Skip to main content
SpringerLink
Log in

Severe adhesive small bowel obstruction

  • Case Report
  • Published:
Frontiers of Medicine Aims and scope Submit manuscript

Abstract

Adhesive small bowel obstruction is a frequent cause of hospital admission. Water soluble contrast studies may have diagnostic and therapeutic value and avoid challenging demanding surgical operations, but if bowel ischemia is suspected, prompt surgical intervention is mandatory. A 58-year-old patient was operated for extensive adhesive small bowel obstruction after having had two previous laparotomies for colorectal surgery, and had a complex clinical course with multiple operations and several complications. Different strategies of management have been adopted, including non-operative management with the use of hyperosmolar water soluble contrast medium, multiple surgical procedures, total parenteral nutrition (TPN) support, and finally use of antiadherences icodextrin solution. After 2 years follow-up the patient was doing well without presenting recurrent episodes of adhesive small bowel obstruction. For patients admitted several times for adhesive small bowel obstruction, the relative risk of recurring obstruction increases in relation to the number of prior episodes. Several strategies for non-operative conservative management of adhesive small bowel obstruction have already addressed diagnostic and therapeutic value of hyperosmolar water soluble contrast. According to the most recent evidencebased guidelines, open surgery is the preferred method for surgical treatment of strangulating adhesive small bowel obstruction as well as after failed conservative management. Research interest and clinical evidence are increasing in adhesions prevention. Hyaluronic acid-carboxycellulose membrane and icodextrin may reduce incidence of adhesions.

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. Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg 2010; 97(4): 470–478

    Article  PubMed  CAS  Google Scholar 

  2. Di Saverio S, Catena F, Ansaloni L, Gavioli M, Valentino M, Pinna AD.Water-soluble contrast medium (gastrografin) value in adhesive small intestine obstruction (ASIO): a prospective, randomized, controlled, clinical trial. World J Surg 2008; 32(10): 2293–2304

    Article  PubMed  Google Scholar 

  3. van Dellen D, Augustine T. Encapsulating peritoneal sclerosis. Br J Surg 2012; 99(5): 601–602 (And a Snapshot in Surgery at the address http://www.bjs.co.uk/view/clinicalLibrary.html?page=5)

    Article  PubMed  Google Scholar 

  4. Di Saverio S, Tugnoli G, Orlandi PE, Casali M, Catena F, Biscardi A, Pillay O, Baldoni F. A 73-year-old man with long-term immobility presenting with abdominal pain. PLoS Med 2009; 6(7): e1000092

    Article  PubMed  Google Scholar 

  5. Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. Eur J Surg Suppl 1997; (577): 5–9

    PubMed  Google Scholar 

  6. Di Saverio S, Tugnoli G, Catena F, Biscardi A, Baldoni F, Spiller R. A tenacious complete small bowel obstruction. Gut 2009; 58(6): 812, 891

    PubMed  Google Scholar 

  7. Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl 1993; 75(3): 147–153

    PubMed  CAS  Google Scholar 

  8. Ellis H. The magnitude of adhesion related problems. Ann Chir Gynaecol 1998; 87(1): 9–11

    PubMed  CAS  Google Scholar 

  9. Fevang BT, Fevang J, Lie SA, Søreide O, Svanes K, Viste A. Longterm prognosis after operation for adhesive small bowel obstruction. Ann Surg 2004; 240(2): 193–201

    Article  PubMed  Google Scholar 

  10. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 1998; 186(1): 1–9

    Article  PubMed  CAS  Google Scholar 

  11. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, Sarr MG. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg 2010; 34(5): 910–919

    Article  PubMed  Google Scholar 

  12. Trésallet C, Lebreton N, Royer B, Leyre P, Godiris-Petit G, Menegaux F. Improving the management of acute adhesive small bowel obstruction with CT-scan and water-soluble contrast medium: a prospective study. Dis Colon Rectum 2009; 52(11): 1869–1876

    Article  PubMed  Google Scholar 

  13. Diaz JJ Jr, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, Collier BR, Cullinane DC, Dwyer KM, Griffen MM, Mayberry JC, Jerome R. Guidelines for management of small bowel obstruction. J Trauma 2008; 64(6): 1651–1664

    Article  PubMed  Google Scholar 

  14. Eastern Association for the Surgery of Trauma Practice Parameter Workgroup for Management of Small Bowel Obstruction. Practice management guidelines for small bowel obstruction 2007. www.east.org (Accessed on September 15, 2009)

  15. Catena F, Di Saverio S, Kelly MD, Biffl WL, Ansaloni L, Mandalà V, Velmahos GC, Sartelli M, Tugnoli G, Lupo M, Mandalà S, Pinna AD, Sugarbaker PH, Van Goor H, Moore EE, Jeekel J. Bologna Guidelines for Diagnosis and Management of Adhesive Small Bowel Obstruction (ASBO): 2010 Evidence-Based Guidelines of theWorld Society of Emergency Surgery.World J Emerg Surg 2011; 6(1): 5

    Article  PubMed  Google Scholar 

  16. Noble TB Jr. Plication of small intestine as prophylaxis against adhesions. Am J Surg 1937; 35(1): 41–44

    Article  Google Scholar 

  17. Childs WA, Phillips RB. Experience with intestinal plication and a proposed modification. Ann Surg 1960; 152(2): 258–265

    Article  PubMed  CAS  Google Scholar 

  18. Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, diZerega GS; Adept Adhesion Reduction Study Group. Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril 2007; 88(5): 1413–1426

    Article  PubMed  Google Scholar 

  19. Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Göhl J. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 2006; 49(1): 1–11

    Article  PubMed  Google Scholar 

  20. Catena F, Ansaloni L, Di Saverio S., Pinna AD. P.O.P.A. study: prevention of postoperative abdominal adhesions by icodextrin 4% solution after laparotomy for adhesive small bowel obstruction. A prospective randomized controlled trial J Gastrointest Surg 2012; 16(2): 382–388

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency Surgery Unit, Department of General and Transplant Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy

    Salomone Di Saverio, Fausto Catena & Luca Ansaloni

  2. Upper GI Surgery Unit, Department of Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK

    Salomone Di Saverio & Michael D. Kelly

  3. Emergency and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy

    Salomone Di Saverio & Gregorio Tugnoli

  4. General Surgery I Dept., Ospedali Riuniti, Bergamo, Italy

    Luca Ansaloni

Authors
  1. Salomone Di Saverio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fausto Catena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael D. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregorio Tugnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Ansaloni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salomone Di Saverio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Saverio, S., Catena, F., Kelly, M.D. et al. Severe adhesive small bowel obstruction. Front. Med. 6, 436–439 (2012). https://doi.org/10.1007/s11684-012-0221-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-012-0221-7

Keywords

Search

Navigation