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 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 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.

scholarly journals Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

2009 ◽  
Vol 91 (3) ◽  
pp. 205-209 ◽  
Author(s):  
JO Larkin ◽  
TB Thekiso ◽  
R Waldron ◽  
K Barry ◽  
PW Eustace
Keyword(s):  
Emergency Surgery ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Sigmoid Volvulus ◽  
High Rate ◽  
Colonoscopic Decompression ◽  
Non Operative Management ◽  
Overall Mortality

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

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

scholarly journals Operative versus non-operative management of adhesive small bowel obstruction: A systematic review and meta-analysis

2017 ◽  
Vol 45 ◽  
pp. 58-66 ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Nilanjan Panda ◽  
Rao Muhammad Asaf Khan ◽  
Samik Kumar Bandyopadhyay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Meta Analysis ◽  
Operative Management ◽  
Adhesive Small Bowel Obstruction ◽  
Non Operative Management

scholarly journals Post Endoscopic Retrograde Cholangiopancrea-Togram (ERCP) Perforation Managed Successfully Conservatively: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Abdul Malek Mohamad ◽  
Azrin Waheedy Ahmad ◽  
Junaini Kasian
Keyword(s):  
Case Report ◽  
Early Recognition ◽  
Hepatic Duct ◽  
Operative Management ◽  
Free Fluid ◽  
Contrast Extravasation ◽  
Distal Common Bile Duct ◽  
Cbd Stone ◽  
The Right ◽  
Non Operative Management

Introduction: We aim to report an uncommon case of post ERCP perforation that effectively managed conservatively in non-hepatobiliary surgery centre. Case report: A 46-year-old man diagnosed to have obstructive jaundice secondary to distal common bile duct (CBD) stone. He underwent ERCP at a private centre, sphincterotomy was performed, but, the operator had failed to insert the stent and complicated with post ERCP perforation evidenced by contrast extravasation beyond 1/3rd of the CBD and referred to our centre. Patient was subjected for re ERCP. There were difficulties in cannulating the CBD and stent was inserted. Cholangiogram revealed contrast leak around the pancreatic duct and bifurcation of hepatic duct. There was no evidence of CBD stone. Computed Tomography (CT) of the abdomen revealed extensive subcutaneous emphysema on the right side of the abdomen to right inguinal region, extensive retroperitoneal free air and pneumoperitoneum, but there were no free fluid or contrast extravasation. The patient subjected for non-operative management (NOM) for the complication and kept fasting with total parenteral nutrition and intravenous antibiotic. He recovered well with the opted management. Patient was programmed with Gastrograffin study after 10 days that showed no evidence of contrast leak to suggest free bowel injury. He was allowed orally after that and was discharged well after 15 days with stent in situ. During follow up, he was well, and the stent removed after 3 months. Patient planned for laparoscopic cholecystectomy and on table cholangiogram. Conclusion:  Post ERCP perforation is uncommon but lethal. Early recognition of the complication is crucial hence appropriate management can be arranged to avoid death. To date, surgery is not the only choice available to manage this complication.

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.

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