Early Small Bowel Obstruction Research Articles

A5240 - Early Small Bowel Obstruction after Laparoscopic Gastric Bypass: A Surgical Emergency

Early small bowel obstruction (ESBO, within 30 days of surgery) after laparoscopic gastric bypass (LRYGB) is reported infrequently (0.5‐5.2%), but it is associated with significant morbidity and treatment is not standardized. Our aim was to review prevalence, causes, associated factors, management, and outcomes of all patients treated for ESBO after LRYGB at a tertiary academic medical center.

Risk Factors for Early Postoperative Small Bowel Obstruction After Anterior Resection for Rectal Cancer.

The aim of the study was to evaluate risk factors for small bowel obstruction (SBO) in early postoperative period after anterior resection for rectal cancer. Patients who underwent anterior resection (AR) [high AR (HAR) or low AR (LAR)] for rectal cancer between January 2009 and April 2016 were enrolled into the study after fulfilling selection criteria. In included patients, risk factors for early postoperative SBO (EPSBO) were analyzed by means of univariate and multivariate analysis. Cases with perioperative major complications other than intestinal obstruction and with simultaneous resection of other organs were excluded. The same analyses were also performed for cases of redo surgery due to EPSBO. EPSBO was defined as clinically and radiologically confirmed SBO that developed after resuming oral intake within 30days following surgery. The logistic regression method was used for statistical analyses. In enrolled 180 patients, EPSBO occurred in 23 (12.8%). In univariate analysis, male sex [odds ratio (OR)=2.17, 95% CI=0.82-6.84, p<0.0001], previous abdominal surgery (OR=0.20, 95% CI=0.03-0.73, p=0.0117), low tumor (OR=3.26, 95% CI=1.28-8.13, p=0.0140), LAR (OR=17.25, 95% CI=3.49-312.55, p<0.0001), D3 node dissection (OR=13.61, 95% CI=2.75-246.69, p=0.0002), defunctioning ileostomy (DI) formation (OR=9.88, 95%=3.80-29.14, p<0.0001), and prolonged operation time (OR=1.01, 95% CI=1.00-1.01, p=0.0122) were significantly related to EPSBO. Multivariate analysis demonstrated that D3 node dissection (OR=10.93, 95% CI=1.94-208.23, p=0.0038) and DI formation (OR=5.82, 95% CI=1.55-25.31, p=0.0083) were independent risk factors for EPSBO. Four cases (17.4%) with EPSBO required re-operation because conservative therapies failed; all were laparoscopic DI formation cases. In three of those four cases, stenosis of stoma at the level of the posterior sheath of rectus abdominis muscle was the reason of SBO, and in one case it was kinking of the stomal limb. D3 lymph node dissection and DI formation are independent risk factors for EPSBO in AR.

Early Small Bowel Obstruction after Laparoscopic Gastric Bypass: A Surgical Emergency

Early Small Bowel Obstruction after Laparoscopic Gastric Bypass: A Surgical Emergency

Closure of mesenteric defects in laparoscopic gastric bypass: a multicentre, randomised, parallel, open-label trial

Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate. This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were offered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01137201. Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n=1259) or non-closure (n=1248). 2503 (99·8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99·0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was significantly reduced in the closure group (cumulative probability 0·055 for closure vs 0·102 for non-closure, hazard ratio 0·56, 95% CI 0·41-0·76, p=0·0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4·3%] for closure vs 35 [2·8%] for non-closure, odds ratio 1·55, 95% CI 1·01-2·39, p=0·044), mainly because of kinking of the jejunojejunostomy. The results of our study support the routine closure of the mesenteric defects in laparoscopic gastric bypass surgery. However, closure of the mesenteric defects might be associated with increased risk of early small bowel obstruction caused by kinking of the jejunojejunostomy. Örebro County Council, Stockholm City Council, and the Erling-Persson Family Foundation.

Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery.

