scholarly journals Predictive Factors for Surgical Intervention in Adhesive Bowel Obstruction: A 5-Year Retrospective Study

2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Afuwape OO ◽  
Ulasi IB ◽  
Ajagbe OA ◽  
Soneye OY ◽  
Ekhaiyeme PA ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Predictive Factors ◽  
Early Phase ◽  
Developing World ◽  
Surgical Intervention ◽  
Operative Management ◽  
Operative Intervention ◽  
Non Operative Management

Background: Adhesive Bowel Obstruction (ABO) is a major cause of intestinal obstruction globally and in the developing world. Although guidelines for its management lean towards initial non-operative management, it is important to identify factors that may predict the need for an operative intervention in the early phase of presentation.

Use of Early Gastrografin Small Bowel Follow-through in Small Bowel Obstruction Management

2013 ◽  
Vol 79 (8) ◽  
pp. 794-796 ◽  
Author(s):  
Nicholas Galardi ◽  
Jay Collins ◽  
Kara Friend
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Operative Management ◽  
Operative Intervention ◽  
Early Implementation ◽  
Non Operative Management ◽  
Mean Time

Small bowel follow-through (SBFT) is a diagnostic tool commonly used in the management of patients with small bowel obstruction (SBO). This study assessed whether early implementation of Gastrografin SBFT would reduce the time to resolution of the SBO and decrease the time to operative intervention. In this retrospective chart review, 103 patients with the clinical diagnosis of adhesive SBO were evaluated. End points of the study were resolution of SBO with non-operative management or operative intervention. The patient group that had received a SBFT was then compared with those that did not receive a SBFT. There were 103 patients with adhesive SBO who met inclusion criteria for this study. Seventy-two of 103 patients had undergone Gastrografin SBFT and 31 did not. In the SBFT group, mean time to the operating room was 1.0 days after SBFTs, whereas in the group that did not receive SBFT, it was 3.7 days ( P < 0.0001). Mean time to nonoperative resolution of SBO in the SBFT group was 1.8 days and 4.7 days in the no SBFT group ( P < 0.0001). There were no Gastrografin-related complications. Obtaining Gastrografin SBFT in patients with adhesive SBO leads to both a shorter time in identifying the need for operative intervention and to resolution of SBO with nonoperative management. SBFT seems to be a more definitive assessment of whether an SBO will resolve on its own or if operative intervention is necessary.

scholarly journals Non-operative Management of Adhesive Intestinal Obstruction in Children over a 12 year period at Waikato Hospital

2021 ◽  
Vol 21 (7) ◽  
pp. 433-439
Author(s):  
Aaron Ooi ◽  
Jitoko Kelepi Cama ◽  
Udaya Samarakkody ◽  
Askar Kukkady ◽  
Stuart Brown
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Case Series ◽  
Operative Management ◽  
Initial Surgery ◽  
Time Period ◽  
Case Series Study ◽  
Significant Difference ◽  
Adhesive Intestinal Obstruction ◽  
Non Operative Management

Title: Non-Operative Management of Adhesive Intestinal Bowel Obstruction in Children over a 12year Period at Waikato HospitalIntroduction: Post-operative small bowel adhesions causing bowel obstruction is common in adults but is uncommon in the paediatric age group. The incidence of adhesive intestinal obstruction (AIO) requiring surgical intervention ranges between 2-8% in paediatric patients and majority would occur within the first 2 years after surgery. Aim: To review our experience at a tertiary centre in children under 15years who were admitted with adhesive intestinal obstruction over a 12 year time period and to compare this with other international reports Methodology: This retrospective case series study of all paediatric surgical patients (aged between 1-15 years) admitted with adhesive intestinal obstruction to Waikato Hospital over a 12 year time period were identified by ICD-10-AM codes. Their demographic variables, information of previous surgery and the admissions details including particulars of management were tabulated. Results: Out of 66 admissions, 10 were excluded and 56 admissions were analysed. 35 patients were successfully managed non-operatively and 21 patients proceeded for operative management (7 early and 14 late). Of the operative group, 3 underwent bowel resections (2 early and 1 late). There was no statistically significant difference between length of stay (LOS) among patients with non-operative and operative management. There was also no statistically significant difference between LOS among patients with early (≤24 hours) operative management and late (>24 hours) operative management. In assessing secondary aims, statistically significant differences in the time of presentation from initial surgery was noted for patients who underwent appendectomy who trended towards earlier presentation compared to other laparotomies. Conclusion: This study demonstrated that there could still be a role of non-operative management of children with adhesive bowel obstruction but decision on further management should be clearly defined within 24hours to prevent development of complications.

scholarly journals A clinical study of acute intestinal obstruction in adults-based on etiology, severity indicators and surgical outcome

2017 ◽  
Vol 5 (8) ◽  
pp. 3688 ◽  
Author(s):  
Saurabh J. Tiwari ◽  
Rajiva Mulmule ◽  
Varsha N. Bijwe
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Early Recognition ◽  
Scoring Systems ◽  
Operative Management ◽  
Sigmoid Volvulus ◽  
Timing Of Surgery ◽  
Mesenteric Ischaemia ◽  
Modes Of Presentation ◽  
Non Operative Management

