Early Postoperative Small-Bowel Obstruction

Abstract

PURPOSE: Early postoperative small-bowel obstruction is a common but poorly defined complication of abdominal surgery. This prospective cohort study was undertaken to examine a reproducible definition of early postoperative small-bowel obstruction, determine its incidence, evaluate potential risk factors for its development, and delineate management strategies. METHODS: Two hundred twenty-five patients undergoing 242 consecutive abdominal operations during a 9-month period were prospectively evaluated from the time of admission until Postoperative Day 30. Early postoperative small-bowel obstruction was present if, within 30 days of surgery, all of the following criteria were met after the return of intestinal function: development of crampy abdominal pain, vomiting, and radiographic findings consistent with intestinal obstruction. Patients with early postoperative small-bowel obstruction were followed up until discharge or reexploration. All patients with early postoperative small-bowel obstruction were initially treated with nasogastric decompression. RESULTS: Two hundred forty-two abdominal procedures were performed on 119 males and 123 females aged 13 to 98 (mean, 51) years. Ulcerative colitis (n = 70), malignancy (n = 59), and Crohn’s disease (n = 41) were the most common diagnoses. One hundred nineteen patients (49.2 percent) had undergone previous laparotomy, and 45 patients (18.6 percent) had previously been diagnosed with intestinal obstruction. Early postoperative small-bowel obstruction occurred in 23 cases (9.5 percent). Patients with and without early postoperative small-bowel obstruction were similar with respect to diagnosis, preoperative immunosuppression, previous laparotomy or obstruction, surgery performed, and time to return of intestinal function. Twenty episodes (87 percent) resolved with nasogastric decompression alone; all but one resolved within six days or less. Three patients (13 percent) required relaparotomy; one required small-bowel resection. Two of three patients whose symptoms did not resolve with six days of nasogastric decompression required reexploration. There were no deaths and no major morbidity. CONCLUSIONS: Early postoperative small-bowel obstruction, defined by an objective data set, was observed in 9.5 percent of cases. No independent risk factors predisposing to early postoperative small-bowel obstruction were identified. Early postoperative small-bowel obstruction was safely and effectively managed by nasogastric decompression in the majority of cases, with low morbidity and no mortality. In general, reexploration should be reserved for those patients whose symptoms do not resolve within six days of nasogastric decompression.