Management Of Small Bowel Obstruction Research Articles

FP7.7 - Evaluation of small bowel obstruction management: A local audit in comparison to NASBO guidelines

Abstract Aims The National Audit of Small Bowel Obstruction (NASBO) report provides recommendations for optimising the management of small bowel obstruction (SBO). We aimed to audit our management and compare our outcomes with the NASBO report. Methods Retrospective case reviews were conducted for 115 patients admitted with SBO from July-December 2022, evaluating adherence to NASBO guidelines and assessing outcomes. Results The average age was 76 (21-94) years old; 53% male and 47% female. Adhesions (41.7%), hernias (30.4%), malignancy (13%) and inflammatory bowel disease (6.1%) were predominant causes. Treatment included conservative management in 67% of cases, surgery in 27% (of which, 6.1% had a trial of conservative management initially) and palliative care in 6.1%. A summary of the management and outcomes below.Table 1:Summary of managementCT scan on admissionAverage time to CTSurgery performedAverage time to surgeryNutritional screening assessmentLocal audit98.3%9 hours27%2.4 days100%NASBO80%2.2 days48%1 day90%Table 2:Summary of outcomesUnable to eat normally for ≥5 daysAverage length of stay30-day mortality30-day readmissionLocal audit12%7 days14%18%NASBO49%10.7 days8%13% Conclusion We are performing CT scans in a timely manner and screening for malnutrition. Despite a shorter length of stay compared to NASBO, our audit has identified opportunities to improve hospital readmission, suggesting that we may be discharging patients prematurely. We have introduced a SBO checklist to ensure NASBO recommendations are adhered to and to improve our 30-day outcomes.

ThP6.16 - Small bowel obstruction (SBO) in NELA patients: A cohort study

Abstract Aims SBO is characterized as mechanical or functional obstruction of intestines, accounting for 15% of acute abdomens & 50% (NASBO 2017) of emergency laparotomies each year in the UK. Aim of study is to assess the surgical management of SBO amongst NELA patients at a single centre. Methods Cohort study carried out from Jan’2014 to Jan’2023. Descriptive demography & post-operative outcomes were evaluated for SBO NELA patients. Other non SBO NELA patient were controls. Results SBO NELA(n = 560) Non SBO NELA(n = 306) Mann Whitney U(p value) Age(yrs) 68.7 65.7 < 0.005 Sex(M:F) 235 : 325 157 : 149 BMI 25.5 26.0 NS ASA 3 3 NS Op time(mins) 112.1 133.0 < 0.0001 ITU stay(n) 229 171 ITU stay(days) ± ± LOS(days) 11 16 < 0.0001 Lap(n) 176 60 Open(n) 384 246 Lactate(mmol/L) 2.0 ± 0.1 2.3 ± 0.2 NS WCC(x109/L) 12.4 ± 0.2 12.4 ± 0.4 NS CRP(mg/L) 62.2 ± 3.9 90.6 ± 5.9 < 0.0001 Physiol score 21.9 ± 0.3 23.5 ± 0.5 < 0.05 Op score 15.4 ± 0.2 19.5 ± 0.3 < 0.0001 Pre possum score 10.4 ± 0.8 21.0 ± 1.7 < 0.0001 PP mortality score 7.3 ± 0.5 9.7 ± 1.1 NS PP morbidity score 60.7 ± 1.4 75.6 ± 1.7 < 0.0001 Adhesions(n) 277 Hernias(n) 48 Other(n) 235 SB resection(n) 115 Conclusion Early radiological diagnosis & management is essential in SBO including nutritional support. Surgery is indicated in SBO where there is potential perforation, strangulation & failed conservative managements. SBO was treated laparoscopically in 31.4% of cases, adhesions (49.4%) was most causes, SB resection was undertaken in 20.5 % cases. Other causes include hernias, FB (gallstones), tumours, intussusception & volvulus.

