Small bowel obstruction in a virgin abdomen.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Surgical exploration is often considered mandatory for small bowel obstruction (SBO) in patients with a virgin abdomen.
• Determining the etiology of SBO in this population is critical for appropriate management.

Purpose of the Study:

• To investigate the causes of small bowel obstruction (SBO) in patients who have not undergone previous abdominal surgery.
• To evaluate the diagnostic yield and outcomes of surgical exploration versus non-operative management in this patient group.

Main Methods:

• Retrospective review of 60 patients with SBO and a virgin abdomen treated at Mayo Clinic (2006-2016).
• Analysis of follow-up data, operative findings, and pathological results to determine SBO etiology.
• Correlation of clinical factors (leukocytosis, weight loss) with exploration outcomes.

Main Results:

• Of 60 patients, 50 (83%) underwent exploration, with 29 (58%) having therapeutic findings.
• Malignancy was diagnosed in 8 patients (13%), including colon cancer, small bowel neuroendocrine tumors, and lymphoma.
• Leukocytosis and absence of recent weight loss were associated with negative explorations.

Conclusions:

• Small bowel obstruction in patients with a virgin abdomen frequently stems from benign etiologies.
• Thorough review of imaging for subtle malignancy signs is essential.
• Non-operative management necessitates close follow-up, including history and colonoscopy.