Common Cause Of Small Bowel Obstruction Research Articles

Uterine leiomyoma as a cause of small bowel obstruction!

Introduction: Small bowel obstruction (SBO) is a condition with many well-recognized common causes and a distinct set of symptoms, including constipation, vomiting, and abdominal distension. Recent developments in both imaging modalities and minimally invasive techniques have meant that patients can be more appropriately selected for surgical intervention and that common causes of SBO can be readily identified. Despite these advances, it must be acknowledged that rare causes of SBO are still causing a diagnostic dilemma. Case Report: We are presenting a rare cause of a 45-year-old lady with mechanical bowel obstruction leading to intestinal gangrene caused by a huge uterine fibroid. Conclusion: It is essential that rare causes of bowel obstruction are identified and presented to facilitate their recognition in future to reach better patient’s outcome.

Non-operative management for small bowel obstruction in a virgin abdomen: a systematic review.

Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non-operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed-loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large-scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long-term follow-up data are warranted to allow for quantitative analysis to reinforce this evidence.

Small bowel obstruction and intestinal ischemia: emphasizing the role of MDCT in the management decision process.

The objective of this article is to assess the computed tomography (CT) findings of small bowel obstruction (SBO) complicated by ischemia. SBO is a frequent clinical entity characterized by high morbidity and mortality. The radiologic aim is not just to diagnose the obstruction itself but to rule out the presence of complications related to SBO. This is crucial for differentiating which patients can be safely treated non-operatively from the ones who may need an urgent surgical approach. The main complication of SBO is intestinal ischemia. In the emergency setting, CT imaging is the modality of choice for SBO because of its ability to assess the bowel wall, the supporting mesentery and peritoneal cavity all in one. On the other hand, the radiologist who documents an intestinal ischemia should think about SBO as possible cause. In this case, the main finding which helps the radiologist in the identification of SBO is the presence of multiple and packed valvulae conniventes in the dilated bowel wall and the "transition zone" that indicates the passage between compressed and decompressed small bowel, otherwise the localization of the obstruction cause. Once the site of obstruction has been recognized, the other issue is to assess the cause of obstruction, considering that the most common cause of SBO remains "unidentified" and related to intra-abdominal adhesions. After that, the following most important point is to rule out the presence of an ischemic bowel and mesenteric changes associated to SBO. CT signs of bowel ischemia include reduced or increased bowel wall enhancement, mesenteric edema or engorgement, fluid or free air in the peritoneal cavity. This condition usually leads to an urgent laparotomy and, in some cases, to a surgical resection.

Factors Predicting the Need for Early Surgical Intervention for Small Bowel Obstruction.

Purpose Small bowel obstruction (SBO) is a common disease that requires hospitalization. The most common cause of SBO is postoperative adhesion. Delayed timing of operations in patients who need surgical intervention results in mortality or morbidity. A number of studies on SBO have established criteria for emergency surgery. However, few objective clinical parameters are available for screening patients who need a delayed operation. Therefore, we analyzed factors that affect the clinical course of SBO to select appropriate therapeutic plans for reducing the risk of complications in these patients.Methods We investigated the clinical characteristics of patients admitted to the surgery department of our hospital between January 1, 2015, and December 31, 2016, who were diagnosed with SBO. Patients were divided into an operative treatment group (n = 12) and a conservative treatment group (n = 96). We compared clinical characteristics between the 2 groups.Results The operative treatment group underwent more operations before SBO than the conservative treatment group (P = 0.007). Initial leukocyte counts (P = 0.004) and C-reactive protein (CRP) levels (P = 0.028) were elevated in the operative group. Body mass index (BMI) was lower in the operative group (P = 0.013).Conclusion The number of operations before SBO, leukocyte counts, CRP levels, and BMI were useful parameters for selecting patients who needed an urgent operation for SBO.

Malnutrition, nutritional interventions and clinical outcomes of patients with acute small bowel obstruction: results from a national, multicentre, prospective audit

ObjectiveThe aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes.DesignProspective cohort study.Setting131 UK...