WP4.11 - Oral Gastrograffin Usage in Adhesive Small Bowel Obstruction: a re-audit

Abstract Aim to establish the successful usage of oral gastrograffin in patients presenting with adhesive small bowel obstruction (SBO). Methods This is a retrospective follow-up study, using a combined data collected from two NHS Trusts, from July 2022 to January 2024. Patients presented with adhesive SBO were included in this study, who were given 100 ml of oral gastrograffin after diagnosis for SBO. Patients were arranged to have plain abdominal x-ray approximately 8-hours post-gastrograffin drinks/or infusion via nasogastric (NG) tube to ascertain if oral contrast had passed the transition point, identified on initial abdominal CT scan. Patients were then reviewed for their symptomatic relief including bowels movement. Results 132 patients were identified but 108 patients were included, who had surgery. 24 patients were excluded because they did not have post-gastrograffin x-ray. Average age of patients was 63+/-14 years. It was observed that 82 patients (75.9%) opened their bowels after administration of first dose of gastrograffin, while 26 patients (24%) did not. 16 out of these 26 patients required surgery; and the remaining 10 (38.4%) had 2nd dose of gastrograffin, of which 4 patients (40%) moved bowels but 6 (60%) still did not and required surgery. Post-contrast x-rays, showed that contrast passed through into large bowel in 76 patients (70.3%) after 1st dose of gastrograffin and in further 40% after 2nd dose. Conclusion clinically significant number of patients responded to such conservative measures. Therefore, routine oral gastrograffin usage is suggested as an effective adjunct to non-operative measures in adhesive SBO management.

Mechanisms and clinical management of small bowel obstruction caused by kinking of the jejunojejunal anastomosis after laparoscopic Roux-en-Y gastric bypass

Currently, obesity and its complications have become increasingly serious health issues. Bariatric surgery is an effective method of treating obesity and related metabolic complications. Among them, Roux-en-Y gastric bypass (RYGB) is still considered the "gold standard" procedure for bariatric surgery. Small bowel obstruction is one of the possible complications after RYGB, and in addition to the formation of intra-abdominal hernias, kinking of the jejunojejunal anastomosis is an important cause of small bowel obstruction. The early clinical symptoms of kinking of the jejunojejunal anastomosis often lack clarity in the early stages. Therefore, early diagnosis, prevention, and effective treatment of kinking of the jejunojejunal anastomosis are challenging but crucial. The occurrence of kinking of the jejunojejunal anastomosis may be related to surgical techniques and the surgeon's experience. The use of anti-obstruction stitch, mesenteric division, and bidirectional jejunojejunal anastomosis may be beneficial in preventing kinking of the jejunojejunal anastomosis. If kinking of the jejunojejunal anastomosis occurs, timely abdominal CT scans and endoscopic examinations should be performed. Gastric and intestinal decompression should be initiated immediately, and exploratory surgery should be prepared.

Can small bowel obstruction during pregnancy be treated with conservative management? A review.

Small bowel obstruction can occur during pregnancy, which, if missed, can lead to dire consequences for both the mother and foetus. Management of this condition usually requires surgical intervention. However, only a small number of patients are treated conservatively. The objective was to review the literature to determine the feasibility of conservative management for small bowel obstruction. A systematic search of the PubMed and Embase databases was performed using the keywords [small bowel obstruction AND pregnancy]. All original articles were then reviewed and included in this review if deemed suitable. Conservative management of small bowel obstruction in pregnant women is feasible if the patient is clinically stable and after ruling out bowel ischaemia and closed-loop obstruction.

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission.

Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO (P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

Robotic-assisted uterine transposition followed by anatomic pelvic repositioning for a patient with intramural fibroids and rectal cancer

