title: Decision Making in Bowel Obstruction: A Review.
abstract: Over the last century there have not been significant changes in the anatomical location of obstruction. The age of presentation has increased along with age related co-morbidity. Management has consequently been challenging as risks keep on increasing with advanced age. Hence, clear decision making has become essential in its management. A selective review of the literature pertaining to common age related aetiologies, diagnosis methods leading to standard decision making and treatment of acute intestinal obstruction was done. The same is obtained from randomized controlled studies, meta-analysis and other related evidence based publications. Predicting the conservative or operative management of Bowel Obstruction (BO) is difficult. BO in young age, in unscarred abdomen and Large Bowel Obstruction (LBO) needs early surgery. Decision on surgery should be taken in paediatric patient by second day and preferably between 3-5 days of admission in adults. Higher American Society of Anaesthesiologists (ASA) grade correlates well with the mortalities. In this article, the timing of surgery, methods to avoid bowel resection and type of surgery in various causes are stressfully analysed and discussed.
authors.affiliation: Professor, Department of Surgery and Surgical Gastroenterology, Vydehi Institute of Medical Sciences and Research Institute , Whitefield, Bangalore, India .
authors.forename: Aswini Kumar
authors.initials: AK
authors.lastname: Pujahari
keywords: Adhesive obstruction; Intestinal obstruction; Non adhesive obstruction; Timing of surgery; Virgin abdomen