Background and Objectives:Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO.Method:This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems.Results:During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P = .16; hazards ratio (HR) 1.4 95% CI 0.82–2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P = .039; HR 2.82; 95% CI 0.78–8.51). Stoma formation was an independent risk factor for development of SBO (P = .049; HR, 0.63; 95% CI 0.39–1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P = .0003; HR, 2.85; 95% CI 1.44–5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P = .0001).Conclusion:The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.

Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery

It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.

Acute early adhesive small bowel obstruction: today`s possibilities of laparoscopy in diagnosis and treatment

Acute early adhesive small bowel obstruction: today`s possibilities of laparoscopy in diagnosis and treatment

Role of the small intestinal decompression tube and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction

To evaluate the role of the small intestinal decompression tube (SIDT) and Gastrografin in the treatment of early postoperative inflammatory small bowel obstruction (EPISBO). Twelve patients presented EPISBO after abdominal surgery in our department from April 2011 to July 2012. Initially, nasogastric tube decompression and other conventional conservative treatment were administrated. After 14 days, obstruction symptom improvement was not obvious, then the SIDT was used. At the same time, Gastrografin was injected into the small bowel through the SIDT in order to demonstrate the site of obstruction of small bowel and its efficacy. In 11 patients after this management, obstruction symptoms disappeared, bowel function recovered within 3 weeks, and oral feeding occurred gradually. Another patient did not pass flatus after 4 weeks and was reoperated. After postoperative follow-up of 6 months, no case relapsed with intestinal obstruction. For severe and long course of early postoperative inflammatory intestinal obstruction, intestinal decompression tube plus Gastrografin is safe and effective, and can avoid unnecessary reoperation.

Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer

We investigated whether regional hyperthermia (HT) increased post-surgical complications in patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT). Between 1996 and 2007, 205 patients treated with preoperative CCRT and curative surgery were evaluable for the analysis of acute and late toxicities. A total dose of 39.6 Gy or 45 Gy was delivered concurrently with one or two cycles of chemotherapy (5-fluorouracil, leucovorin). Eighty-eight patients received regional HT twice a week using an 8-MHz radiofrequency capacitive heating device. Surgery was performed 4∼6 weeks after the completion of preoperative CCRT. The median age was 59 years (range, 18∼83) and the median follow-up period was 61months (range, 2∼191). The 5-year overall survival and complication-free survival rate of all patients was 77.4% and 73.7%, respectively. Early leakage, delayed leakage, anastomotic stricture, fistula, and small bowel obstruction occurred in 1.0%, 2.9%, 1.5%, 5.9%, and 17.1%, resp ectively. HT did not increase all kinds of complications. The 5-year complication-free survival rate was 71.8% in the non-HT group and 76.3% in the HT group (p=0.293). Regional HT did not increase postoperative complications in patients with locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

Role of Gastrografin Challenge in Early Postoperative Small Bowel Obstruction

IntroductionEarly small bowel obstruction following abdominal surgery presents a diagnostic and therapeutic challenge. Abdominal imaging using Gastrografin has been shown to have diagnostic and therapeutic properties when used in the setting of small bowel obstruction outside the early postoperative period (>6 weeks). We hypothesize that a GG challenge will reduce need for re-exploration. MethodsPatients with early small bowel obstruction who underwent a Gastrografin challenge between 2010 and 2012 were case controlled, based on age ±5 years, sex, and operative approach to an equal number of patients that did not receive the challenge. ResultsOne hundred sixteen patients received a Gastrografin challenge. There were 87 males in each group with an average age of 62 years. A laparoscopic approach in the index operation was done equally between groups (18 vs. 18 %). There was no difference between groups in operative re-exploration rates (14 vs. 10 %); however, hospital duration of stay was greater in patients who received Gastrografin challenge (17 vs. 13 days). Two in hospital deaths occurred, one in each group, both of infectious complications. ConclusionUse of the Gastrografin challenge in the immediate postoperative period appeared to be safe. There was no difference, however, in the rate of re-exploration between groups.

