EP.FRI.798 Emergency surgery: Acute intestinal obstruction – how are we doing three years post NASBO guidelines?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Guillaume Lafaurie ◽  
James Butterwoh ◽  
Angeliki Iakovou ◽  
Alec Engeldow
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Holistic Approach ◽  
District General Hospital ◽  
Operative Management ◽  
Acute Intestinal Obstruction ◽  
Water Soluble ◽  
Average Hospital

Abstract Aims 10% of emergency surgical admissions are due to acute intestinal obstruction. If surgery is required, the mortality is raised to 10%. The latest 2017 National Audit of Small Bowel Obstruction (NASBO) has identified several key investigative and therapeutic targets. Our aim is to look into our clinical practice and compare it to the NASBO standards.  Methods In a district general hospital (DGH), we prospectively collected data of 30 patients coming consecutively with acute small bowel obstruction looking into imaging, conservative management, surgical management and outcomes.  Results 30 patients were included in this study with mean age of 69 years (24-88 years old), with an average hospital stay of 7 days (1 - 46 days). Bowel obstruction aetiology included: 15 secondary to adhesions, 5 hernias, 4 crohns strictures and others. 28 patients had AXR on admission as well as CT with average time to CT of 13.4 hours from admission. A third received water soluble contrast, on average 32.9 hours after admission. A third patients required surgery, undertaken on average 60 hours from admission. The outcomes showed 25 recovering well and going home and a 30-day mortality of 13% (4/30). Seven patients received dietician input, two patients were reviewed by geriatricians before surgery and none post-operatively.  Conclusion From a previous review of our practice we improved in terms of instigating timely investigations and prompt decision to surgery. However, we need to clearly work towards a more holistic approach including dietician and geriatrician input within the complex post-operative management of these patients. 

Evaluating suspected small bowel obstruction with the water-soluble contrast challenge

2021 ◽  
Author(s):  
Edward M. Lawrence ◽  
Perry J. Pickhardt
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Operative Management ◽  
Ease Of Use ◽  
Water Soluble ◽  
Oral Contrast ◽  
Tips And Tricks ◽  
Water Soluble Contrast ◽  
Non Operative Management

With optimized technique, the water-soluble contrast (WSC) challenge is effective at triaging patients for operative versus non-operative management of suspected small bowel obstruction (SBO). Standardized study structure and interpretation guidelines aid in clinical efficacy and ease of use. Many tips and tricks exist regarding technique and interpretation, and their understanding may assist the interpreting radiologist. In the future, a CT-based WSC challenge, utilizing oral contrast given as part of the initial CT examination, might allow for a more streamlined algorithm and provide more rapid results.

scholarly journals P53 First Reported Case of Successful Non-Surgical Management for Acute Small Intestinal Obstruction Caused by Enterolith as A Rare Complication of Jejunal Diverticulosis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Fang Fang Quek ◽  
Andrew Tanase ◽  
Fang Fang Quek
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rare Complication ◽  
Acute Intestinal Obstruction ◽  
Jejunal Diverticulosis ◽  
Jejunal Diverticulum ◽  
Life Threatening

Abstract Introduction Enterolith ileus is a rare complication of jejunal diverticulosis, which in itself is a rare entity. Here we report a rare case of enterolith ileus as a complication of jejunal diverticulosis which is successfully managed conservatively. Case Report A 75-year-old female presented with a 7- day history of “gripey” abdominal pain with intermittent vomiting. She was able to pass flatus and had open bowel with small amount of loose stool. Patient was previously fit and well with no significant past medical history and had not undergone previous abdominal surgery. On admission, patient was in no acute distress and was afebrile. On examination, she had a very distended tympanic abdomen with left-sided tenderness but no palpable mass. Bowel sounds were present. Laboratory investigations revealed a white cell count of 22.6 x109/L, C-reactive protein of 26 mg/L and haemoglobin of 144 g/L. Abdominal X-rays revealed distended loops of small bowel indicating small bowel obstruction. CT images did not reveal pneumobilia which would be suggestive of gallstone ileus but showed intraluminal small bowel obstruction secondary to an enterolith in the terminal ileum. The scan also showed an inflamed jejunal diverticulum with fat stranding around but no perforation nor abscess was seen. The working diagnosis was acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum. Since no perforation nor abscess was noted, this patient was treated conservatively. Patient recovered uneventfully and was discharged with an MRI scheduled in 4-6 weeks for follow-up. The follow-up MRI was completely normal and patient has recovered uneventfully with conservative management. Discussion Acute intestinal obstruction caused by jejunal enterolith expulsed from jejunal diverticulum is rare. However, it is important to diagnose jejunoileal diverticulosis timely as they may lead to acute complications which can be life- threatening and may even cause death. Conclusion Many cases have reported jejunoileal diverticulosis being overlooked or misdiagnosed for other acute abdominal conditions. It is important to have a clinical awareness of this condition as although rare, it can lead to life-threatening complications.

scholarly journals Acute intestinal obstruction due to appendicular tie syndrome: a rare case report

