Bowel obstruction (BO) is more common in older adults and is the second most common reason for emergency surgical interventions in this group of patients. The ileum is one of the most frequent occlusion sites in this group; adhesions, tumors, and hernias are the major causes. There is a disagreement about the approach and therapeutic choice; in fact, currently the medical community only recognizes the “tip of the iceberg” and will continue treating the condition inadequately until it is more comprehensively explored. The correct and timely diagnosis is key to the best possible treatment, whether it be conservative or surgical. In addition, there is an increase in inflammatory diseases in the elderly which means that it is increasingly common to find older people with bowel obstruction from Crohn’s disease. Even eating habits can lead to the formation of phytobezoars in the elderly.
Large bowel obstructions (LBO) are caused by carcinomas of the colon which slowly progress to give complete obstruction, inflammatory disease, fecal impaction, sigmoid volvulus, and cecal volvulus. The greatest risk of colic obstruction is cecal relaxation which can lead to intestinal perforation and shock. Colorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population, and surgery is often the only definitive management option. Age, life expectancy, and cancer status in elderly patients may condition the type of treatment. Bowel volvulus is more frequent in the colon than in the ileum and represents an emergency; the endoscopist and the surgeon must work safely in the interests of the patient and get the best therapeutic option in the shortest possible time. A trivial event such as fecaloma formation can be of considerable impact in the elderly as it may cause obstruction. In the surgical treatment of intestinal occlusion in the elderly, the laparoscopic approach is safe and affords multiple advantages including decreased pain and convalescence.
KeywordsElderly Obstruction Surgery Adhesions Cancer Hernia Fecaloma
- 2.Telfer S, Fenyo G, Holt PR, et al. Acute abdominal pain in patients over 50 years of age. Scand J Gastroenterol Suppl. 1998;144:47–50.Google Scholar
- 4.Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the “ignored iceberg” of medicine and surgery. World J Emerg Surg. 2013;8:6.CrossRefGoogle Scholar
- 10.Sartelli M, Coccolini F, van Ramshorst GH, Campanelli G, Mandalà V, Ansaloni L, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl W, Koike K, Kluger Y, Fraga GP, Ordonez CA, Di Saverio S, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP Jr, Taviloglu K, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Tranà C, Cui Y, Kok KYY, Ghnnam WM, Abbas AE-S, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi ARK, Lohse HAS, Kenig J, Mandalà S, Patrizi A, Scibé R, Catena F. WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg. 2013;8:50.CrossRefGoogle Scholar
- 19.Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech J-J. Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg. 2010;5:29.CrossRefGoogle Scholar
- 22.Sartelli M, Catena F, Ansaloni L, Coccolini F, Griffiths EA, Abu-Zidan FM, Di Saverio S, Ulrych J, Kluger Y, Ben-Ishay O, Moore FA, Ivatury RR, Coimbra R, Peitzman AB, Leppaniemi A, Fraga GP, Maier RV, Chiara O, Kashuk J, Sakakushev B, Weber DG, Latifi R, Biffl W, Bala M, Karamarkovic A, Inaba K, Ordonez CA, Hecker A, Augustin G, Demetrashvili Z, Melo RB, Marwah S, Zachariah SK, Shelat VG, McFarlane M, Rems M, Gomes CA, Faro MP, Pereira GA Jr, Negoi I, Cui Y, Sato N, Vereczkei A, Bellanova G, Birindelli A, Di Carlo I, Kok KY, Gachabayov M, Gkiokas G, Bouliaris K, Çolak E, Isik A, Rios-Cruz D, Soto R, Moore EE. WSES guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg. 2016;11:37.CrossRefGoogle Scholar