title: Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored.
abstract: 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.
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Beardsley
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: Ruelan
authors.initials: R
authors.lastname: Furtado
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Mosse
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Gananadha
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Fergusson
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia.
authors.forename: Phil
authors.initials: P
authors.lastname: Jeans
authors.affiliation: Upper GI/HPB Unit, Department of Surgery, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia. Electronic address: edwinbeenen@gmail.com.
authors.forename: Edwin
authors.initials: E
authors.lastname: Beenen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications; D055815:Young Adult
keywords: Intestinal obstruction; Laparotomy; Small intestine; Tissue adhesion