Etiology and Management of Small Bowel Obstruction with Special Reference to Role of Laparoscopy—A Single Centre Experience

Abstract

Background: Small bowel obstruction (SBO) is the commonly diagnosed disease in the emergency department. The diagnosis and management of small bowel obstruction varies among institutions. The role of laparoscopy in the management of small bowel obstruction is debatable. Aim: To study the profile, clinical features and management options of patients of small bowel obstruction with special emphasis on role of laparoscopy. Material and Methods: 51 consecutive patients with documented small bowel obstruction admitted in our department were studied from June 2016 to December 2018. All the patients above 12 years of age with small bowel obstruction were included. The diagnosis of small bowel obstruction (SBO) was made in these cases by detailed history, clinical examination and investigations. All these patients were received and adequately resuscitated. Non-operative (conservative) treatment was confirmed to those who met the standard parameters for such treatment and early surgical treatment was carried out whenever indicated. The operative procedure done was laparoscopy or open depending on the clinical features and condition of patient. Results: In our study, 51 patients mean age was 44.7 years with 27 Males and 24 females. 28 (54.9%) patients of our study presented with continuous abdominal pain followed by colicky pain in 23 (45.1%) patients. 34 (66.7%) patients on admission gave history of effortless vomiting. Distension of abdomen was present in 30 (58.8%) patients and constipation was present in 40 (78.4%) of our studied patients. On CT scan interloop fluid was present in 23 (45.1%) patients while transition point was present in 31 (60.8%) patients. Adhesion obstruction was found to be most common cause of obstruction 27 (52.9%) patients, followed by malignancy in 8 (15.7). 25 (49.0%) patients were managed conservatively and 26 (51%) were operated. 11 (21.6%) patients underwent laparoscopic adhesiolysis and 15 (29.4%) underwent exploratory laparotomy. The average operative time, recovery of bowel moments, hospital stay, and post-operative complications were less in the laparoscopic group than open group with statically significant difference between the two. Conclusion: Post-operative adhesion obstruction is the most common cause of small bowel obstruction. Laparoscopy is a safe and effective tool for the management of acute intestinal obstruction provided it is performed in selected patients by skilled surgeon.