Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions

A new risk scoring system for early prediction of surgical need in patients with adhesive small bowel obstruction: a single-center retrospective clinical study

Purpose

Cases of adhesive small bowel obstruction are a nuisance to surgeons. There have been years of ongoing discussions, and various guidelines have been published for the management of this disease. Both surgical and conservative approaches can have their own complications. It is often difficult to decide which treatment to apply to which patient. We aimed to create a multiparametric scoring system for the optimal management of adhesive small bowel obstruction patients.

Methods

The retrospective laboratory, clinical and radiological records of 100 patients who were hospitalized and followed-up/treated for adhesive small bowel obstruction secondary to surgery in the General Surgery Clinic of Haydarpaşa Numune Education and Research Hospital (Istanbul) between 2011 and 2021 were reviewed and statistically analyzed.

Results

Admittance CRP and the largest diameter of the small intestine in the horizontal section of the admittance CT scans were significantly higher (P = 0.006 and P = 0.007), and the admittance albumin and sodium values were significantly lower (P < 0.001 and P = 0.031) in patients operated on for adhesive small bowel obstruction than in patients not operated on. Free intraperitoneal fluid in CT scans was detected at a higher rate in the operated group. An adhesive small bowel obstruction surgery score above 3.5 points out of 7 was found to be significant (P < 0.001).

Conclusion

With this easy and applicable scoring system, complications of existing disease may be avoided by considering earlier surgical intervention in patients with a score of 4 and above.

Surgery for acute abdomen in adult patients with severe motor and intellectual disabilities

Purpose

The present study aimed to examine the characteristics, outcomes, and problems related to surgery for acute abdomen in adult patients with severe motor and intellectual disabilities (MID).

Methods

The clinical records of 35 adult patients with severe MID who received emergency surgery for acute abdomen between 2011 and 2020 were reviewed.

Results

The median duration from onset to surgery was 48 hours. There were 2 cases of in-hospital mortality (5.7%), and all the patients underwent surgery more than 72 hours after onset. The in-hospital mortality rate was significantly higher in patients who received surgery later than 72 hours after onset. Bowel obstruction was the most common disease among the acute abdomen cases (71.4%) and most often involved volvulus of the small bowel and cecum. Of the patients with bowel obstruction with severe MID, 72.0% had abdominal distention, 16.0% had abdominal pain, and 4.0% had vomiting. The median duration from onset to surgery was significantly longer in the patients with bowel obstruction with severe MID than in those without severe MID (24 hours vs. 16 hours).

Conclusion

Acute abdomen in patients with severe MID was often due to bowel obstruction caused by volvulus. Because patients with severe MID have few symptoms, they are susceptible to adverse surgical outcomes associated with a prolonged duration from onset to surgery.

Magnitude and determinants of treatment outcome among surgically treated patients with intestinal obstruction at Public Hospitals of Wolayita Zone, Southern Ethiopia: a cross sectional study, 2021

Background

Procedures to treat intestinal obstruction range from minimally invasive laparoscopic surgery to more complicated open surgical procedures. It may end with high morbidity and mortality because of different reasons. It is very important to know about the determinants of favorable outcome of surgical management for intestinal obstruction however, little is known about this problem at public hospitals of Southern Ethiopia.

Methods

Facility based cross sectional study was conducted. A total of 230 medical records which fulfill the inclusion criteria were used for this study. Variables with p value of less than 0.25 in the bivariate analysis were entered in multivariable logistic regression to control confounding. Finally, odds ratio with 95% confidence interval was used to identify variables which were significantly associated with dependent variable.

Results

According to this study the magnitude of favorable surgical management outcome of intestinal obstruction was 177(77.0%) [95% CI, 71.4, 82.4]. Having small bowel obstruction (AOR = 2.49) [95% CI 1.91, 5.12], having simple bowel obstruction (AOR = 4.32) [95% CI, 2.00, 9.35], early presentation of patients (AOR = 4.44) [95% CI, 1.99, 9.92] and intraoperative procedure other than resection and anastomosis was performed (AOR = 0.45) [95% CI, 0.21, 0.96] were significantly associated with favorable outcome among surgically treated patients.