Stapled vs hand suture closure of loop ileostomy: a meta‐analysis

Loop ileostomies are widely used in colorectal surgery to reduce the consequences of distal anastomotic failure. The optimal surgical technique for their closure has yet not been defined. A meta-analysis was performed to compare the outcome after stapled or hand sutured ileostomy closure. An electronic literature search of EMBASE, PubMed and the Cochrane Library was undertaken to identify studies reporting stapled and hand sutured ileostomy closure. End-points included postoperative small bowel obstruction (SBO), anastomotic leakage, wound infection, overall postoperative complications, operation time, hospital stay and surgery-related cost. Fourteen studies including 5084 patients were identified. Meta-analysis showed that stapled closure was associated with a lower rate of SBO overall (OR = 0.56, P < 0.00001) and early (within 30 days of closure) SBO (OR = 0.51, P < 0.00001). This difference persisted for direct ileostomy closure (OR = 0.62, P = 0.02) or closure with bowel resection and hand sewn anastomosis (OR = 0.44, P < 0.00001). Stapled closure required a shorter inpatient stay (mean difference -1.22, P < 0.0001) and operating time (mean difference -11.21, P = 0.01). No significant difference was noted between the two techniques in terms of anastomotic leakage, wound infection, overall complications or cost. Stapled side-to-side anastomosis is associated with fewer complications, especially SBO, than hand sewn ileostomy closure by direct suture or resection and anastomosis. It is quicker to perform and associated with fewer postoperative bowel obstructions.

A Novel Case of Thyroid Dysfunction Associated with Adalimumab Use for Crohnʼs Disease

Case Report: A 58-year-old male with history of Crohn's iliocolitis diagnosed in 1997, status post right hemicolectomy secondary to obstruction in 2007, was being evaluated for abdominal pain, nausea, and vomiting of 2 days duration. His medications included mesalamine 2.4 gm per day, losartan, and omeprazole. Vital signs were unremarkable and physical examination revealed slightly distended abdomen with hypoactive bowel sounds. Flat and upright x-ray of abdomen was unremarkable without evidence of obstruction. Computerized tomography scan of abdomen showed early or partial small bowel obstruction most likely secondary to adhesions. Patient was given trial of prednisone with improvement in his symptoms. After all the appropriate workup including negative PPD skin test and hepatitis panel, patient was started on adalimumab. Patient did well with initial injections but developed injection site erythema along with facial swelling and tightness in the throat with second dose. He was treated with methylprednisolone and adalimumab was discontinued. TSH came back elevated at 28.60 mcIU/mL (ref range: 0.465-4.68 mcIU/mL). As the patient did not have any history of thyroid disease, repeat TSH was ordered for confirmation of initial result and it showed worsening of TSH at 45.3 mcIU/mL in just 3 days. Free T4 was low at 0.59 ng/dL (ref range 0.78-2.19ng/dL). Thyroid peroxidase antibody was elevated at 150 IU/mL (ref range: 0- 34 IU/mL) and anti-thyroglubulin antibody was negative. Patient was started on levothyroxine 50 mcg per day. Repeat lab works in 2 months showed normal free T4 along with improvement in TSH to 19.6 mcIU/mL. Patient is currently being treated with azathioprine for his Crohn's disease. Discussion: We report a rare case of thyroid dysfunction associated with adalimumab use. Adalimumab is a recombinant anti-tumor necrosis factor alpha (TNF-alpha) IgG1 monoclonal antibody which blocks inflammatory activity of TNF-alpha. Major indications for use of adalimumab are moderate to severe Crohn's disease, ulcerative colitis, rheumatoid arthritis, psoriatic arthritis, and other autoimmune diseases. The most common adverse reactions are infections (e.g., upper respiratory, sinusitis), injection site reactions, headache, and rash. A study by eHealthMe has reported 15 patients out of 130,505 developing autoimmune thyroiditis while taking adalimumab which accounts for incidence rate of 0.01%. Majority of patients were female (84.21%). A case of subacute thyroiditis after being treated with Adalimumab for refractory palmo-plantar pustular psoriasis has also been described in the literature.

