Risk Factors For Small Bowel Obstruction Research Articles

Small Bowel Obstruction Following Congenital Diaphragmatic Hernia Repair-Incidence and Risk Factors.

Small bowel obstruction (SBO) is a known complication following congenital diaphragmatic hernia (CDH) repair, resulting in significant morbidity and potential mortality. Our study aims to evaluate the incidence and risk factors for SBO following CDH repair. A single-institution retrospective review evaluated all CDH births between January 2010 and September 2022 (n = 120). Risk factors for SBO were analyzed, including operative approach, type of repair, need for extracorporeal membrane oxygenation (ECMO), and additional abdominal surgeries (gastrostomy tube and fundoplication). 120 patients were included. 16 (13%) patients developed an SBO, of which 94% were due to adhesive bands. The median time to SBO was 7.5 months. 15/16 (94%) patients required operative intervention. Need for ECMO (P < 0.01), prior gastrostomy tube (P < 0.01), and prior fundoplication (P < 0.01) were associated with an increased risk of SBO, as were longer time to initial CDH repair (6 days vs 3days; P < 0.01) and longer length of initial hospitalization (63 days vs 29days; P = 0.01). Neonates with increased acuity of illness (ie, those requiring ECMO, additional abdominal operations, longer time to repair, and longer initial hospitalizations) appear to have an increased risk of developing adhesive SBO after CDH repair. More than 90% of patients who developed SBO required surgery.

Risk factors for small-bowel obstruction after colectomy for colorectal cancer: a retrospective study.

Postoperative adhesions are a concerning complication of abdominal surgery with major implications on quality of life. This study aimed to investigate the risk factors for postoperative small-bowel obstruction (SBO) after colectomy for colorectal cancer. We reviewed the clinicopathological variables of 1646 patients who underwent colectomy for colorectal cancer between 2009 and 2018. SBO occurred following primary tumor resection for colorectal cancer in 67 (4.1%) of the 1646 patients. The median observation period was 7.5 (range: 3.0-12.0) years. Multivariate analysis revealed that rectal tumors, anastomotic leakages, previous abdominal surgeries, and longer operating times were all correlated with postoperative SBO, but there were no differences in the incidence of SBO between laparoscopic vs. open surgery. The use of adhesion prevention material had no effect on SBO. Our data showed that the onset of SBO tended to be relatively early, within a year after surgery (89.5%). Tumor localization in the rectum is associated with several problems, including a wide resection area, prolonged operative duration, and high risk of anastomotic leakage, which may increase the risk of SBO. Laparoscopic surgery and adhesion prevention material did not demonstrate a clear preventive effect against SBO.

S3689 Small Bowel Obstruction in COVID-19 Patient Without Risk Factors

Introduction: The documented gastrointestinal associations of COVID-19 infection include enteritis, colitis, ileus, and mesenteric thrombosis from associated coagulopathy. A direct link to small bowel obstruction (SBO) has yet to be proposed. Aside from isolated cases of bacterial enteritis, infection is not a widely accepted cause of SBO. SBO is mostly caused by adhesions formed after intra-abdominal surgery. Other causes include congenital adhesions, neoplasms, hernias, and stenosis from inflammatory bowel disease (IBD) or bowel ischemia. We report a unique case of acute SBO in a patient with COVID-19 symptoms but no known risk factors of SBO. Case Description/Methods: A 67-year-old man with history of HTN and TURP for BPH presented with intermittent fever and dry cough for 1 week. He had no history of abdominal surgery, hernia, malignancy, IBD, or bowel ischemia. He was febrile to 102.6F and O2 saturation was 100% on room air without respiratory distress. SARS-CoV-2 PCR assay was positive. After two days of remdesivir, he was hypoxic requiring nasal cannula and had abdominal pain with loose stool. On exam, abdomen was distended with guarding. CT abdomen showed 2 transition points, multiple dilated bowel loops, and fluid and stool in distal bowel consistent with partial SBO. Nasogastric tube drained gastric contents with bile. He was intubated for ex-lap which showed no transition points or congenital adhesions. Proximal two-thirds of bowel were dilated, thickened, and hyperemic but the distal third was normal caliber. Creeping fat and friable mesentery with ecchymosis were noted throughout. Abdomen was left open with plan for closure the following day. Closure was delayed by 4 days due to worsening hypoxia and new pressor requirements. Oxygen and pressor requirements improved after starting steroid and antibiotic treatment. Abdomen was then closed as bowel remained viable. He was extubated, weaned to room air, and able to tolerate food within 1 week followed by discharge to rehab. Discussion: In our patient who developed partial SBO in the setting of worsening COVID-19 respiratory symptoms with no history of intra-abdominal surgery or other risk factors of SBO, COVID-19 should be considered as a possible etiology. Ex-lap findings were non-specific and could indicate inflammatory or ischemic evidence of COVID-19 gut involvement. Further research is required to better understand this patient’s diagnosis and a possible relationship between COVID-19 enteritis and acute development of SBO.Figure 1:: CT Abdomen Showing Two Transition Points Image A: Transition point in left mid abdomen. Image B: Transition point in right mid abdomen.

Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis.

Purpose Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC.Methods The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters.Results The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14–72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009–8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO.Conclusion The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis.

Small bowel obstruction (SBO) often occurs after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis. Little is known about the association between SBO and surgical procedures for diverting loop‐ileostomy. We conducted a multicenter, retrospective questionnaire survey. Unlinkable anonymized data on ileostomy procedures and ileostomy‐related complications including SBO were collected from institutions specializing in surgery for inflammatory bowel disease. In total, 515 patients undergoing total proctocolectomy and ileal pouch anal anastomosis with loop‐ileostomy among 1022 patients with ulcerative colitis undergoing surgery during a 3‐year period between 2012 and 2014 were analyzed. Twenty‐nine patients without information on complications were excluded. Incidence of ileostomy‐related complications and factors associated with the development of small bowel obstruction were determined in 486 patients. The most common complications were parastomal dermatitis (n=169, 34.8%), SBO (n=111, 22.8%), mucocutaneous dehiscence (n=59, 12.1%), stoma prolapse (n=21, 4.3%), parastomal hernia (n=12, 2.5%), and stoma retraction (n=11, 2.3%). Incidence of small bowel obstruction was significantly higher in patients with distance from the ileal pouch to the ileostomy of less than 30 cm and in patients undergoing laparoscopic surgery. Procedures for diverting loop‐ileostomy after surgery for ulcerative colitis varied among institutions. Incidence of small bowel obstruction was high after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy. Shorter distance between the pouch and the stoma and the laparoscopic surgery were risk factors for SBO in univariate analysis.

Effect of Laparoscopy on the Risk of Small-Bowel Obstruction

To investigate the incidence and risk factors for small-bowel obstruction (SBO) after certain surgical procedures. A population-based retrospective register study. Small-bowel obstruction causes considerable patient suffering. Risk factors for SBO have been identified, but the effect of surgical technique (open vs laparoscopic) on the incidence of SBO has not been fully elucidated. The Inpatient Register held by the Swedish National Board of Health and Welfare was used. The hospital discharge diagnoses and registered performed surgical procedures identified data for cholecystectomy, hysterectomy, salpingo-oophorectomy, bowel resection, anterior resection, abdominoperineal resection, rectopexy, appendectomy, and bariatric surgery performed from January 1, 2002, through December 31, 2004. Data on demographic characteristics, comorbidity, previous abdominal surgery, and death were collected. Episodes of hospital stay and surgery for SBO within 5 years after the index surgery. A total of 108,141 patients were included. The incidence of SBO ranged from 0.4% to 13.9%. Multivariate analysis revealed age, previous surgery, comorbidity, and surgical technique to be risk factors for SBO. Laparoscopy exceeded other risk factors in reduction of the risk of SBO for most of the surgical procedures. Open surgery seems to increase the risk of SBO at least 4 times compared with laparoscopy for most of the abdominal surgical procedures studied. Other factors such as age, previous abdominal surgery, and comorbidity are also of importance.

Small-bowel obstruction after restorative proctocolectomy in patients with ulcerative colitis

The reported risk of small-bowel obstruction (SBO) after major abdominal surgery varies. The aim of this study was to study frequency and risk factors of SBO after ileal pouch-anal anastomosis for ulcerative colitis. Review of the medical records of 188 patients operated with restorative proctocolectomy between 1985 and 1997. All admissions to the hospital were registered and symptoms and X-ray findings consistent with ileus were analysed in relation to preoperative and operative data. SBO was the dominating cause of hospitalization. Forty-eight patients (25.5%) had developed SBO after a median of 76 (range 6-196) months of follow-up, of whom 26 were operated on. The cause of obstruction was adhesion in all but one patient. Early obstruction events were common and accounted for 27% of all operations. Twenty-five of 26 patients who were operated on had a diverting loop-ileostomy compared to 111/162 in the not-operated-on group (p < 0.01). In total, 696 days were spent at the hospital because of SBO. SBO is common following pouch surgery and is the dominating cause of hospitalization postoperatively. About 25% of patients developed SBO and half of them needed surgery. The use of a diverting loop-ileostomy was related to an increased risk of surgery for SBO.