Surg Today 34:793–795

    Article  PubMed  Google Scholar 

  10. Wu JM, Lin HF, Chen KH, Tseng LM, Huang SH (2005) Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band. Surg Laparosc Endosc Percutan Tech 15:294–296

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA

    Muhammad U. Butt, George C. Velmahos, Nikos Zacharias, Hasan B. Alam, Marc de Moya & David R. King

Authors
  1. Muhammad U. Butt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George C. Velmahos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikos Zacharias
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hasan B. Alam
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc de Moya
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David R. King
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George C. Velmahos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Butt, M.U., Velmahos, G.C., Zacharias, N. et al. Adhesional Small Bowel Obstruction in the Absence of Previous Operations: Management and Outcomes. World J Surg 33, 2368–2371 (2009). https://doi.org/10.1007/s00268-009-0200-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0200-6

Keywords

Search

Navigation