Small bowel obstruction in the elderly

The records of 56 consecutive patients, age 70 years or older, who were operated on for mechanical small bowel obstruction were reviewed to determine the effect of early operation versus delayed operation. Delayed operation was defined as a laparotomy performed more than 48 hours after admission. Excluding the 13 patients with hernias, there were no significant differences between the early operation and delayed operation groups in regard to age, cause of small bowel obstruction, duration of prehospitalization symptoms, degree of underlying disease, or physical findings on presentation--with the exception of a significantly higher number of patients in the early operation group who had abdominal tenderness. There were no differences between mortality and small bowel infarction rates in the two groups. There was an increase in the complication rate (60 vs 24%, P less than .05) and the mean length of stay (29.6 vs 20.0 days, P less than 0.05) in the delayed operation group. This increased mean length of stay was directly related to the higher number of complications caused by delay in operation. Advanced age in a patient with complete small bowel obstruction should not stay the surgeon's hand because delay only leads to a prohibitive increase in complications and length of hospitalization.