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Early operation or conservative management of patients with small bowel obstruction?

B T Fevang1, D Jensen, K Svanes

  • 1Department of Surgery, Haukeland University Hospital, University of Bergen, Norway. bjorg.fevang@kir.uib.no

The European Journal of Surgery = Acta Chirurgica
|January 29, 2003
PubMed

Insights

Initial conservative treatment is effective for most small bowel obstruction (SBO) cases without strangulation. Early surgery is reserved for patients with signs of strangulation or complete obstruction requiring further diagnostic evaluation.

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology
  • Abdominal Surgery

Background:

  • Small bowel obstruction (SBO) is a common surgical emergency.
  • Initial management strategies for SBO vary, impacting patient outcomes.
  • Non-operative treatment is a potential approach for select SBO cases.

Purpose of the Study:

  • To evaluate the outcomes of initial non-operative management for patients diagnosed with small bowel obstruction (SBO).
  • To determine the success rates and complications associated with conservative treatment of SBO.
  • To identify predictors for operative intervention in SBO patients.

Main Methods:

  • Prospective study conducted at a university hospital.
  • Included 154 patients (166 episodes) with SBO, excluding specific conditions like cancer-related SBO or incarcerated hernias.
  • Patients with strangulation signs underwent early surgery; others received a trial of conservative treatment.

Main Results:

  • Of 146 patients initially treated conservatively, 64% resolved without surgery.
  • Bowel strangulation occurred in 6% of conservatively treated patients, with a 2% mortality rate.
  • Partial obstructions without strangulation had a 79% resolution rate with conservative management.

Conclusions:

  • Conservative management is recommended as the initial treatment for small bowel obstruction (SBO) in patients without signs of strangulation.
  • Complete SBO may resolve conservatively, but advanced diagnostics may aid in identifying patients needing early surgery.
  • This approach can reduce unnecessary operative interventions for SBO.
Abstract

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