title: Clinical strategies for the management of intestinal obstruction and pseudo-obstruction. A Delphi Consensus study of SICUT (Società Italiana di Chirurgia d'Urgenza e del Trauma).
abstract: BACKGROUND
  Intestinal obstructions/pseudo-obstruction of the small/large bowel are frequent conditions but their management could be challenging. Moreover, a general agreement in this field is currently lacking, thus SICUT Society designed a consensus study aimed to define their optimal workout.
  
  
  METHODS
  The Delphi methodology was used to reach consensus among 47 Italian surgical experts in two study rounds. Consensus was defined as an agreement of 75.0% or greater. Four main topic areas included nosology, diagnosis, management and treatment.
  
  
  RESULTS
  A bowel obstruction was defined as an obstacle to the progression of intestinal contents and fluids generally beginning with a sudden onset. The panel identified four major criteria of diagnosis including absence of flatus, presence of >3.5 cm ileal levels or >6 cm colon dilatation and abdominal distension. Panel also recommended a surgical admission, a multidisciplinary approach, and a gastrografin swallow for patients presenting occlusions. Criteria for immediate surgery included: presence of strangulated hernia, a >10 cm cecal dilatation, signs of vascular pedicles obstructions and persistence of metabolic acidosis. Moreover, rules for non-operative management (to be conducted for maximum 72 hours) included a naso-gastric drainage placement and clinical and laboratory controls each 12 hours. Non-operative treatment should be suspended if any suspects of intra-abdominal complications, high level of lactates, leukocytosis (>18.000/mm3 or Neutrophils >85%) or a doubling of creatinine level comparing admission. Conversely, consensus was not reached regarding the exact timing of CT scan and the appropriateness of colonic stenting.
  
  
  CONCLUSIONS
  This consensus is in line with current international strategies and guidelines, and it could be a useful tool in the safe basic daily management of these common and peculiar diseases.
  
  
  BACKGROUND
  Delphi study, Intestinal obstruction, Large bowel obstruction, Pseudo-obstruction, Small bowel.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Costa
authors.forename: Paolo
authors.initials: P
authors.lastname: Ruscelli
authors.forename: Genoveffa
authors.initials: G
authors.lastname: Balducci
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccoliero
authors.forename: Laura
authors.initials: L
authors.lastname: Lorenzon
authors.forename: Barbara
authors.initials: B
authors.lastname: Frezza
authors.forename: Piero
authors.initials: P
authors.lastname: Chirletti
authors.forename: Franco
authors.initials: F
authors.lastname: Stagnitti
authors.forename: Stefano
authors.initials: S
authors.lastname: Miniello
authors.forename: Francesco
authors.initials: F
authors.lastname: Stella
mesh_terms: D000138:Acidosis / Q000209:etiology; D000072700:Conservative Treatment; D003287:Contrast Media; D003697:Delphi Technique; D003974:Diatrizoate Meglumine; D019468:Disease Management; D004630:Emergencies; D004635:Emergency Medicine / Q000458:organization & administration; D013502:General Surgery / Q000458:organization & administration; D006547:Hernia / Q000150:complications; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007418:Intestinal Pseudo-Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007441:Intubation, Gastrointestinal; D007813:Laparotomy; D012955:Societies, Medical; D015607:Stents; D063189:Symptom Assessment; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine