Small bowel obstruction following low anterior resection: the impact of diversion ileostomy.
BACKGROUND
The incidence of small bowel obstruction following rectal cancer surgery has not been well documented in the era of sphincter-preserving surgery. This report aimed to study the incidence, aetiologies and outcomes of small bowel obstruction in patients after low anterior resection for rectal cancer. The factors that might affect the incidences of small bowel obstruction were analysed.


METHODS
Consecutive patients who had undergone low anterior resection for rectal cancer from August 1993 to March 1999 were studied. Patients with unplanned admissions, with the diagnosis of small bowel obstruction, were reviewed. The aetiologies and outcome of small bowel obstruction were documented.


RESULTS
Two hundred and fourteen patients were included, with a median follow-up time of 39 months; 22 patients presented with 30 episodes of small bowel obstruction, and operations were necessary in nine patients (40.9%). Malignant obstruction occurred in two patients (10.3%). Obstruction within 6 weeks of surgery (including closure of stoma) occurred in 13 patients (6.1%). Early obstruction occurred at a higher incidence in those patients who had had an ileostomy than in those who did not (9.1% vs 2.9%, P=0.048).


CONCLUSIONS
Small bowel obstruction following rectal cancer surgery occurred in 10.3% of patients. The majority of the obstruction was benign in nature. The presence of diversion ileostomy was associated with an increased incidence of early obstruction, and the use of loop ileostomy for proximal diversion should be further assessed.
Poon
Jensen T C
JT
Department of Surgery, Queen Mary Hospital University of Hong Kong Medical Centre, Pokfulam Road, Pokfulam, Hong Kong.
Law
Wai-Lun
WL
Chu
Kin-Wah
KW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
D003287:Contrast Media; D003974:Diatrizoate Meglumine