Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored
Author(s)
Beardsley, Christian
Furtado, Ruelan
Mosse, Charles
Gananadha, Sivakumar
Fergusson, James
Jeans, Phil
Beenen, Edwin
Griffith University Author(s)
Year published
2014
Metadata
Show full item recordAbstract
Background A laparotomy is still considered mandatory for patients without previous abdominal surgery presenting with a small bowel obstruction (SBO) because of a perceived high incidence of underlying lesions. However, there is no evidence in literature to support this assumption. We analyzed the etiology of SBO in this subgroup of patients to establish the need for a mandatory laparotomy. Methods A retrospective analysis was conducted over a 5-year period. Basic demographics, radiology results, operative findings, and outpatient investigations were analyzed. Results Of 689 patients presenting with an SBO, a total of 62 ...
View more >Background A laparotomy is still considered mandatory for patients without previous abdominal surgery presenting with a small bowel obstruction (SBO) because of a perceived high incidence of underlying lesions. However, there is no evidence in literature to support this assumption. We analyzed the etiology of SBO in this subgroup of patients to establish the need for a mandatory laparotomy. Methods A retrospective analysis was conducted over a 5-year period. Basic demographics, radiology results, operative findings, and outpatient investigations were analyzed. Results Of 689 patients presenting with an SBO, a total of 62 patients, 9.0%, had a virgin abdomen. A known underlying disease (inflammatory bowel disease, malignancy) was the cause in 13 patients. The remaining 49 patients had adhesions in 75.5% and a newly diagnosed malignancy in 10.2% as a cause. Conclusions Adhesions are by far the most likely cause of SBO in patients without previous abdominal surgery followed by a small number of newly diagnosed malignancies. Both prevalences are in equal proportion to patients with previous abdominal surgery. A trial of nonoperative management may therefore be justified.
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View more >Background A laparotomy is still considered mandatory for patients without previous abdominal surgery presenting with a small bowel obstruction (SBO) because of a perceived high incidence of underlying lesions. However, there is no evidence in literature to support this assumption. We analyzed the etiology of SBO in this subgroup of patients to establish the need for a mandatory laparotomy. Methods A retrospective analysis was conducted over a 5-year period. Basic demographics, radiology results, operative findings, and outpatient investigations were analyzed. Results Of 689 patients presenting with an SBO, a total of 62 patients, 9.0%, had a virgin abdomen. A known underlying disease (inflammatory bowel disease, malignancy) was the cause in 13 patients. The remaining 49 patients had adhesions in 75.5% and a newly diagnosed malignancy in 10.2% as a cause. Conclusions Adhesions are by far the most likely cause of SBO in patients without previous abdominal surgery followed by a small number of newly diagnosed malignancies. Both prevalences are in equal proportion to patients with previous abdominal surgery. A trial of nonoperative management may therefore be justified.
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Journal Title
The American Journal of Surgery
Volume
208
Issue
2
Subject
Medical and Health Sciences not elsewhere classified
Clinical Sciences