1494 An Audit on The Management of Adhesional Small Bowel Obstruction at St Helier Hospital

Abstract

Abstract Aim To compare our current management of adhesional small bowel obstruction (ASBO) with the BMJ best practice treatment algorithm1 and National audit for small bowel obstruction 20172 guidelines and produce a flow chart to aid stasndardised : Method Data collected prospectively from the general surgical take list over a three-month. Results Thirty-five patients were diagnosed with ASBO. All patients were prescribed IV fluids. Thirty-four (97.1%) and 31 patients (88.6%) received analgesia and anti-emetics, respectively. Twenty-one patients (82.9%) had a NG tube inserted. Five patients (14.3%) underwent laparotomies within 37 hours from time of admission. Thirty patients (85.7%) underwent a trial of conservative management. Twenty-four patients (80%) received water-soluble contrast, of whom 13 (59.1%) were managed successfully. Eight patients (36.3%) failed to resolve and underwent emergency laparotomy within 70 hours from admission. One patient (2.9%) failed conservative management and was palliated. Conclusions Our results are in line with national standards. Our first line management for ASBO (analgesia, anti-emetics and NG insertion) could be instituted more promptly. Failure of NG insertion is multifactorial, an improved insertion rate may have further positive impact on conservative management outcome. A step-by-step sequential flow chart could introduce on induction at the beginning of general surgical rotation could help to re-iterate this management.