Recurrence After Operative Treatment of Adhesive Small-Bowel Obstruction

BackgroundPostoperative adhesions are a common cause of small-bowel obstruction, and up to 53% of patients operated on for adhesive small-bowel obstruction (ASBO) experience recurrence. The primary aim of this study was to identify predictors for recurrence of ASBO. MethodsWe reviewed medical records including operation descriptions from patients who underwent emergency surgery due to ASBO at our institution between 2004 and 2013. Information on the peri- and postoperative periods, including conservatively and surgically treated recurrent ASBO, were obtained from medical records. ResultsIn total, 478 patients were included in the study. Of these, 58 (12.1%) patients experienced recurrence of ASBO during median 2.2 years follow-up. Female gender (hazard ratio [HR] 2.00, P = 0.023), multiple/matted adhesions (HR 1.72, P = 0.046), and fascial dehiscence (HR 3.26, P = 0.009) were associated with increased risk of recurrence. Conversely, intestinal resection decreased the risk of recurrence (HR 0.47, P = 0.036). ConclusionsThe overall recurrence rate after surgically treated ASBO was 12.1%, and the risk of recurrence was persistent several years after index operation. Factors associated with an increased risk were female gender, multiple/matted adhesions, and fascial dehiscence.

Spectrum of MDCT Findings in Bowel Obstruction in a Tertiary Care Rural Hospital in Northern India.

Multidetector Computed Tomography (MDCT) provides clinically and surgically important information in bowel obstruction. It can depict the severity, level and cause of obstruction. To depict the spectrum of MDCT findings in cases of small and large bowel obstruction. Contrast enhanced MDCT examination of 50 patients were retrospectively included in the study who had evidence of clinical as well as MDCT evidence of bowel obstruction and in whom surgical/clinical follow-up for final diagnosis was available. CT scan was done in all the patients with Ingenuity CT (128 slice MDCT, Philips Medical Systems). The axial sections were reconstructed in coronal and sagital planes to determine site and cause of bowel obstruction. There were 34 males and 16 females patients in this study with mean age of 28.4 years. The level of obstruction was in small bowel in 39 patients (76.67%) and large bowel in 11 patients (23.33%). Adhesive bands were the cause of Small Bowel Obstruction (SBO) in 17 patients (43.5% of SBO patients). The most common CT signs in adhesive band SBO were beak sign (seen in 70.6% patients) and fat notch sign (52.9% patients). Five cases of SBO were secondary to benign stricture. Matted adhesions were the cause of obstruction in 3 patients. All these patients showed transition zone in pelvis with positive small bowel faeces sign. Two patients with SBO due to adhesive band had evidence of closed loop obstruction with evidence of gangrenous gut on surgery. Large Bowel Obstruction (LBO) was seen in 11 patients. Most common cause of LBO was primary colonic malignancy, accounting for 7 patients (63.6%). In one patient, the cause was direct invasion of hepatic flexure by carcinoma of gall bladder. Other causes of LBO were pelvic adhesions, faecal impaction and ischaemic stricture. SBO is more common than LBO with adhesive bands being the most common cause of SBO. MDCT is very useful for depicting site and cause of obstruction and any associated complications.

Change in Mechanical Bowel Obstruction Demographic and Etiological Patterns During the Past Century

To compare epidemiological analysis concerning sex, age, location of blockage, and frequency of occurrence of etiological factors in 2 groups of patients treated for mechanical bowel obstruction 100 years apart. Epidemiological analysis of patients undergoing an operation for small-bowel obstruction (SBO) or large-bowel obstruction (LBO) from 1868 to 1898 (group 1) and from 2000 to 2003 (group 2). Second Clinic of Surgery of the Jagiellonian University Medical College. One hundred ninety-three patients in group 1 and 207 in group 2. Change in demographic and etiological patterns of mechanical bowel obstruction during the past 100 years. In both groups, the prevalence of bowel obstruction was similar in particular segments of the intestine (approximately 75% for SBO and 25% for LBO). The primary cause of SBO in group 2 remained incarcerated abdominal hernia (30.8% for group 1 compared with 55.0%). The second most common cause of SBO was intraperitoneal adhesions (29.4% compared with 34.4%). Isolated small-bowel volvulus as the cause of bowel obstruction decreased significantly (P ≤ .05) (16.8% compared with 2.7%). Significant changes were also observed in the etiology of LBO. A century ago, the most common cause was volvulus of the sigmoid colon or of the cecum (72.0%); in the later group, obstruction was caused by cancer in 80.4% of cases. During the past 100 years, no changes were observed concerning the location of bowel obstruction or the patients' sex. Etiological factors in SBO and LBO changed significantly. The age of surgical patients also increased significantly.

