title: Small Bowel Obstructions in a Virgin Abdomen: Is an Operation Mandatory?
abstract: Though conventionally not considered standard of care, nonoperative management of patients with small bowel obstruction (SBO) without previous abdominal operations, so called "virgin abdomens," (VA) is presently being practiced. We aimed to determine outcomes of patients with VA undergoing operative and nonoperative management of SBO. A retrospective review of patients with SBO was performed; outcomes of patients with VA were analyzed. SBO with a VA was found in 103 patients over a 5-year period. With a mean follow-up of 4.5 years, nonoperative management was associated with successful resolution of obstruction in 61 per cent (63/103) of patients. Of those managed nonoperatively, 58/63 (92.1%) did not experience a recurrence. Of the 21 patients with a complete/high-grade SBO on imaging, 16 (76.2%) were managed operatively. Of the 64 patients with a partial/low-grade obstruction or partial obstruction/ileus on imaging, 53 (82.8%) were managed nonoperatively. These data suggest that selected patients with SBO and a VA may safely undergo nonoperative management under close surgical monitoring.
authors: Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
authors: Farees Ricky
authors: FR
authors: Tavangari
authors: Michael
authors: M
authors: Batech
authors: J Craig
authors: JC
authors: Collins
authors: Talar
authors: T
authors: Tejirian
mesh_terms: D034841:Abdominal Cavity / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000601:surgery* / Q000628:therapy; D007421:Intestine, Small / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D055815:Young Adult