[Small bowel obstruction caused by postoperative adhesions: personal experience and review of the literature].
Small bowel obstruction due to postoperative adhesions still remains an important matter in terms of frequency, diagnostic and therapeutic commitment and costs. The Authors report on a series observed over 14 years consisting of 63 patients (71 cumulative hospital admissions). Surgery was required in 42 cases (59.2%), 23 cases were treated in emergency and 19 cases after failure of conservative treatment. In 29 cases (69%) the surgical procedure was limited to adhesiolysis, whereas in 13 cases (31%) an intestinal resection was performed. During operation the mechanisms responsible for obstruction were: strangulation by an adhesive band (39.4%), angulation (34%), bowel loops and volvulus glued together (13.2% in each case). The operative mortality was 4.7% (2 cases). In 29 cases (40.8%), after medical treatment, the obstruction was completely resolved within a mean period of 4.15 days (range: 2-8). The results lead to the conclusion that diagnostic accuracy in cases of obstruction due to postoperative adhesions is still uncertain. The main aspects of treatment and surgical timing are left to the surgeon's personal experience. Medical treatment, however, should be the first therapeutic option and, in case of doubt, further diagnostic investigations are necessary (mainly CT) to identify those cases amenable to surgical treatment.
Pomata
Mariano
M
Dipartimento di Scienze Chirurgiche e Trapianti d'Organo, Sezione di Chirurgia Generale II, Università degli Studi di Cagliari.
Erdas
Enrico
E
Casu
Barbara
B
Pinna
Giovanni
G
Licheri
Sergio
S
Pisano
Giuseppe
G
Daniele
Giovanni Maria
GM
D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D000267:Tissue Adhesions / Q000150:complications