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Small Bowel Obstruction: Conservative vs. Surgical Management

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE

The aim of this study was to assess incidence, risk factors, and recurrence rates for conservative and surgical management of small bowel obstruction.

METHODS

Retrospective chart review was conducted of 329 patients accounting for 487 admissions with small bowel obstruction. Data were obtained from the institutional database and patient charts. Patients with early recurrent small bowel obstruction had prior operations or hospitalization with conservative therapy for small bowel obstruction, then had a hospital stay >10 days following abdominal surgery because of obstruction or required readmission for small bowel obstruction within 30 days. Patients treated for prior small bowel obstruction and then readmitted after 30 days for a recurrent small bowel obstruction were classified as having late recurrent small bowel obstruction.

RESULTS

A total of 329 patients with a diagnosis of small bowel obstruction were identified. At index admission, 43 percent (142) were successfully treated conservatively, whereas 57 percent (187) failed conservative treatment and underwent surgery. Overall, there were eight early deaths, four in each group (2.8 percent conservative vs. 2.1 percent surgical; no significant difference). The frequency of recurrence for those treated nonoperatively was 40.5 percent compared with 26.8 percent for patients treated operatively (P < 0.009). Patients treated without operation had a significantly shorter time to recurrence (mean, 153 vs. 411 days; P < 0.004) and had fewer hospital days for their index small bowel obstruction (4.9 vs. 12.0 days; P < 0.0001). Two hundred one (63 percent) patients had abdominal surgery and 119 (37 percent) patients had no prior abdominal surgery before developing a small bowel obstruction. Previous abdominal operations by procedure type were colorectal surgery (34 percent), gynecologic surgery (28 percent), exploratory laparotomy (20 percent), appendectomy (14 percent), cholecystectomy (12 percent), herniorraphy (8 percent), and gastric bypass (5 percent). The mean time interval between initial procedure and index small bowel obstruction was 1.3 years for gastric bypass, 6.1 years for herniorraphy, 7.8 years for exploratory laparotomy, 8 years for cholecystectomy, 8.4 years for colorectal surgery, 11.8 years for gynecologic surgery, and 22.5 years for appendectomy. There was no significant difference between early and late recurrent small bowel obstruction in patients treated nonoperatively or operatively, regardless of prior history of abdominal surgery. Logistic regression analysis failed to identify any specific risk factors that were predictors of the success of conservative or surgical management.

CONCLUSIONS

Operatively treated patients had a lower frequency of recurrence and a longer time interval to recurrence; however, they also had a longer hospital stay than that of patients treated nonoperatively. There was no significant difference in treatment type or in incidence or type of prior surgery among patients with early and late small bowel obstruction. None of the variables analyzed in this study were significant predictors of the success of a particular treatment.

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REFERENCES

  1. G Miller J Boman I Shrier PH Gordon (2000) ArticleTitleNatural history of patients with adhesive small bowel obstruction Br J Surg 87 1240–7 Occurrence Handle10.1046/j.1365-2168.2000.01530.x Occurrence Handle1:STN:280:DC%2BD3M%2Fjs1Ortg%3D%3D Occurrence Handle10971435

    Article  CAS  PubMed  Google Scholar 

  2. C Tanphiphat S Chittmittraprap K Prasopsunti (1987) ArticleTitleAdhesive small bowel obstruction. A review of 321 cases in a Thai hospital Am J Surg 154 283–7 Occurrence Handle10.1016/0002-9610(89)90611-9 Occurrence Handle1:STN:280:BiiA38znvVQ%3D Occurrence Handle3631405

    Article  CAS  PubMed  Google Scholar 

  3. G McEntee D Pender D Mulvin et al. (1987) ArticleTitleCurrent spectrum of intestinal obstruction Br J Surg 74 976–80 Occurrence Handle1:STN:280:BieD2sfptVI%3D Occurrence Handle3690244

    CAS  PubMed  Google Scholar 

  4. P Mucha (1987) ArticleTitleSmall bowel obstruction Surg Clin North Am 67 597–620 Occurrence Handle3296252

    PubMed  Google Scholar 

  5. HJ Asbun C Pempinello NA Halasz (1989) ArticleTitleSmall bowel obstruction and its management Int Surg 74 23–7 Occurrence Handle1:STN:280:BiaB3Mzis1U%3D Occurrence Handle2651344

    CAS  PubMed  Google Scholar 

  6. JS Bender MJ Busuito C Graham RD Allaben (1989) ArticleTitleSmall bowel obstruction in the elderly Am Surg 55 385–8 Occurrence Handle1:STN:280:BiaB2s7jtlc%3D Occurrence Handle2729777

    CAS  PubMed  Google Scholar 

  7. J Canady Z Jamil J Wilson LJ Bernard (1987) ArticleTitleIntestinal obstruction: still a lethal clinical entity J Natl Med Assoc 79 1281–4 Occurrence Handle1:STN:280:BieC3MbgtF0%3D Occurrence Handle3323541

    CAS  PubMed  Google Scholar 

  8. WD Holder (1988) ArticleTitleIntestinal obstruction Gastroenterol Clin North Am 17 317–40 Occurrence Handle3049348

    PubMed  Google Scholar 

  9. WO Richards LF Williams (1988) ArticleTitleObstruction of the large and small intestine Surg Clin North Am 68 355–76 Occurrence Handle1:STN:280:BieC2MbksVA%3D Occurrence Handle3279551

    CAS  PubMed  Google Scholar 

  10. BJ Zadeh JM Davis PC Canizaro (1985) ArticleTitleSmall bowel obstruction in the elderly Am Surg 51 470–3

    Google Scholar 

  11. W Vrijland LN Tseng HJ Eijkman et al. (2000) ArticleTitleFewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane Ann Surg 235 193–7 Occurrence Handle10.1097/00000658-200202000-00006