2019 ◽  
Vol 6 (9) ◽  
pp. 3446
Author(s):  
Akash Agrawal ◽  
Palak Vora
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Rare Case ◽  
Acute Intestinal Obstruction ◽  
Postoperative Adhesions ◽  
Surgical Emergencies ◽  
Common Causes ◽  
Rare Case Report

Acute intestinal obstruction is one of the most common surgical emergencies encountered by surgeons on daily bases. Most common causes for small bowel obstruction includes postoperative adhesions and hernia. One of the rarest cause of intestinal obstruction is appendicular band syndrome. Here we report a case of small bowel obstruction due to appendicular tie syndrome in a 70 years old male patient at GMERS hospital, Dharpur, Patan, Gujarat, India.

scholarly journals Morphofunctional changes of the hemocirculatory bed of the liver in different types of acute small bowel obstruction

2018 ◽  
Vol 17 (3) ◽  
pp. 92-101
Author(s):  
V. E. Milyukov ◽  
V. G. Motalov ◽  
H. M. Sharifova
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Unit Area ◽  
Clinical Manifestations ◽  
Acute Intestinal Obstruction ◽  
Vascular Bed ◽  
Different Types ◽  
Acute Small Bowel Obstruction

The purpose of the work - to identify patterns of changes in the morphofunctional organization of the vascular bed of the liver at different stages of development of strangulational and obturating acute small bowel obstruction (ASBO). Material and methods. The study was performed on 33 adult mongrel dogs of both sexes weighing 17-20 kg. The morphology of the liver in normal was studied on 2 (two) of those dogs. Twelve animals were simulated with a strangulational ASBO. In 12 animals, a low obturating ASBO was simulated. A morphometric method was used to assess the change in the volume of the vascular bed in terms of the degree of change in the area of the vessels per unit area. Results. In the dynamics of the development of the disease, we revealed patterns of changes in the morphofunctional organization of the vascular bed of the liver. Conclusions. In the process of formation of obturating ASBO, in spite of the absence of clinical manifestations of acute intestinal obstruction, the emergence of a basis for the development of polyorganic insufficiency has already been observed from 2 days.

scholarly journals Acute small bowel obstruction caused by phytobezoar Meckel diverticula

2019 ◽  
pp. 118-121
Author(s):  
S. V. Tarasenko ◽  
A. A. Natal`skij ◽  
O. D. Peskov ◽  
A. Yu. Bogomolov ◽  
P. V. Tarakanov
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Adult Population ◽  
Rare Condition ◽  
Acute Intestinal Obstruction ◽  
Meckel Diverticulum ◽  
Surgical Department ◽  
Acute Small Bowel Obstruction

Introduction. Meckel diverticulum-is a residue of not completely reduced yolk duct. Among the occurring complications of Meckel’s cuticle in the adult population, acute intestinal obstruction prevails. In this case, the most common intussusception and inversion of the intestines. The occurrence of small bowel obstruction due to phytobesoar in the Meckel diverticulum is a rare condition and has been described in the literature in isolated cases. Materials and methods. The patient of 29 years entered the surgical Department with complaints of abdominal pain of a permanent nature, violation of the discharge of stool and gases, vomiting up to 4 times. Sick for about 2 days. Fluoroscopy of the abdomen showed multiple arches with small bowel fluid levels, single bowl kloybera. The man was operated on urgently with a diagnosis of acute mechanical small bowel obstruction. Results. During the operation, Meckel’s phytobezoar diverticula was detected, which caused acute small bowel obstruction, for which the fragmentation of the bezoar was performed with its relegation to the cecum. The postoperative period proceeded without complications, the patient was discharged on the 10th day after surgery. After 6 weeks, the patient underwent laparoscopic diverticulectomy as planned. Discharged for 5 days. Conclusion. A clinical case of treatment of a patient with phytobezoar Meckel diverticulum complicated by acute mechanical small bowel obstruction is presented. The use of delayed diverticulectomy can reduce the risk of anastomosis failure in acute intestinal obstruction, and if proper diet is observed, it reduces the risk of recurrent intestinal obstruction before re-planned hospitalization.

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

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.

scholarly journals Case of combination of acute intestinal obstruction and acute myocardial infarction

2019 ◽  
Vol 178 (3) ◽  
pp. 47-50
Author(s):  
D. A. Smirnov ◽  
A. V. Birjukov ◽  
R. D. Ivanchenko ◽  
D. A. Vaulina ◽  
A. Ju. Korolkov
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Female Patient ◽  
Bowel Obstruction ◽  
Acute Intestinal Obstruction ◽  
Adhesive Small Bowel Obstruction

The case of combination of acute myocardial infarction and acute adhesive small bowel obstruction in 70-years old female patient was reported.

508 Conservative Management of Small Bowel Obstruction: A Local Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Gonzalez ◽  
M Aker ◽  
P Manjunath ◽  
A Mishra ◽  
N Ward
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Positive Impact ◽  
Statistical Significance ◽  
Water Soluble ◽  
Abdominal Adhesions ◽  
Initial Management ◽  
Local Experience ◽  
Immediate Surgery

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.

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