To report the first described case of robotic-assisted utero-ovarian transposition followed by anatomic repositioning in the pelvis and cervicovaginal anastomosis in a woman with uterine fibroids, which was performed for fertility preservation in the context of pelvic radiation for rectal cancer. Description of technique and live-action narrated surgical footage showing uterine transposition and repositioning. University hospital. A 36-year-old woman with a new diagnosis of cT3N2M0 rectal adenocarcinoma planned for neoadjuvant chemotherapy and pelvic radiation and desired fertility preservation permissive of future pregnancy. A transvaginal ultrasound revealed a 5-cm posterior leiomyoma and a normal endometrial cavity. The patient elected for utero-ovarian transposition before chemoradiation. The patient included in this video gave consent for publication and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites. Per institutional guidelines, an Institutional Review Board review was not required. Robotic-assisted utero-ovarian transposition was performed in an inpatient setting 2 weeks after ovarian stimulation and oocyte retrieval. She was given a gonadotropin-releasing hormone agonist for menstrual suppression after oocyte retrieval. The uterus and adnexa were transposed en bloc to the upper abdomen, with perfusion via retroflected infundibulopelvic ligaments. Intravenous indocyanine green was administered intraoperatively to visualize uterine perfusion. Three weeks postoperatively, the patient underwent surgical management of small bowel obstruction, which was successfully managed with laparoscopic adhesiolysis. The patient subsequently completed chemoradiation and had a complete response to the rectal tumor. She therefore elected for surveillance. Seven months after transposition and 2 months after completion of treatment, the patient underwent uncomplicated robotic-assisted utero-ovarian anatomic repositioning in the pelvis with cervicovaginal anastomosis. Chromopertubation confirmed tubal patency. Restoration of normal pelvic anatomy and resumption of reproductive physiology. At her 4-month postoperative visit, the cervix and vagina were normal in appearance. The patient reported the return of spontaneous menses and sexual activity without complications. This case is unique because of the presence of bulky intramural uterine fibroids. The described technique may be useful for selected cancer patients who desire to carry a pregnancy after pelvic radiation for cancer treatment, and demonstrates that patients considering utero-ovarian transposition need not be excluded solely on the basis of the presence of uterine fibroids.

Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction

Background:: Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined. Objective:: This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis. Methods:: We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter. Results:: Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity. Conclusion:: Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

CLINICAL AND SURGICAL DILEMMAS IN OCTOGENARIAN PATIENTS WITH SMALL BOWEL OBSTRUCTION.

Small bowel obstruction (SBO) is a major problem in emergencies. Comorbidities increase morbimortality, which is reflected in higher costs. There is a lack of Latin American evidence comparing the differences in postoperative results and costs associated with SBO management. To compare the risk of surgical morbimortality and costs of SBO surgery treatment in patients older and younger than 80 years. Retrospective analysis of patients diagnosed with SBO at the University of Chile Clinic Hospital from January 2014 to December 2017. Patients with any medical treatment were excluded. Parametric statistics were used (a 5% error was considered statistically significant, with a 95% confidence interval). A total of 218 patients were included, of which 18.8% aged 80 years and older. There were no differences in comorbidities between octogenarians and non-octogenarians. The most frequent etiologies were adhesions, hernias, and tumors. In octogenarian patients, there were significantly more complications (46.3 vs. 24.3%, p=0.007, p<0.050). There were no statistically significant differences in terms of surgical complications: 9.6% in <80 years and 14.6% in octogenarians (p=0.390, p>0.050). In medical complications, a statistically significant difference was evidenced with 22.5% in <80 years vs 39.0% in octogenarians (p=0.040, p<0.050). There were 20 reoperated patients: 30% octogenarians and 70% non-octogenarians without statistically significant differences (p=0.220, p>0.050). Regarding hospital stay, the average was significantly higher in octogenarians (17.4 vs. 11.0 days; p=0.005, p<0.050), and so were the costs, being USD 9,555 vs. USD 4,214 (p=0.013, p<0.050). Patients aged 80 years and older with surgical SBO treatment have a higher risk of medical complications, length of hospital stay, and associated costs compared to those younger.

Surgical management of small bowel obstruction: What you need to know.

Abstract Small bowel obstruction management has undergone a paradigm shift over the past decade. Surgical dictum had taught us to never let the “sun rise or set on a small bowel obstruction.” We have subsequently learned that a nuanced approach to this disease using practice management guidelines to drive our clinical decision making must be taken. In this review, we will delve into the process of deciding who needs an urgent/emergent operation versus observing a patient on the ward. We will also discuss how long to wait until an exploration should be performed for those patients initially undergoing non-operative management, and, once in the operating room, the fundamental techniques and newer approaches which should be in surgeon’s armamentarium. Lastly, we will highlight the approach to less common causes of small bowel obstruction including malignant bowel obstruction, virgin abdomens, and Crohn’s disease.

Colonic-enteric lumen-apposing metal stents: a promising and safe alternative for endoscopic management of small-bowel obstruction

Lumen-apposing metal stents (LAMS) have revolutionized the treatment of various gastroenterological conditions that previously required surgery. The use of LAMS for the management of small-bowel obstruction (SBO) involves endoscopic ultrasound guided colo-enterostomy (EUS-CE) between colon and a dilated loop of the small intestine proximal to the point of obstruction. This procedure is potentially beneficial for patients with malignant SBO who are poor surgical candidates. A retrospective cohort study was conducted at two tertiary care hospitals. Patients who underwent EUS-CE for SBO were identified and data regarding patient demographics, indication for the procedure, location of obstruction, procedural details and adverse events were collected. The primary outcome was technical success of the procedure. Secondary outcomes included clinical success, resolution of symptoms, ability to tolerate enteral nutrition, and adverse events. Twenty-six patients who underwent the EUS-CE procedure were included. Technical success was achieved in all cases (26/26), and clinical success (resolution of obstructive symptoms) was achieved in 92.3% (24/26), and the ability to resume enteral nutrition in 84.6% (22/26) of patients. Adverse events occurred in four patients (15.4%) and included bleeding (1/26), diarrhea (2/26), and post-procedure sepsis (1/26). Patients were followed for a mean of 54.8 days (range 2-190). This study highlights that EUS-CE with LAMS can be performed with high technical and clinical success for the management of SBO, particularly in patients with malignant obstructions who are not suitable candidates for surgical interventions. Further research with larger sample sizes will be essential to substantiate its efficacy and safety.

Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

ObjectivesTo identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction.MethodsTwo researchers systematically reviewed indexed literature 2001–2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies.ResultsThirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36).ConclusionsSystematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery.Clinical relevance statementVia systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility.Key Points• While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely.• Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery.• Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.

Results of laparoscopic surgery in management of small bowel obstruction for patients previously operated on for intra-abdominal malignancy at K Hospital

Results of laparoscopic surgery in management of small bowel obstruction for patients previously operated on for intra-abdominal malignancy at K Hospital

Management of adhesive small bowel obstruction: the results of a large retrospective study

BackgroundPostoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial.MethodsWe conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet.ResultsSeventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia.ConclusionsOur protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

1309 A Quality Improvement Project on Small Bowel Obstruction Operative Mortality Rate

Abstract Aim Higher than average emergency laparotomy mortality rates had been identified via the National Emergency Laparotomy Audit (NELA), at a particular hospital. Small bowel obstruction (SBO) is the commonest cause for emergency laparotomy. The aim of this project was to evaluate the management of SBO, and to implement changes to reduce the operative SBO mortality rate. Method NELA was used to assess emergency laparotomy cases between 1st Dec 2018 - 30th Nov 2019; (n = 198), of which there were 24 mortalities. The dataset was filtered for SBO (n = 87), of which there were 12 mortalities. The clinical management of these 12 SBO mortality cases were analysed and compared to the latest ASGBI and NCEPOD recommendations on SBO management. Following this review, a systematic change in the management of SBO was introduced with the aim of reducing time to operation, appropriate candidate selection and avoiding drifting in management. This consisted of producing a SBO management flowchart as well as ensuring allocation of theatre slot within 72 hours for patients suitable for operation. Results Following the intervention, we assessed cases between 1st April 2021 - 31st March 2022 (n = 152), of which there were 13 mortalities. The dataset was filtered for SBO cases (n = 57), of which there were 3 mortalities. Emergency laparotomy mortality rate reduced from 12% to 9%. SBO operative mortality rate reduced from 14% to 5%. Emergency laparotomy deaths relating to SBO reduced from 50% to 23%. Conclusions The intervention resulted in improvement in SBO operative mortality rates as well as overall emergency laparotomy mortality rates.

Laparoscopic adhesiolysis versus open adhesiolysis in acute adhesive small bowel obstruction.

Exploratory laparotomy is still the standard therapy for patients who need surgical intervention for adhesive small bowel obstruction (SBO). However, the use of laparoscopy in the management of adhesive SBO is still controversial. We aimed to detect the short-term outcomes between open and laparoscopic adhesiolysis for SBO. This is a retrospective study of patients with adhesive SBO who underwent either laparoscopic or open surgery from June 2019 to July 2022 at Ain Shams University Hospitals. Intraoperative and early post-operative outcomes were compared in the two groups. A total of 89 patients with adhesive SBO were included in our study. Fifty-one cases underwent open adhesiolysis and 38 cases underwent laparoscopic adhesiolysis. Laparoscopic adhesiolysis is associated with a remarkable decrease in the operative time (71 min vs. 107 min, P = 0.001) and blood loss (50 ml vs. 120 ml, P = 0.001) in comparison to open adhesiolysis. In addition to that, those who underwent adhesiolysis by laparoscopy had a short hospital stay (2.4 days vs. 3.8 days, P = 0.001), early recovery (time to pass flatus 1.3 days vs. 2.8 days) and less post-operative complications (surgical site infection [SSI] 2.6% vs. 19.6%, P = 0.001). Moreover, open adhesiolysis is associated with a higher rate of early post-operative mortality. In addition to that, the incidence of iatrogenic injury was higher in the open group. Laparoscopic adhesiolysis is a safe and feasible approach for the management of SBO and has better short-term outcomes, especially if done by skilled surgeons in advanced laparoscopic techniques.