Laparoscopic Management of Small Bowel Obstruction in Children

The use of laparoscopy in the treatment of acute small bowel obstruction (SBO) faces inherent obstacles, including dilated loops of bowel, a limited working space, and postoperative adhesions. The objective of this study was to outline the efficacy of laparoscopic management of SBO in children. With Institutional Review Board (IRB) approval, children who presented with a diagnosis of SBO and underwent management via a laparoscopic approach at our institution from January 2001 to December 2008 were retrospectively reviewed. Medical records were reviewed for age, weight, etiology of obstruction, radiographic findings, need for conversion, number of operations, length of stay, and postoperative complications. Statistical analyses of data comparison between those patients who were managed utilizing a laparoscopic approach and those in whom the laparoscopic approach was converted to a laparotomy were performed using a Chi-squared or a two-tailed Student's t-test with significance reported for P < 0.05. Thirty-four patients underwent laparoscopic management of SBO. Mean age was 8.1 ± 5.9 years with a mean weight of 32.8 ± 24.6 kg. Sixty-seven percent were male. A preoperative computed tomography scan was obtained in 21 patients (62%). Eleven cases (32%) required conversion to laparotomy. The most common reason for conversion to the open approach was poor working space (45.4%) followed by intestinal volvulus (27.2%), inability to identify source of obstruction (18.2%), and enterotomy (9%). The most common cause of SBO was postoperative adhesions (73.5%), followed by Meckel's diverticulum (8.8%), volvulus (8.8%), and other (8.8%). Postoperative complications occurred in 5 patients (14.7%). One patient died within 30 days of exploration due to intestinal ischemia secondary to midgut volvulus and subsequent septic shock. Five patients (14.7%) had a recurrent SBO with a mean time to recurrence of 2.6 ± 2.1 months. There were no significant differences in demographic or preoperative variables between patients who were successfully managed with laparoscopy alone versus those patients in whom conversion to laparotomy was necessary. In patients who required conversion, the laparoscopic evaluation did aid in identifying the etiology and allowed for a directed surgical approach when appropriate. Laparoscopy for the management of SBO in children is safe and can be therapeutic in the majority of patients. We recommend that consideration for initial exploration in children with SBO be carried out via the laparoscopic approach, with an understanding that conversion to an open approach may be necessary to complete the operation.

Early outcomes of surgery for small bowel obstruction: analysis of risk factors

The study aimed to review the etiologies of patients who underwent surgery for small bowel obstruction (SBO) and to evaluate the risk factors affecting the early postoperative outcomes. A case series of 430 patients (252 men) with a mean age of 64.5 years, who underwent 437 operations for SBO, were retrospectively reviewed. Peritoneal adhesions and hernia were the most common causes of SBO, contributing 42.3 and 26.8% of all cases, respectively. Strangulation occurred in 27.7% and caused nonviable bowel in 13.0% of obstructing episodes. Old age (age >/= 70 years), female patient, nonadhesive obstruction, and hernia were the independent significant factors associated with bowel strangulation. The 30-day mortality was 6.5%, and the median postoperative hospital stay was 8 days. Old age, the presence of premorbid pulmonary disease, and malignant obstruction were the independent factors associated with operative mortality. The overall complication rate was 35.5%, and old age was the only significant factor associated with postoperative complications. Surgery for SBO is still associated with significant mortality and morbidity. As old age is significantly associated with an increased incidence of strangulation, operative mortality, and complications, this group of patients should be managed with extra cautions to avoid unfavorable outcome of surgery.

Small Bowel Obstruction in Patients without a Previous History of Abdominal Operation

Purpose: Intra-abdominal adhesion related to prior abdominal surgery is the most common cause of small bowel obstruction (SBO). However, there are subsets of patients with SBO without a history of previous operation. We studied the characteristics of these patients. Methods: The medical records of 311 patients underwent operations at Seoul National University Hospital between Jan. 1994 and Oct. 2005 were reviewed. A retrospective analysis of the incidence, etiology, diagnostic method, preoperative hospital stay, operative findings and methods, complication rates, postoperative hospital stay, re-admission rate, and reoperation rate of SBO was performed, and the results were compared with those of patients with a history of previous operation. Results: Among the 311 patients (54.4±14.7 yr, M：F=1.5：1), 48 patients (15.3%) had no history of operation. The etiologies of SBO without a history of operation were malignancy (23.0%), bezoar (14.5%), adhesion (10.4%), Crohn’s disease (10.4%), tuberculosis (8.3%), and appendicitis (8.3%). SBO without prior abdominal surgery showed a longer preoperative hospital stay, which was not statistically significant. The accuracies of CT and small bowel series among patients without a history of operation were 68.4% and 54.5%, respectively. SBO without prior abdominal surgery showed a lower complication rate (8.3% vs. 26.6%, P=0.006) and shorter postoperative hospital stays (12.7±6.9 days vs. 16.1±10.4 days, P=0.032). Conclusions: Among the patients who underwent an operation for SBO, 15.3% had no history of previous operation. The most common cause of SBO without a history of operation was malignancy. SBO without a history of operation showed a lower complication rate and a shorter postoperative hospital stay compared with SBO with a history of operation.

