Management of patients diagnosed as acute intestinal obstruction secondary to adhesions

In an attempt to define an optimal strategy for managing small bowel obstruction secondary to adhesions, we reviewed 116 such cases encompassing a 5-year period at Hackensack Medical Center. Ninety-five patients underwent a trial of nonoperative treatment with a 35 per cent failure rate necessitating operation. This result was not influenced by the type of enteral tube used for decompression or predictable on the basis of initial clinical or laboratory findings. Significant complications occurred in those patients delayed more than 48 hours. The classic signs were poor indicators of strangulation. Patients with small bowel obstruction secondary to adhesions should be operated upon early (within 24 hours) but may be treated nonoperatively for 24 to 48 hours, provided that no signs of strangulation are present or develop. Failure to show improvement during this 48-hour period requires immediate operative intervention. The group as a whole would have benefited if early operation were done routinely.