scholarly journals Enhanced Recovery After Surgery Protocol in Emergency Laparotomy: A Randomized Control Study

2021 ◽  
Vol 07 (02) ◽  
pp. e92-e99
Author(s):  
Jyoti Sharma ◽  
Navin Kumar ◽  
Farhanul Huda ◽  
Yashwant Singh Payal
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Intestinal Perforation ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Randomized Study ◽  
Conventional Care ◽  
Care Group ◽  
Emergency Laparotomy

Abstract Introduction There is established evidence on the role of enhanced recovery after surgery (ERAS) protocols in elective surgeries but its effectiveness in emergency surgeries has been nominally studied. We aimed at studying the feasibility and effectiveness of ERAS protocols in patients undergoing emergency abdominal surgery for intestinal perforation and small bowel obstruction and compare their surgical outcomes with conventional care. Materials and methods This prospective randomized study was performed for a period of 16 months. A total of 100 patients presenting either with intestinal perforation or acute small bowel obstruction were recruited; 50 each in the ERAS and the conventional care groups. The primary outcomes studied were the postoperative length of stay and 30-day morbidity and mortality. Results It was seen that the median (interquartile range) of the duration of hospital stay in the ERAS group was 4 (1) days while it was 7 (3) days in the conventional care group, which was statistically significant (W = 323.000, p ≤ 0.001). Similarly, postoperative morbidities like a chest infection and surgical site infections) were significant in the conventional care group. Conclusion The ERAS protocols are safe and effective in emergency surgeries and result in a better postoperative outcome.

Diaphragm disease in emergency surgery

2020 ◽  
Vol 81 (3) ◽  
pp. 1-6
Author(s):  
Diwakar R Sarma ◽  
Pratik Bhattacharya
Keyword(s):  
Risk Factors ◽  
Small Intestine ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Emergency Laparotomy ◽  
Diaphragm Disease ◽  
Inflammatory Drugs ◽  
Acute Small Bowel Obstruction ◽  
Anti Inflammatory

Background/Aims Diaphragm disease of the small bowel has been described in the literature over the last three decades. The pathognomonic characteristic of multiple circumferential stenosis is noted on gross examination of the bowel. It is a severe form of non-steroidal anti-inflammatory drug-induced enteropathy, often presenting as acute small bowel obstruction. A systematic review was performed to identify risk factors and patient outcomes in histologically-proven diaphragm disease of the small intestine in patients undergoing emergency operation for small bowel obstruction. Methods A comprehensive search was performed between January 1975 and March 2019 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. Diaphragm disease of the small intestine was defined as macroscopically detected thin diaphragm-like mucosal folding inside the lumen of the bowel. The parameters assessed included patient characteristics, duration of use of non-steroidal anti-inflammatory drugs, type of emergency surgery performed, complications, recurrence, presentation and diagnosis of diaphragm disease. Results A total of 21 studies were analysed which included 17 case reports, one case series, and three retrospective comparative studies. Overall 29 patients with diaphragm disease of the small bowel were reported following emergency laparotomy for small bowel obstruction. Use of non-steroidal anti-inflammatory drugs was noted in all cases with an average duration of 3–5 years. All patients presented acutely with features of small bowel obstruction and had emergency laparotomy, except one who underwent laparoscopic resection. In the comparative studies patients were more likely to be female and to have been taking non-steroidal anti-inflammatory drugs for more than 7 years. Conclusions This is a rare disease, difficult to diagnose and often confirmed by the intra-operative macroscopic appearance of circumferential stenosis of the bowel. Risk factors for developing small bowel diaphragm disease include long-term use of non-steroidal anti-inflammatory drugs, and female gender. Patients with this disease are at increased risk of developing acute small bowel obstruction, so early identification is important.

scholarly journals Small bowel obstruction due to herniation into an extra-anatomical arterial bypass tunnel: a first case report