Laparoscopic diagnostics and treatment of acute early adhesive small bowel obstruction after gynecological operations performed by laparoscopic access

The Results of treatment of 8 female patients with early acute adhesive small bowel obstruction (AASBO) after laparoscopic gynecological surgery are presented. Diagnostic laparoscopy appeared to be the most helpful and the safest diagnostic technique, confirming the AASBO diagnosis and helping to choose operative treatment mode. In 5 patients AASBO was successfully treated using laparoscopic method, while in 3 patient median laparotomy was required: 1 patient with AASBO relapse, and 2 patients with pelvic peritonitis progression.

Mo1760 Assessment of Postoperative Complications in Patients With IBD. A Single Academic Medical Center Experience

Introduction: Early small bowel obstruction (ESBO) following abdominal surgery presents a diagnostic and therapeutic challenge. Abdominal imaging using Gastrografin (GG), has been shown to have diagnostic and therapeutic properties when used in the setting of small bowel obstruction outside the early postoperative period (. 6weeks). We hypothesize that a GG challenge will reduce need for re-exploration in patients with ESBO. Methods: Patients with ESBO (, 6 weeks following abdominal surgery) who underwent a GG challenge between 2010 2012 were case controlled, based on age ± 5 and sex, to an equal number of patients that did not receive a GG challenge. Groups were compared to assess differences in rates of reoperation for obstruction. Results: 105 patients with ESBO who received a GG challenge. There were 76 males in each group (72%) with an average age of 64 years (range, 59-68). An open or laparoscopic approach in the index operation was done equally between groups (67% vs 70% and 33% vs 30%, respectively p=0.44). The mean time from surgery to GG challenge was (11.3, range=9.8-12.9) days. There was no difference between groups in the rate of re-operation (12% vs 9%, p=0.48), days from surgery to re-operation (9.1 [range 4.2-14] vs 13.5 [range 7.9-19.2], p=0.23), morbidity (35% vs 42%, p=0.23), and mortality (8% vs 7%, p=0.78). Hospital length of stay was greater in patients who received GG (18.2 vs 11.5, p=0.0001) days. There were no GG aspiration events. . There were more patients that received abdominal computed tomography in the GG group (74% vs 45%, p= 0.0001), of these patients, the GG group were more likely to have a transition point (55% vs 33%, p=0.01).The GG challenge had a positive predictive value of 91%, negative predictive value of 50%, sensitivity of 96% and specificity of 30% to predict ESBO resolution without operative intervention. Conclusion: Use of the GG challenge in the immediate postoperative period appeared to be safe. There was no difference, however, in the rate of re-exploration between groups. Further study in a prospective, randomized fashion is needed to elucidate the effects of GG in ESBO.

A bidirectional stapling technique for laparoscopic small bowel anastomosis

BackgroundSmall bowel anastomoses can present a technical challenge during laparoscopic procedures, particularly gastric bypass procedures. Early small bowel obstruction (SBO) rates associated with such procedures occur in .7%–5.2% of patients. Herein, we describe how a bidirectional stapling technique moves the enterotomy to the center of the anastomosis, decreasing the chances of an afferent limb obstruction. MethodsA prospectively collected cohort of 2263 consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass with bidirectional stapling of the small bowel anastomosis was evaluated for early SBO. All patients met the National Institutes of Health criteria for bariatric surgery. ResultsOverall, 3 patients’ perioperative courses were complicated by perioperative, early SBO (.13%). These instances were all attributable to intraluminal blood clots and not from inadvertent narrowing of the afferent limb. One was diagnosed on postoperative day 1 by upper gastrointestinal study (UGI); 2 were diagnosed on postoperative day 2 by computed tomography (CT) scan with oral contrast. All 3 patients’ complications were managed with a laparoscopic operation. ConclusionThe bidirectional stapling technique for small bowel anastomoses, with our modifications, is a rapid, well-tolerated, and effective technique that offers potential advantages over standard laparoscopic anastomotic techniques by reducing perioperative SBO complications.