Conclusion

The overall magnitude of favorable surgical management outcome of intestinal obstruction was moderate compared to other study. Having small bowel obstruction, having simple bowel obstruction, other procedure other than resection and anastomosis done, and early presentation of patients were significant predictors. Physicians should diagnose intestinal obstruction early and appropriate interventions should be taken on time before the complication happened. On time consultation and decision at the hospital setting is also recommended.

Effect of sodium hyaluronate-arboxycellulose membrane (Seprafilm®) on postoperative small bowel obstruction: A meta-analysis

BACKGROUND

This meta-analysis was performed to evaluate the effect of Seprafilm® on postoperative small bowel obstruction.

METHODS

A literature search was conducted in the PubMed and EMBASE databases through August 2020. The pooled risk ratios as well as the corresponding 95% confidence intervals were calculated using RevMan 5.3 software.

RESULTS

A total of 9 clinical control trials involving 4,351 patients (2,123 in the Seprafilm® group and 2,228 in the control group) were included. The overall analysis showed that the pooled risk ratio was 0.45 (95% confidence interval = 0.34-0.60; P < .00001), indicating that the risk of postoperative small bowel obstruction can be significantly decreased by the application of Seprafilm®. Similarly, an obvious effect of Seprafilm® on reducing the rate of postoperative small bowel obstruction was also shown in the subgroup analyses by population (adult participants), study design (randomized control study or nonrandomized control study), region (Japan or Korea), follow-up duration (2 years or 5 years), and sheet number of Seprafilm® (1 sheet or >1 sheet).

CONCLUSION

In conclusion, the use of Seprafilm® is beneficial for decreasing the rate of postoperative small bowel obstruction.

Etiologic Spectrum of Intestinal Obstruction in Ningxia District: A Retrospective Analysis of 4908 Cases in a 10-Year Period

BACKGROUND

Economic disparity contributes to the variation of intestinal obstruction (IO) etiologic spectrum. Clarifying the etiology distribution in local regions can help to unravel IO and promote early diagnosis, henceforth making sure standardized therapeutic interventions.

METHODS

Medical data of 4908 inpatients diagnosed with IO admitted to the General Hospital of Ningxia Medical University between January 2004 and December 2013 were recruited and analyzed retrospectively. The associated profiles included demographic features, clinical manifestations, and previous therapeutic operations.

RESULTS

4908 cases of intestinal obstruction were identified during the period of study. It denoted that the hospitalization rate of IO has maintained upward momentum; the top four causes of IO were adhesion, tumor, intussusception, and hernias. These covered up nearly 80% of the total constitution. Among them, adhesive intestinal obstruction accounted for 45.17%, malignant bowel obstruction for 21.09%, intussusception for 8.72%, and hernia for 4.73%; abdominal surgery constituted for the majority (78.62%) of adhesive obstruction. The followed up analysis also found that appendectomy accounted for the biggest percentage, 28% of operation cases. Malignant bowel obstruction can have a rate of 96.43% in 1035 cases led by tumor lesions. Of which, the primary intestinal malignant tumor accounted for 68.64% and metastatic tumors for 31.36%. Nearly 50% occurred in the large intestine. The overall mortality of all 4908 cases was 4.7%.

CONCLUSION

The hospitalizations of IO delineated an increasing trend. Adhesion was the main etiology in IO. The odds of malignant bowel obstruction was increasing in the proportion of IO. There were some differences towards the etiologic spectrum compared with western countries.

Praxagoras of Cos (4th Century BC) and His Innovative Method of a Diverting Enterocutaneous Fistula to Relieve Small Bowel Obstruction

Born in an island with huge medical tradition in ancient Greece, Praxagoras of Cos became an esteemed medico-philosopher and surgeon. The evolution made by the Hippocratic School of Medicine further boosted his talent and helped him perform surgical operations, which were believed impossible for his era. Praxagoras introduced an innovative surgical technique to confront small bowel obstruction, by creating an enterocutaneous fistula. This historical review connects all available data to present the life and work of an important medical figure of the ancient Hellenic School.