    Article  Google Scholar 

  12. R Ferland D Mulani PK Campbell (2001) ArticleTitleEvaluation of a sprayable polyethylene glycol adhesion barrier in a porcine efficacy model Hum Reprod 16 2718–23 Occurrence Handle10.1093/humrep/16.12.2718 Occurrence Handle1:STN:280:DC%2BD3MnotVCkuw%3D%3D Occurrence Handle11726601

    Article  CAS  PubMed  Google Scholar 

  13. JM Becker MT Dayton VW Fazio et al. (1996) ArticleTitlePrevention of postoperative adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study J Am Coll Surg 183 297–306 Occurrence Handle1:STN:280:ByiD3c%2FhtFA%3D Occurrence Handle8843257

    CAS  PubMed  Google Scholar 

  14. G Miller J Boman I Shrier PH Gordon (2000) ArticleTitleEtiology of small bowel obstruction Am J Surg 180 33–6 Occurrence Handle10.1016/S0002-9610(00)00407-4 Occurrence Handle1:STN:280:DC%2BD3M%2FjsValsw%3D%3D Occurrence Handle11036136

    Article  CAS  PubMed  Google Scholar 

  15. H Ellis (1997) ArticleTitleThe clinical significance of adhesions: focus on intestinal obstruction Eur J Surg 557 5–9

    Google Scholar 

  16. RW Luijendijk DC Lange Particlede CC Wauters et al. (1996) ArticleTitleForeign material in postoperative adhesions Ann Surg 223 242–8 Occurrence Handle10.1097/00000658-199603000-00003 Occurrence Handle1:STN:280:BymC1Mbgt10%3D Occurrence Handle8604903

    Article  CAS  PubMed  Google Scholar 

  17. D Menzies H Ellis (1990) ArticleTitleIntestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 72 60–3 Occurrence Handle1:STN:280:By%2BC2cngsVc%3D Occurrence Handle2301905

    CAS  PubMed  Google Scholar 

  18. D Seror E Feigin A Szold et al. (1993) ArticleTitleScientific papers: how conservatively can postoperative small bowel obstruction be treated? Am J Surg 165 121–6 Occurrence Handle1:STN:280:ByyC3Mfot1Y%3D Occurrence Handle8418687

    CAS  PubMed  Google Scholar 

  19. H Barkan S Webster S Ozeran (1995) ArticleTitleFactors predicting the recurrence of adhesive small bowel obstruction Am J Surg 170 361–5 Occurrence Handle10.1016/S0002-9610(99)80304-3 Occurrence Handle1:STN:280:BymD3MzivFw%3D Occurrence Handle7573729

    Article  CAS  PubMed  Google Scholar 

  20. J Landercasper TH Cogbill WH Merry RT Stolee PJ Strutt (1993) ArticleTitleLong term outcome after hospitalization for small bowel obstruction Arch Surg 128 765–71 Occurrence Handle1:STN:280:ByyA3crgtVc%3D Occurrence Handle8317958

    CAS  PubMed  Google Scholar 

  21. MR Cox IF Gunn MC Eastman RF Hunt AW Heinz (1993) ArticleTitleThe operative etiology and types of adhesions causing small bowel obstruction ANZ J Surg 63 848–52 Occurrence Handle1:STN:280:ByuD38bnsVI%3D

    CAS  Google Scholar 

  22. I Matter L Khalemsky J Abrahson E Nash E Sabo S Eldar (1997) ArticleTitleDoes the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg 163 767–72 Occurrence Handle1:STN:280:DyaK1c%2FjvFSltw%3D%3D Occurrence Handle9373228

    CAS  PubMed  Google Scholar 

  23. FJ Montz CH Holschneider S Solh LC Schuricht BJ Monk (1994) ArticleTitleSmall bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings Gynecol Oncol 53 114–20 Occurrence Handle10.1006/gyno.1994.1097 Occurrence Handle1:STN:280:ByuB38bmtVY%3D Occurrence Handle8175009

    Article  CAS  PubMed  Google Scholar 

  24. JE Filip SG Mattar SP Bowers CD Smith (2002) ArticleTitleInternal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity Am Surg 68 640–3 Occurrence Handle12132750

    PubMed  Google Scholar 

  25. S Ellozy M Harris J Bauer S Gorfine I Kreel (2002) ArticleTitleEarly postoperative small bowel obstruction: a prospective evaluation in 242 consecutive abdominal operations Dis Colon Rectum 45 1214–7 Occurrence Handle10.1007/s10350-004-6395-6 Occurrence Handle12352239

    Article  PubMed  Google Scholar 

  26. AR MacLean A Cohen HM MacRae et al. (2002) ArticleTitleRisk of small bowel obstruction after the ieal pouch-anal anastomosis Ann Surg 235 200–6 Occurrence Handle10.1097/00000658-200202000-00007 Occurrence Handle11807359

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, The George Washington University, Washington, D.C.

    Stephen B. Williams B.S., Jose Greenspon M.D., Heather A. Young M.P.H. & Bruce A. Orkin M.D.

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  1. Stephen B. Williams B.S.
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  2. Jose Greenspon M.D.
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  3. Heather A. Young M.P.H.
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  4. Bruce A. Orkin M.D.
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Corresponding author

Correspondence to Bruce A. Orkin M.D..

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Reprints are not available.

S. B. Williams funded by the 2002 W. T. Gill Jr. Research Fellowship.

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Williams, S., Greenspon, J., Young, H. et al. Small Bowel Obstruction: Conservative vs. Surgical Management. Dis Colon Rectum 48, 1140–1146 (2005). https://doi.org/10.1007/s10350-004-0882-7

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  • DOI: https://doi.org/10.1007/s10350-004-0882-7

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