Outcomes of Conservative Management of Postoperative Adhesive Small Bowel Obstruction among Yemeni Patients

Abstract

Background: Adhesive small bowel obstruction (ASBO) is a surgical emergency and represents the leading cause of small bowel obstruction, accounting for 60–75% of cases. Conservative management is the main approach for treating ASBO in the absence of complications. Therefore, the present study aimed to assess the success rate, outcomes and complications of conservative management for ASBO in Yemen.
 Methods: A prospective, case-series study of 102 patients with ASBO was conducted at two tertiary care hospitals in Sana’a city, Yemen; namely, Al-Thawra Modern General Hospital and Kuwait University Hospital, in the period from January 2021 to January 2023. A structured data collection sheet was used to collect pre- and postoperative data, including demographic characteristics, history of previous surgery, type of surgery, time of presentation from initial symptoms, presenting symptoms, details of non-surgical management, success or failure of conservative treatment, intraoperative findings, complications during hospital stay, and condition at discharge. Data were then analyzed and presented using descriptive statistics.
 Results: Of 102 patients with ASBO, 69 patients (67.6%) responded well to conservative management and did not require surgical management, while conservative management failed and surgical intervention was indicated for 33 patients (32.4%). The condition of most patients undergoing conservative management (88.4%) improved within 1–2 days, while five patients (7.3%) improved within one day and three patients (4.3%) improved after three days. For patients who required surgical intervention, continuous abdominal compromise was observed in 31 patients (93.9%), fever in 23 patients (69.7%), tachycardia in 28 patients (84.8%), tenderness in 31 patients (93.9%), and leukocytosis in 13 patients (39.4%). However, one patient was diagnosed with peritonitis, and one patient did not show any improvement within three days. During the surgical intervention for the 33 patients who failed conservative management, fibrous bands were identified in 51.5% of patients, while diffuse adhesions were observed in 45.4% of patients. On the other hand, 3.1% of patients showed gangrenous bowels. Out of patients undergoing surgical intervention, two patients (6%) experienced venous thromboembolism, three patients (9%) developed wound infections, two patients (6%) developed fistulas, one patient (3%) experienced a pulmonary complication, and one patient (3%) died.
 Conclusion: Conservative management of Yemeni patients with ASBO is safe and preferred over surgical intervention. This approach can be attempted for 72 hours unless signs or symptoms of bowel compromise or peritonitis develop. By opting for conservative management, the risk of surgical intervention can be reduced, and the length of hospital stay can be shortened. Therefore, conservative management should be considered the primary treatment option for ASBO. However, it is crucial to carefully evaluate and monitor patients to exclude any signs of bowel compromise or peritonitis that would require discontinuation of conservative management and prompt initiation of surgical intervention.