English

Abdominal cocoon syndrome is characterized by encapsulation of the small bowel by a fibrous peritoneal sac. We describe the case of a middle aged male patient who presented with sub acute intestinal obstruction. Treatment involves exploratory laparotomy, excision of the sac and adhesiolysis. Early post operative small bowel obstruction is a rare entity in this disease and can be managed conservatively. It is important to have a high degree of suspicion as Abdominal cocoon syndrome has variable clinical presentation and non specific imaging findings. INTRODUCTION: Sclerosing peritoneal encapsulation is a rare developmental malformation characterized by the encasement of all or part of the small bowel by a thick, accessory peritoneal sheath [1]. It was first described by Owtschinnikow in 1907 as “peritonitis chronica fibrosa incapsulata” [2] and termed “abdominal cocoon” by Foo in 1978 [2,3] .It is characterized by a complete or partial encasement of the small bowel by a thick and fibrotic membrane (cocoons) The loops within the cocoon are normal and adherent to each other. Abdominal cocoon generally presents as recurrent acute or sub acute intestinal obstruction with or without a mass [4]. The ideal treatment is operative, with dissection of the membrane from the intestine and separation of adherent loops of the small bowel until they are laid free and return to their normal configuration. [5] CASE REPORT: A 35-year-old male presented with complains of multiple episodes of vomiting, constipation, and abdominal discomfort since twenty days. He suffered similar complaints about a month previously for which he underwent a diagnostic laparoscopy at a small nursing home, which revealed cocooning of small bowel loops. Patient was investigated for Tuberculosis of the abdomen; however ascitic fluid ADA levels and ESR were not suggestive of Tuberculosis. Physical examination revealed a mildly tender lump in the Left hypochondrium with minimal abdominal distension. There was no hyperperistalsis on auscultation of the abdomen. Patient was otherwise vitally stable and systemic examination was normal. Blood parameters were all within normal limits. X-ray erect abdomen revealed 4-5 air fluid levels; USG abdomen showed clumping of small bowel loops in the Left hypochondrium with distal small intestine free. A provisional diagnosis of sub acute intestinal obstruction was made and patient was kept nil per oral, nasogastric decompression and IV hydration was administered. CECT abdomen was done which revealed clumping of jejunal and ileal loops

Surgical management of early small bowel obstruction after laparoscopic Roux-en-Y gastric bypass

BackgroundLimited data are available regarding early postoperative small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of the present study was to review our experience with early SBO after LRYGB. The setting was a tertiary referral bariatric center. MethodsWe reviewed a prospectively maintained database to assess the diagnosis, management, and outcomes of patients who underwent surgery for SBO within 30 days of LRYGB. ResultsFrom April 2004 to December 2011, 2126 patients underwent LRYGB. Of these patients, 11 (.5%) required surgical management for early SBO. Of the 11 patients, 9 were women and 2 were men. with a mean age of 53 years (range 35–70) and mean body mass index of 45 kg/m2 (range 38–65). The average interval from LRYGB to the presentation of SBO was 5.0 days (range 2–15). All early SBOs were diagnosed by computed tomography with oral contrast. The causes of early SBO included kinking at the jejunojejunostomy in 4, an intraluminal blood clot near the jejunojejunostomy in 2, angulation of the Roux limb in 1, mesenteric hematoma in 1, intra-abdominal hematoma in 1, obstruction of common channel in 1, and pelvic adhesions from previous surgery in 1. Diagnostic laparoscopy was attempted in all patients. Four patients required conversion to open surgery. Postoperative complications developed in 5 patients; no patient died. Laparoscopic management of early SBO resulted in fewer complications than the open approach. ConclusionEarly SBO after LRYGB is uncommon; however, a prompt diagnosis and surgical intervention are important to prevent additional morbidity. The ability to complete the reoperation laparoscopically varies with the etiology and location of the obstruction.

