Intestinal obstruction in patients with previous laparotomy for non-malignancy.
BACKGROUND
Intestinal obstruction is one of the most common surgical emergencies. The aim of this study was to identify important management information from the evaluation of patients with intestinal obstruction who had undergone previous laparotomy for non-malignancy.


METHODS
Data from 176 patients with previous laparotomy for non-malignancy, and who were operated on for intestinal obstruction, were collected and analyzed retrospectively.


RESULTS
Gastroduodenal operations, appendectomy, and obstetric/gynecologic procedures were the 3 most common previous abdominal surgeries. More than half of all bowel obstructions developed within 10 years after previous laparotomy, and particularly within the first 5 years. Most obstructions were related to adhesion, although their etiologies were diverse. The rate of bowel strangulation was much higher in patients with internal herniation, volvulus, intussusception, closed loop, and diaphragmatic hernia than in patients with simple adhesion, bezoar, tumor, and inflammation (48.3% vs 12.2%). The surgical mortality rate correlated significantly with bowel strangulation: the overall rate was 6.8%, that in patients with strangulation was 18.8%, and that in patients without strangulation was 4.2%.


CONCLUSIONS
The etiologies of intestinal obstruction were not only significantly related to bowel strangulation, but were also an important determinant of therapeutic strategy.
Chou
Nan-Hua
NH
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, R.O.C. nhchou@isca.vghks.gov.tw
Chou
Nan-Song
NS
Mok
King-Tong
KT
Liu
Shiuh-Inn
SI
Wang
Being-Whey
BW
Hsu
Ping-I
PI
Tsai
Cheng-Chung
CC
Chen
I-Shu
IS
Yeh
Ming-Hsin
MH
Chen
Yu-Chia
YC
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007813:Laparotomy / Q000009:adverse effects*; D008875:Middle Aged