Successful Non-Operative Management of Adhesive Small Bowel Obstruction: Is it Really a Success?

Area of Science:

• Gastroenterology
• Surgical Outcomes
• Abdominal Surgery

Background:

• Adhesive small bowel obstruction (ASBO) is a common surgical complication.
• Water-soluble contrast challenge is used to predict successful non-operative management (NOM) for ASBO.
• Long-term outcomes comparing 8-hour versus 24-hour contrast transit times for ASBO are not well-established.

Purpose of the Study:

• To investigate the one-year recurrence rates of ASBO based on water-soluble contrast transit time to the colon.
• To determine if longer transit times are associated with increased ASBO recidivism.

Main Methods:

• Retrospective review of 137 patients with ASBO undergoing successful NOM over 4 years.
• Patients were stratified into 8-hour and 24-hour groups based on contrast reaching the right colon.
• One-year follow-up was conducted to assess ASBO recurrence.

Main Results:

• The 24-hour group (n=25) had a significantly higher one-year recurrence rate (40%) compared to the 8-hour group (n=112, 21.4%; P=0.05).
• Median time to recurrence was shorter in the 24-hour group (13 days) versus the 8-hour group (113 days; P=0.02).
• First-time ASBO and 24-hour transit time were identified as risk factors for recurrence on univariable analysis.

Conclusions:

• Patients with ASBO managed non-operatively with a 24-hour contrast transit time experienced nearly double the recurrence rate compared to the 8-hour group.
• Consideration for operative exploration at the 8-hour contrast mark may be beneficial for ASBO patients, particularly those with a first-time obstruction.