Diagnosis and treatrment of 68 patients with early postoperative inflammatory small bowel obstruction

Objective To investigate the clinical features of early postoperative inflammtory small bowel obstruction,and discuss its diagnosis,treatment and preventive measures.Methods The clinical data of 68 cases of early postoperative inflammatory small bowel obstruction were analyzed retrospectively.Results Within the 68 cases,65 cases were cured by non-operative treatment including gastrointestinal decompression,anti-inflammatory drugs,somatostatin,total parenteral nutrition(TPN) and traditional Chinese medicine.The mean time from the onset of symptoms to the recovery of bowel function was 14 days.Three cases were cured by transferring to operation.One case of them was transferred to operation for strangulated intestinal obstruction during the period of conservative treatment.One case underwent oper.ion because the patient didn t recover after 4 weeks expectant treatment.One case underwent operation for the impatience with the conservative treatment of both the doctors and the patient.Conclusion Non-operative therapy should be the first choice for the treatment of early postoperative inflammatory small bowel obstruction,and its therapeutical effect was well-accepted. Key words: Intestinal pseudo-obstruction; Digestive system surgical procedures/adverse effects; Intubation; gastrointestinal

In-hospital Small Bowel Obstruction After Exploratory Laparotomy for Trauma

The purpose of this study was to examine the incidence and risk factors of in-hospital small bowel obstruction (SBO) after exploratory laparotomy for trauma. A retrospective review of patients surviving over 72 hours after an exploratory laparotomy for trauma. Patients with intestinal obstructive symptoms were reviewed by a consensus panel, which evaluated the clinical, laboratory, and radiologic findings to validate the diagnosis of SBO. A total of 571 patients met inclusion criteria. The incidence of early SBO was 3.9%, with 22.7% of these patients requiring surgical intervention. Patients with gastrointestinal (GI) perforation had a significantly higher incidence of SBO, compared with those with no GI perforation (5.7% vs. 1.3%, p = 0.007). A forward logistic regression identified the presence of a GI perforation as the only factor independently associated with early SBO (adjusted odds ratio: 4.39; 95% confidence interval: 1.28-15.15; p = 0.019). The overall hospital stay was significantly longer for SBO patients (27.0 days ± 26.7 days vs. 16.0 days ± 22.8 days; adjusted mean difference: 11.5; 95% confidence interval: 1.6-21.3; p = 0.022). Development of SBO increased the cost by 59.7%. The incidence of in-hospital SBO after laparotomy for trauma is significant at 3.9%. The presence of a GI perforation is independently associated with the development of this complication. Over a fifth of patients with early SBO will require a surgical intervention. The use of preventive strategies may be justified in selected, high-risk patients to reduce the burden associated with early SBO.

Incarcerated Retroperitoneal Hernia Following Total Extraperitoneal Laparoscopic Radical Nephrectomy

Small bowel obstruction (SBO) is a common entity encountered in surgical patients. The most common causes of the SBO range from postoperative adhesions to cancer. We present the case of a 55-year-old male who underwent a laparoscopic left radical nephrectomy and presented with an early SBO. An imaging study revealed an obstructive pattern with proximal dilated jejunum with decompressed distal small bowel. The patient underwent an exploratory laparotomy with extensive lysis of adhesions and release/resection of a long segment of incarcerated jejunum from an 8-cm retroperitoneal hernia in the left renal fossa. The patient was discharged home, and at 3-month follow-up no bowel complaints were reported.