Non-operative management of adhesive small bowel obstruction: Should there be a time limit after which surgery is performed?

John O Hwabejire; Daniel D Tran; Terrence M Fullum

doi:10.1016/j.amjsurg.2018.03.010

Non-operative management of adhesive small bowel obstruction: Should there be a time limit after which surgery is performed?

Am J Surg. 2018 Jun;215(6):1068-1070. doi: 10.1016/j.amjsurg.2018.03.010. Epub 2018 Mar 7.

Authors

John O Hwabejire¹, Daniel D Tran¹, Terrence M Fullum²

Affiliations

¹ Department of Surgery, Howard University College of Medicine, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA.
² Department of Surgery, Howard University College of Medicine, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060, USA. Electronic address: tfullum@howard.edu.

PMID: 29544648
DOI: 10.1016/j.amjsurg.2018.03.010

Abstract

The management of adhesive small bowel obstruction (ASBO) has evolved from "the sun should not rise and set on a small bowel obstruction", implying mandatory immediate surgical exploration to selective non-operative management. Not every patient with adhesive small bowel obstruction meets criteria for non-operative management and treating all comers the same way can lead to catastrophic outcomes. Water Soluble Contrast Medium (WSCM) has important diagnostic and therapeutic utility in the management of ASBO and should be employed ab initio. Laparoscopy has emerged as a reasonable and safe alternative to laparotomy for surgical management of ASBO in carefully selected patients and has distinct advantages.

Publication types

Review

MeSH terms

Humans
Intestinal Obstruction / diagnosis
Intestinal Obstruction / etiology
Intestinal Obstruction / surgery*
Intestine, Small / diagnostic imaging
Intestine, Small / surgery*
Laparoscopy / methods*
Tissue Adhesions / complications
Tissue Adhesions / surgery*
Tomography, X-Ray Computed
Treatment Outcome