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Adhesive small bowel obstruction: how long can patients tolerate conservative treatment?
Shou-Chuan Shih1, Kuo-Shyang Jeng, Shee-Chan Lin
1Gastroenterology Section, Department of Internal Medicine, Mackay Memorial Hospital and Mackay Junior College of Nursing, No. 92, section 2, Chang-San North Road, Taipei, Taiwan, China. sschuan@ms2.mmh.org.tw
Aim:
To evaluate how long patients with small bowel obstruction caused by postoperative adhesions can tolerate conservative treatment.
Methods:
The records of patients with small bowel obstruction due to postoperative adhesions were retrospectively reviewed. Data collected included the number of admissions, type of management for each admission, duration of conservative treatment, number of repeat laparotomies, and operative findings.
Results:
One hundred fifty-five patients with this condition from January 1999 to December 2001, for a total of 293 admissions were enrolled in this study. Medical treatment alone was given in 220 admissions, and repeat laparotomy was performed in 73 admissions. The period of observation in patients managed medically ranged from 2 to 12 days (average: 6.9 days), while for those who underwent surgery, the range was 1 to 14 days (average 5.4 days). At surgery, adhesions were the only finding in 46 cases, while there were intestinal complications in 27, or 9.2 % of all 293 admissions. Fever and leukocytosis greater than 15 000/mm(3) were prediction of intestinal complications.
Conclusion:
With closely monitoring, most patients with small bowel obstruction due to postoperative adhesions could tolerate supportive treatment and recover well averagely within 1 week, although some patients require more than 10 days of observation.