2010 ◽  
Vol 92 (2) ◽  
pp. e20-e22
Author(s):  
Jacqueline Simms ◽  
Karim El-Sakka ◽  
Domenico Valenti ◽  
Mark Tyrrell ◽  
Klaus-Martin Schulte
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bypass Graft ◽  
Small Bowel Resection ◽  
Critical Limb Ischaemia ◽  
Emergency Laparotomy ◽  
Limb Ischaemia ◽  
Arterial Bypass ◽  
First Case

Introduction We highlight the importance of considering rarer causes of small bowel obstruction in patients presenting after extra-anatomical arterial bypass. Case presentation Our patient underwent a left common iliac-to-bifemoral bypass extra-anatomical graft for critical limb ischaemia. The patient developed mechanical small bowel obstruction on the 20th postoperative day. Emergency laparotomy revealed incarcerated, obstructed small bowel trapped in the graft tunnel. Recovery was satisfactory following small bowel resection. Conclusions To the best of our knowledge, small bowel herniation into an arterial bypass graft tunnel, with successful treatment outcome, has not been reported to date.

scholarly journals Evaluation of the role of oral gastrografin in management of simple adhesive small bowel obstruction in children

2019 ◽  
Vol 6 (2) ◽  
pp. 498
Author(s):  
Almoutaz A. Eltayeb ◽  
Nagla H. Abufaddan
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Randomized Study ◽  
Total Duration ◽  
Oral Feeding ◽  
Adhesive Small Bowel Obstruction ◽  
Number Of Patients

Background: The risk of post-operative adhesive small intestinal obstruction is highest during the first post-operative year. Bowel injury during adhesiolysis increases the post-operative morbidity. Consequently, the conservative management of small bowel obstruction has considerable interest. The aim of this study was to evaluate the therapeutic role of gastrografin in the management of small bowel obstruction.Methods: All patients with simple adhesive small bowel obstruction will be included and treated conservatively for 48hours unless there was evidence of strangulation. After the first 48hours all the patients were given oral gastrografin unless improved or signs of strangulation arise.  The evaluating parameters are the success rate, time to start full oral feeding and total duration of hospital stay.Results: Twenty-five cases were included in which two of them developed clinical evidence of strangulation during the first 48hours and were explored. Three cases improved on the conservative treatment. The remaining twenty cases were given oral gastrografin. Fourteen cases out of twenty showed the contrast dye in their large bowel by 24hours. Those 14 cases tolerated full oral feeding earlier and had shorter hospital stay than the remaining 6 cases that declared treatment failure and underwent surgical exploration.Conclusions: The use of gastrografin as a preliminary step of non-surgical treatment of simple adhesive intestinal obstruction may be helpful. However, further randomized study on a large number of patients was needed.

scholarly journals NELA.01The Impact of Laparoscopy on Emergency Surgery for Adhesional Small Bowel Obstruction: Prospective Single Centre Cohort Study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alexander Darbyshire ◽  
Ina Kostakis ◽  
Phil Pucher ◽  
Simon Toh ◽  
Stuart Mercer
Keyword(s):  
Regression Analysis ◽  
Cohort Study ◽  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Linear Regression Analysis ◽  
Surgical Approaches ◽  
Emergency Laparotomy ◽  
Single Centre

Abstract Aims Laparoscopic adhesiolysis is being increasingly used to treat adhesional small bowel obstruction (ASBO). However, concerns regarding iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre’s experience of adopting laparoscopy as the standard operative approach for ASBO. Methods A single centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; 01/01/2015-31/12/2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and in-hospital outcome data were compared between different surgical approaches. Linear regression analysis was performed for length of stay. Results Of 299 cases, 76.3% were started laparoscopically and 52.2% successfully completed. Rates of attempted laparoscopy increased over the 5 year period. Patients treated laparoscopically had lower P-POSSUM-mortality (2.1 vs 5.7%, p = <0.001), shorter post-operative LOS (4.2 vs 11.3 days, p = 0.000) and lower in-hospital mortality (2 vs 7 deaths, p = <0.001). In regression analysis, laparoscopy had the strongest association with post-operative LOS ( 8.51, p = 0.002). Conclusion Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is now the standard approach in our centre, with 83.3% of cases started laparoscopically in 2019. It is associated with reduced post-operative length of stay with no impact on complications or mortality. This challenges the widely held view that laparoscopy should be for selected, straightforward cases.

scholarly journals 976 Traumatic Damage to The Liver Capsule: An Unusual Cause of Small Bowel Obstruction

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Aloni ◽  
H Harris ◽  
G Colucci ◽  
M McFall
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Blunt Trauma ◽  
Bowel Obstruction ◽  
Primary Anastomosis ◽  
Operative Management ◽  
Small Bowel Resection ◽  
Medical Attention ◽  
Emergency Laparotomy ◽  
Liver Capsule

Abstract A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.

scholarly journals Predictor of early post-operative small bowel obstruction in patients undergoing emergency laparotomy and the role of computed tomography in detecting need for re-laparotomy

2018 ◽  
Vol 5 (10) ◽  
pp. 3321
Author(s):  
Sunil Kumar Singh ◽  
Arun Singh ◽  
Rajnikant Kumar
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Operative Procedure ◽  
Wound Dehiscence ◽  
Emergency Laparotomy ◽  
Previous Surgery ◽  
Cross Sectional ◽  
History Of

Background: Early Post-Operative Small Bowel Obstruction (EP-SBO) is common complication following laparotomy. Pathophysiology of early post-operative small bowel obstruction is poorly understood.Methods: This cross-sectional observational study was conducted over a period of 18 month on 180 patients who underwent emergency abdominal laparotomy.Results: EP-SBO developed in 35.55% patients. History of previous surgery, location of disease, degree of peritonitis, operative procedure, wound dehiscence was found to be significantly related with occurrence of EP-SBO.Conclusions: EP-SBO is more likely to develop if patient had history of previous surgery, peritonitis, some operative procedure, ostomy, wound dehiscence. We should have a preventive attitude towards any risk factor at any stage- Before, During and After surgery and CECT-Abdomen is a helpful tool in establishing need of re-laparotomy.

scholarly journals UK-based, multisite, prospective cohort study of small bowel obstruction in acute surgical services: National Audit of Small Bowel Obstruction (NASBO) protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016796 ◽  
Author(s):  
Matthew J Lee ◽  
Adele E Sayers ◽  
Thomas M Drake ◽  
Marianne Hollyman ◽  
Mike Bradburn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Prospective Cohort Study ◽  
Bowel Obstruction ◽  
Prospective Cohort ◽  
Emergency Laparotomy ◽  
National Audit ◽  
Nutritional Interventions ◽  
The Uk

IntroductionSmall bowel obstruction (SBO) is a common indication for emergency laparotomy in the UK, which is associated with a 90-day mortality rate of 13%. There are currently no UK clinical guidelines for the management of this condition. The aim of this multicentre prospective cohort study is to describe the burden, variation in management and associated outcomes of SBO in the UK adult population.Methods and analysisUK hospitals providing emergency general surgery are eligible to participate. This study has three components: (1) a clinical preference questionnaire to be completed by consultants providing emergency general surgical care to assesses preferences in diagnostics and therapeutic approaches, including laparoscopy and nutritional interventions; (2) site resource profile questionnaire to indicate ease of access to diagnostic services, operating theatres, nutritional support teams and postoperative support including intensive care; (3) prospective cohort study of all cases of SBO admitted during an 8-week period at participating trusts. Data on diagnostics, operative and nutritional interventions, and in-hospital mortality and morbidity will be captured, followed by data validation.Ethics and disseminationThis will be conducted as a national audit of practice in conjunction with trainee research collaboratives, with support from patient representatives, surgeons, anaesthetists, gastroenterologists and a clinical trials unit. Site-specific reports will be provided to each participant site as well as an overall report to be disseminated through specialist societies. Results will be published in a formal project report endorsed by stakeholders, and in peer-reviewed scientific reports. Key findings will be debated at a focused national meeting with a view to quality improvement initiatives.

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