508 Conservative Management of Small Bowel Obstruction: A Local Experience

Abstract Introduction Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively. Method We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t. Results 118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p < 0.001). Conclusions Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.

Download Full-text

1494 An Audit on The Management of Adhesional Small Bowel Obstruction at St Helier Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.165 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M G Rivera Cartland ◽

Z Anjum ◽

S Saadat ◽

T Studd ◽

R Camprodon

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Conservative Management ◽

Best Practice ◽

Positive Impact ◽

Water Soluble ◽

National Standards ◽

Flow Chart ◽

Emergency Laparotomy

Abstract Aim To compare our current management of adhesional small bowel obstruction (ASBO) with the BMJ best practice treatment algorithm1 and National audit for small bowel obstruction 20172 guidelines and produce a flow chart to aid stasndardised : Method Data collected prospectively from the general surgical take list over a three-month. Results Thirty-five patients were diagnosed with ASBO. All patients were prescribed IV fluids. Thirty-four (97.1%) and 31 patients (88.6%) received analgesia and anti-emetics, respectively. Twenty-one patients (82.9%) had a NG tube inserted. Five patients (14.3%) underwent laparotomies within 37 hours from time of admission. Thirty patients (85.7%) underwent a trial of conservative management. Twenty-four patients (80%) received water-soluble contrast, of whom 13 (59.1%) were managed successfully. Eight patients (36.3%) failed to resolve and underwent emergency laparotomy within 70 hours from admission. One patient (2.9%) failed conservative management and was palliated. Conclusions Our results are in line with national standards. Our first line management for ASBO (analgesia, anti-emetics and NG insertion) could be instituted more promptly. Failure of NG insertion is multifactorial, an improved insertion rate may have further positive impact on conservative management outcome. A step-by-step sequential flow chart could introduce on induction at the beginning of general surgical rotation could help to re-iterate this management.

Download Full-text

EP.FRI.758 Management of Small Bowel Obstruction: A Retrospective Audit

British Journal of Surgery ◽

10.1093/bjs/znab312.116 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Alice Baggaley ◽

Caterina Clements ◽

Vera Tudyka

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Conservative Management ◽

Best Practice ◽

District General Hospital ◽

Water Soluble ◽

Initial Assessment ◽

Retrospective Audit ◽

Immediate Surgery

Abstract Aims How does management of small bowel obstruction (SBO) at a district general hospital in London compare with current recommendations from the BMJ Best Practice algorithm and the National Audit for Small Bowel Obstruction (NASBO)? Methods This retrospective audit captured patients admitted with SBO over a four-month period. Two authors searched the general surgery admission lists and extracted hospital numbers. A total of 59 patients were identified initially but nineteen of these patients were subsequently excluded, leaving 40 to be analysed. Inclusion criteria involved age 18 or over and SBO proven on imaging. Results The majority of the obstructions were secondary to adhesions (65%), with 10% due to hernia, 7% due to inflammatory bowel disease and 5% due cancer. All but one patient underwent computed tomography (CT) and in 90% of cases this was performed within 12 hours of initial assessment. For those who underwent a period of conservative management, 64% received a water-soluble study. Seven patients had immediate surgery within 12 hours of admission, and 5 patients proceeded to surgery after failed conservative management. Of the patients who failed conservative management, only one was operated on after the 72 hours. Conclusions Access to CT was excellent, as was time to theatre when the decision was made for immediate surgery. There was not a difference in access to imaging or theatre given the time or day of the week. Use of water-soluble studies in conservative management could be increased and the time to this study could be formalised.

Download Full-text

Small Bowel Obstruction Induced by Concurrent Postoperative Intra-Abdominal Adhesions and Small Bowel Fecal Materials in a Young Dog

Veterinary Sciences ◽

10.3390/vetsci8050083 ◽

2021 ◽

Vol 8 (5) ◽

pp. 83

Author(s):

Jae-Eun Hyun ◽

Hyun-Jung Han

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Surgical Intervention ◽

Gastrointestinal Symptoms ◽

Exploratory Laparotomy ◽

Abdominal Adhesions ◽

Abdominal Radiography ◽

Foreign Body Removal ◽

Small Intestinal

A 7-month-old neutered male poodle dog presented with general deterioration and gastrointestinal symptoms after two separate operations: a jejunotomy for small-intestinal foreign body removal and an exploratory laparotomy for diagnosis and treatment of the gastrointestinal symptoms that occurred 1 month after the first surgery. The dog was diagnosed as having small-bowel obstruction (SBO) due to intra-abdominal adhesions and small-bowel fecal material (SBFM) by using abdominal radiography, ultrasonography, computed tomography, and laparotomy. We removed the obstructive adhesive lesion and SBFM through enterotomies and applied an autologous peritoneal graft to the released jejunum to prevent re-adhesion. After the surgical intervention, the dog recovered quickly and was healthy at 1 year after the surgery without gastrointestinal signs. To our knowledge, this study is the first report of a successful treatment of SBO induced by postoperative intra-abdominal adhesions and SBFM after laparotomies in a dog.

Download Full-text

Therapeutic Role of Gastrograffin in Adhesive Small Bowel Obstruction After Unsuccessful Conservative Treatment

Med Phoenix ◽

10.3126/medphoenix.v5i1.31395 ◽

2020 ◽

Vol 5 (1) ◽

pp. 26-31

Author(s):

MD Alam Shahid ◽

Pashupati Bhatta ◽

Akash Raya ◽

Binod Kumar Rai

Keyword(s):

Small Bowel ◽

Conservative Treatment ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Appendectomy ◽

Sampling Technique ◽

Exploratory Laparotomy ◽

Water Soluble ◽

Adhesive Small Bowel Obstruction ◽

Therapeutic Role

Background: The management of adhesive small bowel obstruction is quite debatable. Gastrograffin, a water-soluble hyperosmolar contrast is used as a diagnostic tool widely but it also has impressive therapeutic role. Hence this study was to determine its therapeutic role in management of adhesive bowel obstruction after failure of conservative treatment. Methods: This cross-section observational study of 42 patients was conducted in 1-year duration from 01 July 2018 to 30 June 2019 using non-probability purposive sampling technique. All the patients were first managed conservatively for 48 hrs, and then given 100ml of gastrograffin through NG tube and clamped. Appearance of dye in cecum on radiograph at different time frame (4, 8, 12 and 24 hours of administration) signifies the success and who failed to do so within 24 hrs. were planned for laparotomy. Results: A total of 42 patients with their age ranged 14-80 years (mean 44.6) were included. Among them 32 (76.19%) were male and 10 (23.80%) female. Most had open appendectomy followed by gynaecological surgery and exploratory laprotomy. Majority had midline incision followed by gridiron and pfanensteil incision. After 8 hrs of gastrograffin administration, it was positive in 12 patients while 19 had at 24 hrs. Total 31 patients showed complete resolution, while remaining 11 showed no improvement and undergone exploratory laparotomy. Conclusion: Thus, the administration of gastrograffin is an effective approach in the management of adhesive small bowel obstruction after failed conservative management and prevents surgeries.

Download Full-text