Adhesion prevention in gynecologic surgery.

The objectives of this study are to evaluate the magnitude of postsurgical adhesions clinically, their impact on the hospital budget, and the available adhesion-reducing substances. We conducted a review of relevant literature on intraabdominal adhesion, adhesion-reducing substances, and their related cost. The relevance of adhesions to gynecology not only relates to infertility and abdominal pain, but also to the occurrence of bowel obstruction. There have been many substances and materials used to decrease the adhesion formation. However, there is still no adhesion-reducing substance that is unequivocally effective. Its use is also costly. The most common cause of small-bowel obstruction is postsurgical adhesions. Indeed, more than one half of patients with adhesion-related small-bowel obstruction had previous gynecologic operations, and a high percentage occurs after abdominal hysterectomy. To date, there has been no study suggesting that the use of adhesion-reducing substances decreases the risk of bowel obstruction or the long-term costs to the healthcare system. The long-awaited substance or barrier that unequivocally prevents adhesion formation is yet to come. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to list the causes of small bowel obstruction, to describe the commercially available adhesion-reducing substances, and to compare the efficacy of the various adhesion-reducing substances.

Etiology of small bowel obstruction

Background: Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure in hospitals around the world. The leading cause of SBO in the western world has become adhesions. The goal of this study was to determine the causes of SBO. Methods: The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 552 patients accounting for 1,001 admissions. Results: The etiology of SBO was adhesions (74%), Crohn’s disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Patients with Crohn’s disease were younger than patients with other etiologies. Surprisingly, recurrence rates were similar for patients treated operatively as for those treated nonoperatively with the exception in the hernia group where higher recurrence rates were noted for patients initially treated in a nonoperative manner. Conclusion: The most common cause of SBO is adhesions followed by Crohn’s disease and neoplasia.

Adhesion-related small-bowel obstruction after gynecologic operations

Objective: Our purpose was to evaluate a possible relationship between adhesion-related small-bowel obstruction and gynecologic operations. Study Design: The records of all female patients with the diagnosis of small-bowel obstruction from 1989 to 1996 were studied. The cause of bowel obstruction, the type and technique of previous operations, and whether the parietal peritoneum was closed at the completion of the procedure or was left open were evaluated. Results: Among 262 women the most common cause of small-bowel obstruction was intra-abdominal adhesions (37.0%). Among 92 women with adhesion-related small-bowel obstruction, 35 women (38%) had undergone a previous abdominal hysterectomy. The incidence of small-bowel obstruction after an abdominal hysterectomy was 16.3 per 1000 hysterectomies. The incidence of small-bowel obstruction after cesarean delivery (5/10,000 cesarean deliveries) was significantly less than after other abdominal operations. Adhesions were found between the small bowel and the pelvis in 14 women (29.8%), and all were in women who had undergone a hysterectomy. In 33 others (70.2%) the adhesions were found between the previous abdominal incision and the intestine. The median interval between the initial operation and the small-bowel obstruction was 5.3 years. Conclusion: The most common cause of small-bowel obstruction is postsurgical adhesions. Adhesionrelated small-bowel obstruction is commonly found after an abdominal hysterectomy. Bowel obstruction can occur many years after the initial abdominal surgery. (Am J Obstet Gynecol 1999;180:313-5.)

Silicone Fluid in the Prevention of Intestinal Adhesions

POSTOPERATIVE intestinal adhesions are the most common cause of small-bowel obstruction in the United States. Therefore, their prevention is desirable. While this goal is evident, the means of preventing adhesions are not. Elimination of operative trauma to the bowel which initiates the development of intestinal adhesions is often impossible. Should the intestinal serosa be abraded at operation, an inflammatory reaction begins minutes after injury. Within hours a fibrin exudate forms. The exudate undergoes organization, and fibroplasia is apparent as early as three to four days after injury. Fibroblast proliferation and collagen deposition lead to fibrous adhesions within ten days of operation. Maturation of adhesions proceeds rapidly up to 35 days after injury.1,2 Drugs which prevent clotting and lyse clots, act as lubricants, reduce inflammation, and inhibit fibroplasia have been employed in attempts to prevent intestinal adhesions, eg, steroids, antihistamines, heparin, amniotic fluid, mineral oil, lubricating jelly, fibrinolysin, dimethylsulfoxide, dextran,