Management of Small Bowel Obstructions in Emergency General Surgery Patients Is Not Affected by an In-House Acute Care Surgical Model: An Adjusted Patient Comparison

Baimas-George, Maria MD, MPH; Paton, Lauren MD, FACS; Yang, Hongmei PhD; Reinke, Caroline E MD, FACS; Barbat, Selwan MD, FACS; Matthews, Brent Duane MD, FACS; Schiffern, Lynnette Marie MD, FACS Author Information

Utility of Abbreviated Small Bowel Follow Through Study in the Management of Small Bowel Obstruction.

Small bowel obstruction is a common surgical complaint. Most small bowel obstructions are managed successfully nonoperatively. Unanimous guidelines for nonoperative management of small bowel obstruction do not exist. A standardized protocol for water-soluble contrast administration and abbreviated small bowel follow through imaging was implemented in January of 2021. A retrospective chart review identified 111 patients admitted for SBO from 6/2019 to 9/2019 for a control group. A planned follow-up review identified 158 patients managed according to the new protocol from 3/2021 to 10/2021. The primary outcome was in-hospital length of stay. Standard statistical analyses were performed and pre-specified. Before implementation of the standardized protocol patients that were managed strictly nonoperatively, the mean length of stay (LOS) was 8.3 days. After implementation, the average LOS was 4.8 (P < .0001). Comparatively, patients admitted after protocol implementation were more likely to undergo CT scan with PO contrast on admission (98.1% vs 90.1%; P < .005), undergo NG tube decompression (84.7% vs 68.5%; P < .005), and undergo water-soluble contrast with abbreviated or formal SBFT (75.3% vs 37.8%; P < .0001). Implementation of a standardized protocol utilizing abbreviated SBFT with water-soluble contrast for the management of SBO at our institution resulted in a decrease in the average length of stay for patients definitively managed in a nonoperative fashion.

Management of small bowel obstruction and therapeutic role of contrast media: A multicenter study

Management of small bowel obstruction and therapeutic role of contrast media: A multicenter study

Survey of Diagnostic and Management Practices in Small Bowel Obstruction: Individual and Generational Variation Despite Practice Guidelines.

Background: Small bowel obstruction (SBO) is a common disorder managed by surgeons. Despite extensive publications and management guidelines, there is no universally accepted approach to its diagnosis and management. We conducted a survey of acute care surgeons to elucidate their SBO practice patterns.Methods: A self-report survey of SBO diagnosis and management practices was designed and distributed by email to AAST surgeons who cared for adult SBO patients. Responses were analyzed with descriptive statistics and Chi-square test of independence at α = .05.Results: There were 201 useable surveys: 53% ≥ 50years, 77% male, 77% at level I trauma centers. Only 35.8% reported formal hospital SBO management guidelines. Computed tomography (CT) scan was the only diagnostic exam listed as "essential" by the majority of respondents (82.6%). Following NG decompression, 153 (76.1%) would "always/frequently" administer a water-soluble contrast challenge (GC). There were notable age differences in approach. Compared to those ≥50years, younger surgeons were less likely to deem plain abdominal films as "essential" (16.0% vs 40.2%; P < .01) but more likely to require CT scan (88.3% vs 77.6%; P = .045) for diagnosis and to "always/frequently" administer GC (84.0% vs 69.2%; P < .01). Younger surgeons used laparoscopy "frequently" more often than older surgeons (34.0% vs 21.5%, P = .05).Discussion: There is significant variation in diagnosis and management of SBO among respondents in this convenience sample, despite existing PMGs. Novel age differences in responses were observed, which prompts further evaluation. Additional research is needed to determine whether variation in practice patterns is widespread and affects outcomes.