Mechanical small bowel obstruction due to adhesions

During the years 1971-1975, 103 patients were operated on for adhesive small bowel obstruction, giving an incidence of 80 per 1 million inhabitants per year. Previous laparotomy caused the obstruction-provoking adhesions in 90% of the cases. Appendicectomy, gynaecological operations, and operations on the intestine were the three most common surgical procedures performed prior to the obstruction. In 40 cases with clinically less severe symptoms and signs follow through radiological studies with contrast medium secured the diagnosis of obstruction. The mortality rate was 5.8% and increased with the duration of symptoms. Two patients died of complications caused by intestinal fistula following lysis of extensive, firm adhesions. Bypass or bowel resection might be safer procedures in those cases. Bowel resection did not affect the mortality rate. None of the 23 patients with strangulation died. This may be due to early operation since the mortality rate in the series as a whole doubled when symptoms had lasted for more than 24 hours. Recurrence rate after operation for adhesive small bowel obstruction was 27.8% and eight patients required relaparotomy.