Background: Patients with bowel obstruction still represent some of the most difficult and vexing problems that surgeons face today. While the adage, “never let the sun rise or set on a bowel obstruction” remains true, there has been a trend towards selective non-operative management of this problem. Aims and objectives were to study the various causes and modes of presentation of intestinal obstruction and to evaluate the importance of different severity indicators of obstruction with early recognition, diagnosis and thus timely abdominal exploration.Methods: 2 years prospective study conducted in PDMMC college, Amravati, Maharashtra, India, from September 2013 to September 2015. Each intestinal obstruction patient was evaluated with specific severity indicators, scored and then analyzed.Results: The commonest cause of intestinal obstruction in adults in this study series was adhesions in 33.33% cases. Other causes were mesenteric ischaemia, i.e. 7 (11.67%), Koch’s abdomen, i.e. 5 (8.33%), sigmoid volvulus, i.e. 5 (8.33%) and carcinoma, i.e. 5 (8.33%). Resection anastomosis was most commonly performed procedure in 45.7 % cases, followed by adhesiolysis in 14% patients. 66.66% patients having a score less than 3 were managed conservatively, 95.83 % having a score of 3 or more where operated on.Conclusions: The evaluation of patients endeavours not only to confirm the diagnosis but also to determine the need for and timing of surgery. Certain severity indicators and scoring systems can help to optimize this timing of surgery and prevent mortality.

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

scholarly journals SMALL BOWEL OBSTRUCTION SECONDARY TO OBTURATOR HERNIA: A PRE-OPERATIVE DIAGNOSIS AT COMPUTED TOMOGRAPHY

2021 ◽  
Vol 6 (1) ◽  
pp. 46-49
Author(s):  
Marlina Tanty Ramli ◽  
Mohd Shukry Mohd Khalid ◽  
Kartini Rahmat
Keyword(s):  
Computed Tomography ◽  
Small Bowel ◽  
Elderly Patients ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Obturator Hernia ◽  
Uneventful Recovery ◽  
Presenting Symptoms

Obturator hernia is rare, but it must be considered in elderly patients who present with small bowel obstruction. The diagnosis is challenging unless there is a high index of suspicion as the presenting symptoms and signs are usually non-specific. Presence of positive Howship-Romberg sign is considered pathognomonic. Early diagnosis and rapid surgical intervention will reduce the high morbidity and mortality associated with undiagnosed obturator hernia. We report a case of a 93-year-old female patient who was admitted to our surgical department with symptoms of intestinal obstruction of 3-days duration. Howship-Romberg sign was negative. Computed tomography (CT) demonstrated the presence of left obturator hernia with proximal small bowel obstruction and no sign of strangulation. The patient had emergency laparotomy post-CT where the incarcerated bowel loop was released and the obstructed bowel was decompressed without any complication. The hernial defect was close with a mesh and the patient had an uneventful recovery post-surgery. In this case, we highlight that diagnosis of obturator hernia must always be considered in elderly patients who present with intestinal obstruction. Urgent CT could establish a rapid pre-operative diagnosis and aids inappropriate surgical intervention planning which is crucial in optimising the outcome.

Surgical Ascariasis in Children in Kashmir

1997 ◽  
Vol 27 (1) ◽  
pp. 13-14 ◽  
Author(s):  
Satish Kumar Pandit ◽  
Habib Ullah Zarger
Keyword(s):  
Retrospective Study ◽  
Intestinal Obstruction ◽  
Endemic Area ◽  
Surgical Intervention ◽  
Ileal Perforation ◽  
Biliary Ascariasis ◽  
High Incidence ◽  
Surgical Conditions

A retrospective study of 85 children aged 3–12 years revealed 25 cases who needed surgical intervention due to ascariasis. The surgical conditions found at laparotomy were intestinal obstruction (18) appendicitis (3), ileal perforation (2), biliary ascariasis (2). The study highlights the high incidence of surgical ascariasis among children with abdominal complaints in an endemic area.

scholarly journals Surgical treatment of tarsal coalitions in children and adolescents

2020 ◽  
Vol 5 (2) ◽  
pp. 80-89
Author(s):  
Alpesh Kothari ◽  
Javier Masquijo
Keyword(s):  
Surgical Intervention ◽  
Operative Management ◽  
Foot And Ankle ◽  
Ankle Pain ◽  
Tarsal Coalition ◽  
Algorithmic Approach ◽  
Tarsal Bones ◽  
Non Operative Management ◽  
Impaired Quality

A tarsal coalition is an abnormal connection between two or more tarsal bones caused by failure of mesenchymal segmentation. The two most common tarsal coalitions are calcaneonavicular coalition (CNC) and talocalcaneal coalition (TCC). Both CNC and TCC can be associated with significant foot and ankle pain and impaired quality of life; there may also be concomitant foot and ankle deformity. Initial, non-operative management for symptomatic tarsal coalition commonly fails, leaving surgical intervention as the only recourse. The focus of this article is to critically describe the variety of methods used to surgically manage CNC and TCC. In review of the pertinent literature we highlight the ongoing treatment controversies in this field and discuss new innovations. The evidence-based algorithmic approach used by the authors in the management of tarsal coalitions is illustrated alongside some clinical pearls that should help surgeons treating this common, and at times complex, condition. Cite this article: EFORT Open Rev 2020;5:80-89. DOI: 10.1302/2058-5241.5.180106

Longer Trials of Non-operative Management for Adhesive Small Bowel Obstruction Are Associated with Increased Complications

2019 ◽  
Vol 24 (4) ◽  
pp. 890-898 ◽  
Author(s):  
Benjamin S. C. Fung ◽  
Ramy Behman ◽  
May-Anh Nguyen ◽  
Avery B. Nathens ◽  
Nicole J. Look Hong ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Operative Management ◽  
Adhesive Small Bowel Obstruction ◽  
Non Operative Management
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