Obstruction of the small bowel in the early postoperative period

To analyze factors related to etiology, diagnosis, and outcome, we reviewed the records of 26 patients in whom a clinical picture of small bowel obstruction developed within one month after abdominal surgery. The initial operation was an emergency procedure in 20 cases and an exploratory laparotomy after trauma in 11. The colon was the organ most commonly operated upon initially, being involved in ten procedures (38%), all of which were emergencies. The clinical diagnosis of bowel obstruction was made within ten days postoperatively in most cases. Surgical reexploration was required in 15 patients (58%), whereas the obstructive symptoms resolved with nasogastric suction in 11. Two patients, both of whom survived, required resection of strangulated bowel; in both a treatment delay of at least 72 hours was documented. There were two deaths (8%), neither of which was directly related to the bowel obstruction. Diagnosis of this clinical entity requires a high index of suspicion, especially after emergency procedures that involve the colon. Optimal survival is achieved by prompt recognition and early intervention when a mechanical bowel obstruction is suspected in the early postoperative period.