Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital

A retrospective study was carried out on 321 cases of adhesive small bowel obstruction in 289 patients admitted at the Chulalongkorn Hospital over an 8 year period. Appendectomy was the most common operation preceding the obstruction. Early operation was performed in 54 cases with two deaths, and nonviable and borderline bowel was found in 30.2 percent. Continuous abdominal pain, generalized tenderness, guarding, and distension appeared to influence the attending surgeons' decisions to operate early. A trial of conservative treatment with nasogastric decompression was carried out in 267 cases with one death. Conservative treatment was successful in 126 cases, but in 140 cases, there was no improvement or the condition became worse and a delayed operation was required. There was no mortality in the delayed operation group and nonviable and borderline bowel was found in 22.8 percent of cases. The incidence of nonviable and borderline bowel did not increase with the length of delay, but was more frequent in those whose condition grew worse after conservative treatment. No preoperative factors that could reliably predict bowel strangulation were found. However, the results in this series justify a trial of conservative treatment with close observation in patients without clinical evidence of strangulation or marked abdominal distension.