Surgical Intervention in Adhesive Intestinal Obstruction

Abstract

Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.