title: Large-bowel disease presenting as small-bowel obstruction is associated with a poor prognosis.
abstract: BACKGROUND
  Small-bowel obstruction (SBO) is a common cause of admission to the surgical service. On rare occasions, a diagnosed SBO is actually due to large-bowel pathology combined with an incompetent ileocecal valve. The purpose of this study was to investigate this phenomenon.
  
  
  METHODS
  We performed a retrospective medical record review of patients that were admitted with a diagnosis of SBO at University of Louisville hospital and the Veterans Affairs hospitals in Louisville, KY, from 2006 until 2014.
  
  
  RESULTS
  A total of 498 patients were admitted with SBO during this time period. Forty-one patients were found to have an underlying large-bowel disease. The most common large-bowel pathologies included malignancy (51%), inflammation (15%), and infection (15%). Fifteen (43%) of these patients died during admission; 93% of these were due to either their bowel obstruction or the underlying disease state. This was significantly higher than the general population (9.4% mortality, 6% due to underlying disease).
  
  
  CONCLUSIONS
  Patients that present with SBO due to a large-bowel source have a much higher mortality rate than those that present with other causes. Rapid identification of these patients will allow for more timely and appropriate treatment.
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA; Robley Rex Veterans Affairs Medical Center, 800 Zorn Ave, Louisville, KY, 40206, USA. Electronic address: jlweav08@louisville.edu.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Weaver
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA; Robley Rex Veterans Affairs Medical Center, 800 Zorn Ave, Louisville, KY, 40206, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Barnett
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA; Robley Rex Veterans Affairs Medical Center, 800 Zorn Ave, Louisville, KY, 40206, USA.
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Patterson
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA.
authors.forename: Vikram G
authors.initials: VG
authors.lastname: Ramjee
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Riedinger
authors.affiliation: Robley Rex Veterans Affairs Medical Center, 800 Zorn Ave, Louisville, KY, 40206, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Younga
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA.
authors.forename: Ernesto A
authors.initials: EA
authors.lastname: Sepulveda
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Keskey
authors.affiliation: Hiram C. Polk Jr MD Department of Surgery, University of Louisville School of Medicine, 550 South Jackson St, Louisville, KY, 40292, USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Cheadle
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006547:Hernia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D007420:Intestine, Large / Q000000981:diagnostic imaging / Q000473:pathology*; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007629:Kentucky; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D014057:Tomography, X-Ray Computed; D055815:Young Adult