Cost effectiveness analysis of duration of nonoperative management for adhesive bowel obstruction in a developing country

Background

Adhesive bowel obstruction (ABO) costs billions of dollars in developed countries. Cost is unknown in developing countries. This depends on the type of management and duration of hospital stay. Nonoperative management (NOM) of uncomplicated obstruction is safe for up to 10 days. While it remains cost effective, the most efficient duration of nonoperative management must retain its advantages over operative management.

Aim

To describe cost effectiveness of various durations of nonoperative management of adhesive obstruction in a developing country.

Method

Over 2 year period, Patients who had uncomplicated adhesive obstruction were observed on trial of nonoperative management. Length of hospital stay and success rate were combined as surrogates for Cost effectiveness analysis of 2 to 5 days and ≥7 days nonoperative management.

Results

41 patients (24(58.5%) females) were eligible. Mean age 38.4 ± 14.7 (range 18–80) years. 31 (75.6%) were first time admissions. The most common previous abdominal operations were for appendix and obstetrics and gynecologic pathologies. Median duration of nonoperative management (dNOM) was 4 days, median LOS was 9 days. Nonoperative management was successful in 53.7% (22 patients). Total estimated direct hospital cost of 41 adhesive bowel obstructions was $133,279. Total personnel charges were $112,142. Mean operative and nonoperative management was $4,914 and $1,814 respectively (p <0.0001). Most of successful nonoperative management was within 5 days. 4 days nonoperative management had the highest cost utility.

Conclusion

From this study, without indications for immediate surgical intervention, 4 days nonoperative management is the most cost effective course, after which surgical intervention may be considered if there is no improvement.

Complete ileal transection: A rare complication of adhesive bowel disease—A case report

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Post-operative adhesions are common after abdomino-pelvic surgery.

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Adhesions have been named the commonest cause of intestinal obstruction.

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Various risk factors for formation of adhesions.

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Halstedian principles to be followed to minimize risk of post-operative adhesions.

Introduction

Adhesive bowel disease is a sequel of abdominal surgeries and has come forth as the leading cause of small bowel obstruction (SBO). It may also lead to chronic abdomino-pelvic pain and infertility in women. Adhesions form as a result of peritoneal irritation, giving rise to an inflammatory process. The treatment of choice for adhesive small bowel obstruction remains controversial, and relies on the surgeon’s judgment.

Case presentation

Being described is an unusual case of a young girl who developed complete ileal transection secondary to postoperative adhesive band formation.

Conclusions

Adhesive small bowel disease (ASBD) and small bowel obstruction are a major cause of patient distress and financial and clinical practice burden. It is usually a diagnosis of exclusion and leads to delayed treatment and morbidity. Many preventive techniques and materials are being tested to prevent adhesion formation. A lot more needs to be done to prevent, in the first place, the formation of adhesions or treat this condition to reduce such morbid outcomes as strangulation or transection of gut.

Adhesions small bowel obstruction in emergency setting: conservative or operative treatment?

Adhesions small bowel obstructions (aSBO) are among the leading causes of emergency operative intervention. About the 80% of aSBO cases resolve without a surgical treatment. It's important to identify which patients could undergo a conservative treatment to prevent an useless surgery The aim of this study is to determine findings that can indicate whether patients with aSBO should undergo a conservative or a surgical treatment. 313 patients with diagnosis of submission of aSBO were restudied. Patients were divided into two groups based on the different type of treatment received, 225 patients who underwent surgical treatment within 24 hours after admission, 88 patients which underwent conservative treatment successfully. For each patient, clinical, hematochemical and radiological findings have been analysed. The treatment of aSBO should be, at the beginning, conservative except that cases that presents clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum).