© Copyright 2007 – Eastern Association for the Surgery of Trauma 1

PRACTICE MANAGEMENT GUIDELINES

FOR SMALL BOWEL OBSTRUCTION

EAST Practice Parameter Workgroup for Management of Small Bowel Obstruction

© Copyright 2007 – Eastern Association for the Surgery of Trauma 2

Jose J. Diaz, Jr. MD; Co-Chair

Vanderbilt University Medical Center

Nashville, TN

E-mail: jose.diaz@vanderbilt.edu

Faran Bokhari, MD; Vice-Chair

Stroger Hospital of Cook County

Chicago, IL

fbokhari2000@yahoo.com

Nathan T. Mowery, MD

Vanderbilt University Medical Center

Nashville, TN

nate.mowery@vanderbilt.edu

Jose A. Acosta, MD

San Diego, CA

macosta@centennialpr.net

Ernest F.J, Block, MD

Orlando Regional Healthcare System

Orlando, FL

eblock@orhs.org

William J. Bromberg, MD

Memorial Health University Medical Center

Savannah, GA

brombwi1@memorialhealth.com

© Copyright 2007 – Eastern Association for the Surgery of Trauma 3

Bryan R. Collier, DO

Vanderbilt University Medical Center

Nashville, TN

Bryan.collier@vanderbilt.edu

Daniel C. Cullinane, MD

Mayo Clinic

Rochester, MN

cullinane.daniel@mayo.edu

Kevin M. Dwyer, MD

Inova Fairfax Hospital

Falls Church, VA

kevin.dwyer@inova.com

Margaret M. Griffen, MD

SHANDS – Jacksonville

Jacksonville, FL

maggie.griffen@jax.ufl.com

John C. Mayberry, MD

Oregon Health & Science University

Portland, OR

mayberrj@ohsu.edu

Rebecca Jerome

Vanderbilt University Medical Center

Nashville, TN

rebecca.jerome@vanderbilt.edu

© Copyright 2007 – Eastern Association for the Surgery of Trauma 4

Practice Management Guidelines for Small Bowel Obstruction

I. Statement of the Problem

The description of patients presenting with small bowel obstruction dates back to the

third or fourth century, when early surgeons created enterocutaneous fistulas to relieve a

bowel obstruction. Despite this success with operative therapy, the nonoperative

management of these patients with attempted reduction of hernias, laxatives, ingestion of

heavy metals (e.g., lead or mercury), and leeches to remove toxic agents from the blood

was the rule until the late 1800s, when antisepsis and aseptic surgical techniques made

operative intervention safer and more acceptable. A better understanding of the

pathophysiology of bowel obstruction and the use of isotonic fluid resuscitation,

intestinal tube decompression, and antibiotics have greatly reduced the mortality rate for

patients with mechanical bowel obstruction.1, 2 However, the means for determining when

a period of observation is warranted versus early surgical intervention continues to be an

area of debate. With the advances in imaging techniques additional information can be

supplied to the clinical information obtained from the history and physical. The question

of whether these technological advancements have allowed a more sophisticated

evaluation of these patients is yet to be determined. In addition which tests supply the

most information has yet to be clearly described.

Additionally the optimal length of observation continues to be debated. In the era

of a push toward shorter hospital stays correctly identifying patients who are to fail

observation is even more important. It is important to determine if clinical or

radiographic clues can increase our sensitivity in determining such patients.

Finally, as minimally invasive surgery grows and finds new applications are there

reproducible benefits to the patients in pursuing these intervention as both a diagnostic

and therapeutic intervention.

II. Process

A computerized search of the National Library of Medicine MEDLINE database was

undertaken using the PubMed Entrez interface. English language citations during the

period of 1991 through 2006 using the primary search strategy:

© Copyright 2007 – Eastern Association for the Surgery of Trauma 5

intestinal obstruction[mh] AND intestine, small[mh] AND humans[mh] NOT

(case reports[pt] OR letter[pt] OR comment[pt] OR news[pt])

Review articles were also excluded. The PubMed Related Articles algorithm was also

employed to identify additional articles similar to the items retrieved by the primary

strategy. Of approximately 550 articles identified by these two techniques, those dealing

with either prospective or retrospective studies examining small bowel obstruction were

selected, comprising 131 institutional studies evaluating diagnosis and management of

adult patients with suspected or proven small bowel obstruction. The articles were

reviewed by a group of eleven trauma / critical care surgeons who collaborated to

produce this practice management guideline. (Table 1)

The correlation between the evidence and the level of recommendations is as follows:

Level 1: This recommendation is convincingly justifiable based on the available scientific

information alone. It is usually based on Class I data, however, strong Class II evidence

may form the basis for a level 1 recommendation, especially if the issue does not lend

itself to testing in a randomized format. Conversely, weak or contradictory Class I data

may not be able to support a level 1 recommendation.

Level 2: This recommendation is reasonably justifiable by available scientific evidence

and strongly supported by expert critical care opinion. It is usually supported by Class II

data or a preponderance of Class III evidence.

Level 3: This recommendation is supported by available data but adequate scientific

evidence is lacking. It is generally supported by Class III data. This type of

recommendation is useful for educational purposes and in guiding future studies.3

III. Recommendations (Figure 1 – Flow diagram)

Diagnosis:

© Copyright 2007 – Eastern Association for the Surgery of Trauma 6

1. All patients being evaluated for small bowel obstruction should have plain films

due to the fact that plain films are as sensitive as CT to differentiate obstruction

vs. non-obstruction. LEVEL III

2. All patients with inconclusive plain films for complete or high grade SBO should

have a CT as CT scan gives incremental information over plain films in regard to

differentiating grade of obstruction and etiology of small bowel obstruction

leading to changes in planned management. LEVEL I

3. Multiple signs on CT suggesting strangulation should suggest a low threshold for

operative intervention (Table 2). LEVEL II

4. MRI and ultrasound are an alternative to CT with similar sensitivity and

identification of etiology, but have several logistical limitations. LEVEL III

5. There is a variety of literature that contrast studies should be considered in

patients who fail to improve after 48 hours of conservative management as a

normal contrast study can rule out operative small bowel obstruction. LEVEL II

6. Nonionic low osmolar weight contrast is an alternative to barium for contrast

studies to evaluate for SBO for diagnostic purposes. LEVEL I

Management:

1. Patients with plain film finding of small bowel obstruction and Clinical markers

(fever, leukocytosis, tachycardia, metabolic acidosis and continuous pain) or

peritonitis on physical exam warrant exploration. LEVEL I

2. Patients without the above mentioned clinical picture, and a partial SBO or a

complete SBO can undergo non-operative management safely; although, complete

obstruction has a higher level of failure. LEVEL I

3. Patients without resolution of the there SBO by day 3-5 of non-operative

management should undergo water soluble study or surgery. LEVEL III

4. There is no significant difference with regard to the decompression achieved, the

success of nonoperative treatment, or the morbidity rate after surgical intervention

comparing long tube decompression with the use of nasogastric tubes. LEVEL I

© Copyright 2007 – Eastern Association for the Surgery of Trauma 7

5. Water soluble contrast (Gastrograffin) given in the setting of partial SBO can

improve bowel function (time to BM), decrease length of stay, and is both therapeutic

and diagnostic. LEVEL II

6. In a highly selected group of patients the laparoscopic treatment of small bowel

obstruction should be considered and leads to a shorter hospital length of stay.

LEVEL II

Scientific Foundation

A. Historical Background

Mechanical small-bowel obstruction is the most frequently encountered surgical disorder

of the small intestine. Although a wide range of etiologies for this condition exist, intra-

abdominal adhesions related to prior abdominal surgery is the etiologic factor in up to

75% of cases of small-bowel obstruction. More than 300,000 patients are estimated to

undergo surgery to treat adhesion-induced small-bowel obstruction in the United States

annually.4

B. Diagnostic Evaluation of Small Bowel Obstruction

The diagnostic evaluation should focus on the following goals: distinguishing mechanical

obstruction from ileus; determining the etiology of the obstruction; discriminating partial

(low grade) from complete (high grade) obstruction; and discriminating simple from

strangulating obstruction.

Important elements to obtain on history include prior abdominal operations (suggesting

the presence of adhesions) and the presence of abdominal disorders (e.g., intra-abdominal

cancer or inflammatory bowel disease) that may provide insights into the etiology of

obstruction. Upon examination, a meticulous search for hernias (particularly in the

inguinal and femoral regions) should be conducted. The stool should be checked for

gross or occult blood, the presence of which is suggestive of intestinal strangulation.

Plain Films

The diagnosis of small-bowel obstruction is usually confirmed with radiographic

examination. The abdominal series consists of a radiograph of the abdomen with the

© Copyright 2007 – Eastern Association for the Surgery of Trauma 8

patient in a supine position, a radiograph of the abdomen with the patient in an upright

position, and a radiograph of the chest with the patient in an upright position. There is

class III evidence to suggest that plain films are as sensitive as CT for the detection of a

high grade bowel obstruction (86% vs. 82%).5 Data also suggests that plain films are less

sensitive in the setting of low grade or partial bowel obstruction. The sensitivity of

abdominal radiographs in the detection of small-bowel obstruction ranges from 70 to

86%.6, 7 Despite these limitations, abdominal radiographs remain an important study in

patients with suspected small-bowel obstruction because of their widespread availability

and low cost.

Computed tomographic (CT)

There is numerous Class II data to suggest that CT provides incremental information over

other imaging forms to the level, etiology and accuracy at differentiating low grade from

high grade bowel obstruction leading to changes in planned management.8-10 Computed

tomographic (CT) scanning is 80 to 90% sensitive and 70 to 90% specific in the detection

of small-bowel obstruction.11 The findings of small-bowel obstruction include a discrete

transition zone with dilation of bowel proximally, decompression of bowel distally,

intraluminal contrast that does not pass beyond the transition zone, and a colon

containing little gas or fluid.

There is class II data to suggest that CT is 85 -100% sensitive for ischemia and

strangulation later confirmed by surgery.12-15 Ischemia was suggested on CT with:

serrated beak, unusual course of mesenteric vasculature, mesenteric haziness, reduced

wall enhancement, wall thickening, mesenteric fluid, mesenteric venous congestion, and

ascites.16-18 CT scanning also offers a global evaluation of the abdomen and may

therefore reveal the etiology of obstruction.19-21 The global picture afforded is especially

relevant when evaluating the acute abdomen when multiple etiologies are on the

differential diagnosis.

© Copyright 2007 – Eastern Association for the Surgery of Trauma 9

Enteroclysis

A limitation of CT scanning is its low sensitivity (<50%) in the detection of low-grade or

partial small-bowel obstruction. A subtle transition zone or unsuspected closed loop

obstruction may be difficult to identify in the axial images obtained during CT scanning.

In such cases, contrast examinations of the small bowel, either small-bowel series (small-

bowel follow-through) or enteroclysis, can be helpful.22 Nonionic low osmolar weight

contrast is an alternative to barium for contrast studies to evaluate for SBO.23 These

examinations are more labor intensive and less-rapidly performed than CT scanning, but

may offer greater sensitivity in the detection of luminal and mural etiologies of

obstruction, such as primary intestinal tumors, with sensitivity and specificity

approaching 100% when coupled with CT.24 Enteroclysis is rarely performed in the acute

setting, but offers greater sensitivity than small-bowel series in the detection of lesions

that may be causing partial small-bowel obstruction.25

Ultrasound

Class II data suggests ultrasound is comparable to plain film for the diagnosis, etiology

and strangulation in small bowel obstruction and can better identify free fluid which may

signal the need for operative intervention.26-30

MRI

Class II data reports the accuracy MRI at least approaches that of CT with both

differentiating obstruction vs no obstruction at an almost 100% sensativity.31 MRI has

also been shown to be effective in defining location and etiology of obstruction with at

least equivalent accuracy of CT.32-34 Limitations of MRI include: lack of availability

after hours, poor definition of mass lesions, and poor visualization of colonic obstructions

did not show inflammation as well as CT, and does not show viability.35, 36

C. Evaluation of the Evidence Supporting Early Operative Management

The standard therapy for small-bowel obstruction is expeditious surgery. The rationale

for this approach is to minimize the risk for bowel strangulation, which is associated with

© Copyright 2007 – Eastern Association for the Surgery of Trauma 10

an increased risk for morbidity and mortality. The literature would suggest that clinical

signs supported by simple imaging studies can identify the vast majority of patients

presenting with surgical small bowel obstruction.37, 38 Early operative intervention in

patients with fever, leukocytosis, peritonitis, tachycardia, metabolic acidosis, and

continuous pain will identify strangulation 45% of the time39-41 Complete SBO should be

operated on early as the primary mode of therapy. Studies would suggest that 31-43% of

patients with complete SBO or peritonitis will resolve without requiring some form of

bowel resection. 42, 43

Other reported benefits of the operative management of SBO is the description by class II

data that reports lower reoccurrence rate and longer disease free intervals with operative

intervention when compared to conservative management. 44-47

D. Evaluation of the Evidence Supporting Conservative Management

Exceptions to the recommendation for expeditious surgery for intestinal obstruction

include partial small-bowel obstruction, obstruction occurring in the early postoperative

period, intestinal obstruction as a consequence of Crohn's disease, and carcinomatosis.

Progression to strangulation (3-6% with conservative management) is unlikely to occur

with partial small-bowel obstruction, and an attempt at nonoperative resolution is

warranted.48 Level II data suggests that nonoperative management has been documented

to be successful in 65 to 81% of patients with partial small-bowel obstruction or in

patients without peritonitis.1 Of those successfully treated non-operatively, only 5 to 15%

have been reported to have symptoms that were not substantially improved within 48

hours after initiation of therapy.49-52 Therefore, most patients with partial small

obstruction whose symptoms do not improve within 48 hours after initiation of

nonoperative therapy should undergo surgery. There has been some level III data to

suggest that this time period can be safely lengthened to 5 days without increase the

likelihood of strangulation necessitating bowel resection although definite data to support

these claims is not available.2 Patients undergoing non-operative therapy should be

© Copyright 2007 – Eastern Association for the Surgery of Trauma 11

followed with serial abdominal exams for signs of peritonitis which would necessitate

immediate operative intervention.

Adjuncts to Conservative Management

Hypertonic contrast in PSBO

The administration of hypertonic water-soluble contrast agents, such as Gastrografin used

in upper GI and small-bowel follow-through examinations, causes a shift of fluid into the

intestinal lumen, thereby increasing the pressure gradient across the site of obstruction.

Level II data suggests that this effect may speed the return of bowel function (time to

bowel movement) and decrease the length of stay of patients undergoing non-operative

management of partial small bowel obstruction.53-58

E. Operative Approach

Successful laparoscopic surgery for bowel obstruction is being reported with greater

frequency. Reported data suggest that up to 60% of small-bowel obstruction cases caused

by adhesions may be amenable to laparoscopic therapy.59 The reported conversion rate is

20-51.9%60-67 and the complication rate (bowel injury) is 6.5-18.0%.60, 68 Conversion to

open procedure have been reported secondary to density of adhesions, inability to fix the

obstruction, cause of obstruction not amenable to laparoscopic therapy, intestinal

necrosis, and intestinal perforation. Factors that favor laparoscopic success are SBO post

appendectomy, with bands as cause, with less then two previous surgeries, and shorter

time of symptoms.69 It has been reported that conversion rate can be decreased to as low

as 6.9% when the surgery is guided by preoperative enteroclysis.70 The laparoscopic

treatment of small bowel obstruction appears to be effective and leads to a shorter

hospital stay in a highly selected group of patients.71, 72 There has also been literature to

support that patients treated with laparoscopic intervention have lower hernia rate and

SBO but require the same amount of operative intervention.73 Patients fitting the criteria

for consideration of laparoscopic management include those with (1) mild abdominal

distention allowing adequate visualization, (2) a proximal obstruction, (3) a partial

obstruction, and (4) an anticipated single-band obstruction. Currently, patients who have

advanced, complete, or distal small bowel obstructions are not candidates for

laparoscopic treatment. Unfortunately, the majority of patients with obstruction are in this

© Copyright 2007 – Eastern Association for the Surgery of Trauma 12

group. Similarly, patients with matted adhesions or those who remain distended after

nasogastric intubation should be managed with conventional laparotomy. Therefore, the

future role of laparoscopic procedures in the treatment of these patients remains to be

defined.

F. Adjuncts to Surgery

Antibiotics

Broad-spectrum antibiotics are commonly administered because of concerns that

bacterial translocation may occur in the setting of small-bowel obstruction; however,

there are no controlled data to support or refute this approach.74

Long Tube

Prospective randomized trials demonstrated no significant differences with regard to the

decompression achieved, the success of nonoperative treatment, or the morbidity rate

after surgical intervention compared with the use of nasogastric tubes. Furthermore, the

use of these long tubes has been associated with a significantly longer hospital stay,

duration of postoperative ileus, and postoperative complications in some series.

Therefore, it appears that long intestinal tubes offer no benefit in the preoperative setting

over nasogastric tubes.75, 76

Hyaluronic acid-carboxycellulose membrane (Seprafilm)

The overall rate of post-operative SBO showed no difference with or without Seprafilm.

However, Seprafilm did have lower (1.8 vs 3.4%) of SBO requiring reoperation.77-80

V. Summary

To summarize, plain abdominal radiographs are usually diagnostic of bowel obstruction

in more than 60% of the cases, but further evaluation (possibly by CT or barium

radiography) may be necessary in 20% to 30% of cases. CT examination is particularly

useful in patients with a history of abdominal malignancy, in postsurgical patients, and in

patients who have no history of abdominal surgery and present with symptoms of bowel

© Copyright 2007 – Eastern Association for the Surgery of Trauma 13

obstruction. Barium studies are recommended in patients with a history of recurring

obstruction or low-grade mechanical obstruction to precisely define the obstructed

segment and degree of obstruction.

VI. Future Investigations

Future studies should be conducted in a prospective, randomized fashion concentrating

on the timing of operative intervention for small bowel obstruction.

© Copyright 2007 – Eastern Association for the Surgery of Trauma 14

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1 Nauta RJ 2 Seror D

Pr

actic

e M

anag

emen

t Gui

delin

es fo

r M

anag

emen

t of S

mal

l Bow

el O

bstr

uctio

n in

the

Sett

ing

of P

revi

ous A

bdom

inal

Sur

gery

19

91 –

Pre

sent

Firs

t Aut

hor

Yea

r R

efer

ence

Titl

e C

lass

C

oncl

usio

ns

Dia

gnos

is –

Pla

in F

ilm/K

UB

Lapp

as JC

20

01

Abd

omin

al ra

diog

raph

y fin

ding

s in

smal

l-bow

el o

bstru

ctio

n: re

leva

nce

to

triag

e fo

r add

ition

al d

iagn

ostic

imag

ing.

AJR

Am

J R

oent

geno

l. 20

01

Jan;

176(

1):1

67-7

4.

III

(N=8

1; re

trosp

ectiv

e) P

lain

film

s hel

p di

ffer

entia

te lo

w g

rade

fr

om h

igh

grad

e bu

t CT

give

s inc

rem

enta

l and

nee

ded

if pl

ain

film

was

inco

nclu

sive

M

aglin

te D

D

1997

R

elia

bilit

y an

d ro

le o

f pla

in fi

lm ra

diog

raph

y an

d C

T in

the

diag

nosi

s of

smal

l-bow

el o

bstru

ctio

n. A

JR A

m J

Roe

ntge

nol.

1996

Dec

;167

(6):

1451

-5.

II

I Pl

ain

film

s and

CT

have

equ

al se

nsiti

vity

for g

rade

of

obst

ruct

ion.

The

y re

com

men

d pl

ain

film

s ini

tially

on

all

susp

ecte

d SB

O w

ith C

T as

a fo

llow

-up

if ne

eded

for c

linic

al

purp

oses

. D

iagn

osis

-CT

Bog

usev

iciu

s A

2002

Pr

ospe

ctiv

e ra

ndom

ised

tria

l of c

ompu

ter-

aide

d di

agno

sis a

nd c

ontra

st

radi

ogra

phy

in a

cute

smal

l bow

el o

bstru

ctio

n. E

ur J

Sur

g. 2

002;

168(

2):7

8-83

.

I C

ompu

ter p

rogr

am th

at d

iffer

entia

tes b

etw

een

com

plet

e an

d pa

rtial

SB

O w

hen

36 c

linic

al v

aria

bles

, inc

ludi

ng th

e pl

ain

radi

ogra

phic

find

ings

, are

ent

ered

, but

the

time

to d

iagn

osis

w

as o

nly

1 ho

ur w

ith th

e co

mpu

ter p

rogr

am a

nd 1

6 ho

urs

with

con

trast

radi

ogra

phy.

Za

lcm

an M

20

00

Hel

ical

CT

sign

s in

the

diag

nosi

s of i

ntes

tinal

isch

emia

in sm

all-b

owel

ob

stru

ctio

n. A

JR A

m J

Roe

ntge

nol.

2000

Dec

;175

(6):

1601

-7.

II

(N

=144

: ret

rosp

ectiv

e) T

hey

spec

ifica

lly lo

oked

for r

educ

ed

wal

l enh

ance

men

t, w

all t

hick

enin

g, m

esen

teric

flui

d m

esen

teric

ven

ous c

onge

stio

n, a

nd a

scite

s in

orde

r to

dete

rmin

e pr

esen

ce o

f isc

hem

ia.

Stra

ngul

atio

n w

as

pros

pect

ivel

y di

agno

sed

if re

duce

d w

all e

nhan

cem

ent o

r 2 o

f th

e ot

her 4

sign

s wer

e pr

esen

t.

Laza

rus D

E 20

04

Freq

uenc

y an

d re

leva

nce

of th

e "s

mal

l-bow

el fe

ces"

sign

on

CT

in p

atie

nts

with

smal

l-bow

el o

bstru

ctio

n.

AJR

Am J

Roe

ntge

nol.

2004

Nov

;183

(5):

1361

-6.

II

(N=3

4: re

trosp

ectiv

e) T

he fe

ces s

ign

help

ed id

entif

y th

e po

int

of o

bstru

ctio

n an

d w

as m

ore

likel

y in

hig

her d

egre

es o

f ob

stru

ctio

n.

Obu

z F

2003

Th

e ef

ficac

y of

hel

ical

CT

in th

e di

agno

sis o

f sm

all b

owel

obs

truct

ion.

Eu

r J R

adio

l. 20

03 D

ec;4

8(3)

:299

-304

. II

(

N=4

1; P

rosp

ectiv

e) H

elic

al C

T (1

998-

2001

) CT

was

83%

ac

cura

te in

diff

eren

tiatin

g ob

stru

ctio

n vs

non

-obs

truct

ion,

85

% a

ccur

ate

in d

eter

min

ing

caus

e, a

nd 1

00%

acc

urat

e in

de

term

inin

g st

rang

ulat

ion/

isch

emia

. Su

ri S

1999

C

ompa

rativ

e ev

alua

tion

of p

lain

film

s, ul

traso

und

and

CT

in th

e di

agno

sis o

f in

test

inal

obs

truct

ion.

Ac

ta R

adio

l. 19

99 J

ul;4

0(4)

:422

-8.

II

(N=3

2; P

rosp

ectiv

e) S

uspe

cted

SB

O w

ho h

ad p

lain

ra

diog

raph

s, U

S an

d C

T sc

an (1

990-

93).

Pla

in ra

diog

raph

y w

as 7

5% a

ccur

ate,

US

was

84%

acc

urat

e, a

nd C

T w

as 9

4%

accu

rate

at d

eter

min

ing

obst

ruct

ion

vs n

o ob

stru

ctio

n. L

evel

of

obs

truct

ion

60%

, 70%

, and

93%

. C

ause

of o

bstru

ctio

n 7%

, 23

%, a

nd 8

7%.

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Taou

rel P

G

1995

V

alue

of C

T in

the

diag

nosi

s and

man

agem

ent o

f pat

ient

s with

susp

ecte

d ac

ute

smal

l-bow

el o

bstru

ctio

n. A

JR A

m J

Roe

ntge

nol.

1995

N

ov;1

65(5

):11

87-9

2.

II

(N=5

7; P

rosp

ectiv

e) P

atie

nts w

ith su

spic

ion

of S

BO

(199

1 -

1994

). T

he su

rgeo

n w

as in

terv

iew

ed p

rior t

o th

e C

T sc

an.

In

33 p

ts th

e cl

inic

ian

wan

ted

to d

iffer

entia

te b

etw

een

SBO

or

ileus

and

in 2

4 pt

s the

clin

icia

n w

ante

d to

kno

w th

e ca

use

of

SBO

. C

T co

rrec

tly c

hang

ed th

e di

ffer

entia

tion

betw

een

SBO

&

ileu

s in

21%

of c

ases

. C

T ch

ange

d th

e di

agno

sis (

caus

e) o

f SB

O in

43%

and

cor

rect

ly c

hang

ed p

rese

nce

or a

bsen

ce o

f st

rang

ulat

ion

in 2

3.

Cat

alan

o O

19

97

The

faec

es si

gn. A

CT

findi

ng in

smal

l-bow

el o

bstru

ctio

n.

Radi

olog

e. 1

997

May

;37(

5):4

17-9

.

III

(N=9

4; R

etro

spec

tive)

Fec

es si

gn w

as o

nly

pres

ent i

n 7%

of

case

s, on

ly 1

of w

hich

had

stra

ngul

atio

n.

Cho

u C

K

2000

D

iffer

entia

tion

of o

bstru

ctiv

e fr

om n

on-o

bstru

ctiv

e sm

all b

owel

dila

tatio

n on

C

T.

Eur J

Rad

iol.

2000

Sep

;35(

3):2

13-2

0.

III

(N=1

46; R

etro

spec

tive)

Eva

luat

ed 4

crit

eria

: co

ntin

uity

of

prox

imal

SB

, tra

nsiti

on z

one,

intra

lum

inal

flui

d, &

col

onic

co

nten

ts.

The

prob

abili

ty o

f tru

e ob

stru

ctio

n w

as c

alcu

late

d fo

r eac

h si

gn.

Con

tinui

ty 6

9%, T

rans

ition

zon

e ab

rupt

80%

, hi

gh a

mou

nt o

f SB

flui

d 79

%, m

inim

al c

olon

ic c

onte

nts 9

0%.

D

anes

hman

d S

1999

Th

e ut

ility

and

relia

bilit

y of

com

pute

d to

mog

raph

y sc

an in

the

diag

nosi

s of

smal

l bow

el o

bstru

ctio

n.

Am S

urg.

199

9 O

ct;6

5(10

):92

2-6.

III

Ret

rosp

ectiv

e st

udy

of 1

03 p

ts (1

997-

8) w

ith su

spec

ted

SBO

. C

ompa

rison

of p

lain

radi

ogra

phs w

ith C

T in

det

erm

inin

g pa

rtial

vs c

ompl

ete

SBO

and

in d

eter

min

ing

caus

e. P

lain

fil

ms w

ere

75%

sens

itive

and

53%

spec

ific

for p

artia

l vs

com

plet

e. C

T w

as 9

2% se

nsiti

ve a

nd 7

1% sp

ecifi

c. C

ause

w

as c

orre

ctly

det

erm

ined

or i

nfer

red

to b

e ad

hesi

ons b

y C

T in

91

% o

f cas

es.

Gol

lub

MJ

2006

D

oes t

he C

T w

hirl

sign

real

ly p

redi

ct sm

all b

owel

vol

vulu

s?: E

xper

ienc

e in

an

onc

olog

ic p

opul

atio

n.

J C

ompu

t Ass

ist T

omog

r. 20

06 J

an-F

eb;3

0(1)

:25-

32.

III

Ret

rosp

ectiv

e an

alys

is o

f 120

0+ C

T sc

ans o

f pts

with

su

spec

ted

SBO

at a

can

cer c

ente

r. W

hirl

sign

was

foun

d in

33

pts b

y a

seni

or ra

diol

ogis

t and

14

pts b

y a

seni

or ra

diol

ogy

resi

dent

. Th

e w

hirl

sign

had

a se

nsiti

vity

of 6

4% fo

r vol

vulu

s by

the

seni

or ra

diol

ogis

t and

muc

h le

ss b

y th

e re

side

nt.

They

co

nclu

ded

that

the

whi

rl si

gn is

a re

lativ

ely

poor

pre

dict

or o

f vo

lvul

us in

this

pop

ulat

ion

Ha

HK

19

97

Diff

eren

tiatio

n of

sim

ple

and

stra

ngul

ated

smal

l-bow

el o

bstru

ctio

ns:

usef

ulne

ss o

f kno

wn

CT

crite

ria.

Radi

olog

y. 1

997

Aug;

204(

2):5

07-1

2.

III

(N=8

4; R

etro

spec

tive)

Pat

ient

s with

kno

wn

outc

omes

, sim

ple

vs st

rang

ulat

ed S

BO

(199

1-19

96).

The

y id

entif

ied

6 C

T fin

ding

s as b

est a

t det

erm

inin

g st

rang

ulat

ion:

redu

ced

wal

l en

hanc

emen

t, se

rrat

ed b

eak,

asc

ites,

and

unus

ual c

ours

e of

m

esen

teric

vas

cula

ture

, mes

ente

ric h

azin

ess,

and

mes

ente

ric

veno

us e

ngor

gem

ent.

Usi

ng th

ese

sign

s the

y w

ere

able

to

find

85%

of s

trang

ulat

ions

Ja

ffe

TA

2006

Sm

all-b

owel

obs

truct

ion:

cor

onal

refo

rmat

ions

from

isot

ropi

c vo

xels

at 1

6-II

I R

etro

spec

tive

anal

ysis

of a

dded

val

ue o

f cor

onal

refo

rmat

ions

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

sect

ion

mul

ti-de

tect

or ro

w C

T.

Radi

olog

y. 2

006

Jan;

238(

1):1

35-4

2. E

pub

2005

Nov

17.

(200

3-4)

in 1

00 p

ts w

ith su

spec

ted

SBO

. C

oron

al im

ages

ad

ded

conf

iden

ce to

the

thre

e re

ader

’s d

iagn

ostic

acc

urac

y of

ob

stru

ctio

n vs

no

obst

ruct

ion.

K

im JH

20

04

Use

fuln

ess o

f kno

wn

com

pute

d to

mog

raph

y an

d cl

inic

al c

riter

ia fo

r di

agno

sing

stra

ngul

atio

n in

smal

l-bow

el o

bstru

ctio

n: a

naly

sis o

f tru

e an

d fa

lse

inte

rpre

tatio

n gr

oups

in c

ompu

ted

tom

ogra

phy.

W

orld

J S

urg.

200

4 Ja

n;28

(1):

63-8

.

III

Ret

rosp

ectiv

e st

udy

of 1

46 C

Ts lo

okin

g fo

r stra

ngul

atio

n vs

no

stra

ngul

atio

n (1

992-

98).

Thr

ee ra

diol

ogis

ts w

ere

72%

- 82

% a

ccur

ate

in d

eter

min

ing

stra

ngul

atio

n. T

he fo

ur c

linic

al

crite

ria, f

ever

, ten

dern

ess,

tach

ycar

dia,

leuk

ocyt

osis

, with

out

CT

findi

ngs w

ere

equa

lly a

ccur

ate,

how

ever

!

Mak

ita O

19

99

CT

diff

eren

tiatio

n be

twee

n ne

crot

ic a

nd n

onne

crot

ic sm

all b

owel

in c

lose

d lo

op a

nd st

rang

ulat

ing

obst

ruct

ion.

Ab

dom

Imag

ing.

199

9 M

ar-A

pr;2

4(2)

:120

-4.

III

Ret

rosp

ectiv

e an

alys

is o

f CT

findi

ngs d

iffer

entia

ting

necr

osis

fr

om n

on-n

ecro

sis i

n 25

pts

with

pro

ven

stra

ngul

atio

n.

Find

ings

pre

dict

ive

of n

ecro

sis w

ere:

asc

ites,

vasc

ular

di

lata

tion,

mes

ente

ric a

ttenu

atio

n, a

nd ra

dial

dis

tribu

tion,

but

m

esen

teric

atte

nuat

ion

was

mos

t pre

dict

ive.

D

iagn

osis

–M

RI

Bea

ll D

P 20

02

Imag

ing

bow

el o

bstru

ctio

n: a

com

paris

on b

etw

een

fast

mag

netic

reso

nanc

e im

agin

g an

d he

lical

com

pute

d to

mog

raph

y.

Clin

Rad

iol.

2002

Aug

;57(

8):7

19-2

4.

II

Pros

pect

ive

com

paris

on o

f hel

ical

CT

(ora

l/IV

con

trast

) with

ul

trafa

st H

AST

E M

RI i

n 44

pts

with

susp

ecte

d SB

O (1

997

-19

98).

Fin

ding

s: C

T (7

1%, S

ensi

tivity

; 71%

Spe

cific

ity) M

R

(95%

sens

itivi

ty; 1

00%

Spe

cific

ity).

in d

iffer

entia

ting

obst

ruct

ion

vs n

o ob

stru

ctio

n. N

o m

entio

n of

diff

eren

tiatin

g hi

gh-g

rade

vs l

ow g

rade

obs

truct

ion.

Lim

itatio

ns o

f MR

I in

clud

e la

ck o

f ava

ilabi

lity

afte

r hou

rs, p

oor d

efin

ition

of

caus

e of

obs

truct

ion,

and

poo

r vis

ualiz

atio

n of

col

onic

ob

stru

ctio

ns.

K

im JH

20

00

Use

fuln

ess o

f MR

imag

ing

for d

isea

ses o

f the

smal

l int

estin

e: c

ompa

rison

w

ith C

T.

Kor

ean

J Ra

diol

. 200

0 Ja

n-M

ar;1

(1):

43-5

0.

III

Pros

pect

ive

com

paris

on o

f hel

ical

CT

(ora

l/IV

con

trast

) with

H

AST

E M

RI i

n 34

pts

with

a v

arie

ty o

f SB

dis

ease

s (19

96 -

1999

). 1

5 pt

s had

susp

ecte

d SB

O.

MR

I and

CT

wer

e bo

th

100%

acc

urat

e in

dia

gnos

ing

or e

xclu

ding

SB

O.

MR

I was

be

tter a

t det

erm

inin

g th

e pr

ecis

e ca

use

of o

bstru

ctio

n (7

3% v

60

%).

MR

I poo

r at l

ooki

ng a

t om

entu

m.

Le

e JK

19

98

MR

imag

ing

of th

e sm

all b

owel

usi

ng th

e H

AST

E se

quen

ce.

AJR

Am J

Roe

ntge

nol.

1998

Jun

;170

(6):

1457

-63.

II

I M

R w

ith H

AST

E se

quen

ce c

an d

istin

guis

h be

twee

n no

rmal

sm

all b

owel

and

abn

orm

al sm

all b

owel

. Mot

ion

did

not a

ffec

t th

ese

stud

ies

Reg

an F

19

98

Fast

MR

imag

ing

and

the

dete

ctio

n of

smal

l-bow

el o

bstru

ctio

n.

AJR

Am J

Roe

ntge

nol.

1998

Jun

;170

(6):

1465

-9.

II

I H

AST

E M

R c

an b

e hi

ghly

acc

urat

e in

dia

gnos

ing

SBO

and

id

entif

ying

the

leve

l of o

bstru

ctio

n 26

/29

patie

nts w

ith S

BO

w

ere

said

to h

ave

been

cor

rect

ly id

entif

ied

by H

AST

E M

R

(sen

sitiv

ity 9

0%, s

peci

ficity

86%

) and

73%

had

the

corr

ect

leve

l of o

bstru

ctio

n id

entif

ied.

Lim

itatio

ns id

entif

ied

incl

ude:

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

abse

nce

of d

ilatio

n in

situ

atio

ns w

here

pro

long

ed N

G su

ctio

n ha

s bee

n em

ploy

ed, M

RI i

s not

goo

d at

iden

tifyi

ng m

asse

s in

clud

ing

mal

igna

ncie

s, di

d no

t sho

w in

flam

mat

ion

as g

ood

as C

T, a

nd d

oes n

ot sh

ow v

iabi

lity.

Dia

gnos

is –

Ultr

asou

nd

Schm

utz

GR

19

97

Smal

l bow

el o

bstru

ctio

n: ro

le a

nd c

ontri

butio

n of

sono

grap

hy.

Eur R

adio

l. 19

97;7

(7):

1054

-8.

II

U

ltras

ound

was

per

form

ed o

n 12

3 pa

tient

s who

wer

e ev

alua

ted

for s

mal

l bow

el o

bstru

ctio

n. O

f the

se p

atie

nts1

4 ha

d to

o m

uch

gas o

n in

itial

eva

luat

ion

and

the

stud

y w

as n

ot

conc

lude

d. O

vera

ll ac

cura

cy w

as 8

1%. D

eter

min

atio

n of

lo

catio

n of

obs

truct

ion

was

80%

acc

urat

e in

the

true

posi

tives

. D

eter

min

atio

n of

cau

se o

f obs

truct

ion

was

63%

acc

urat

e in

th

e tru

e po

sitiv

es.

The

stud

ies w

ere

perf

orm

ed b

y an

ex

perie

nced

radi

olog

ist.

Ultr

asou

nd w

as b

ette

r in

iden

tifyi

ng

the

caus

e of

obs

truct

ion

than

pla

in fi

lms.

Cze

chow

ski J

1996

C

onve

ntio

nal r

adio

grap

hy a

nd u

ltras

onog

raph

y in

the

diag

nosi

s of s

mal

l bo

wel

obs

truct

ion

and

stra

ngul

atio

n. A

cta

Radi

ol. 1

996

Mar

;37(

2):1

86-9

. II

I R

etro

spec

tive

revi

ew o

f 96

pts (

1992

-199

3) w

ho h

ad a

cute

ab

dom

en a

nd c

onve

ntio

nal r

adio

grap

hy w

as n

ot d

iagn

ostic

. Th

e st

udy

com

pare

s pla

in ra

diog

raph

y ve

rsus

ultr

asou

nd in

pa

tient

s with

susp

ecte

d sm

all b

owel

obs

truct

ion.

The

aut

hors

cl

aim

that

US

adde

d in

form

atio

n su

ch a

s the

loca

tion

of th

e ob

stru

ctio

n an

d w

heth

er st

rang

ulat

ion

was

pre

sent

(abs

ence

of

peris

tals

is, e

xtra

lum

inal

flui

d).

Gra

ssi R

20

04

The

rele

vanc

e of

free

flui

d be

twee

n in

test

inal

loop

s det

ecte

d by

sono

grap

hy

in th

e cl

inic

al a

sses

smen

t of s

mal

l bow

el o

bstru

ctio

n in

adu

lts. E

ur J

Rad

iol.

2004

Apr

;50(

1):5

-14.

III

Ret

rosp

ectiv

e re

view

of 1

84 p

atie

nts (

2002

) in

who

m S

BO

w

as e

vent

ually

con

firm

ed.

Thes

e pt

s all

had

both

pla

in fi

lms

and

US.

Pur

pose

of t

he st

udy

was

to d

eter

min

e if

intra

perit

onea

l flu

id w

as h

elpf

ul in

diff

eren

tiatin

g hi

gh-g

rade

vs

low

-gra

de o

bstru

ctio

n. T

he a

utho

rs re

port

that

US

was

10

0% a

ccur

ate

in fi

ndin

g fr

ee fl

uid

but i

n 34

pts

(20%

), th

e fr

ee fl

uid

was

exp

lain

ed b

y m

edic

al c

ause

s. W

hen

thes

e pt

s w

ere

excl

uded

from

ana

lysi

s, su

rger

y co

nfirm

ed fr

ee fl

uid

and

eith

er th

in w

alle

d sm

all b

owel

or i

mpe

ndin

g ne

cros

is in

all

pts.

K

o Y

T 19

93

Smal

l bow

el o

bstru

ctio

n: so

nogr

aphi

c ev

alua

tion.

Rad

iolo

gy. 1

993

Sep;

188(

3):6

49-5

3.

II

I R

etro

spec

tive

revi

ew o

f 54

pts w

ith k

now

n or

susp

ecte

d B

O

(198

7 –

1992

). P

ts h

ad a

lread

y ha

d pl

ain

film

s exc

ept f

or 2

pr

egna

nt p

ts.

SBO

was

cor

rect

ly d

iagn

osed

in 8

9%.

Leve

l of

obst

ruct

ion

was

cor

rect

ly p

redi

cted

in 7

6%.

Cau

se o

f ob

stru

ctio

n 20

%.

Ultr

asou

nd is

bet

ter t

han

plai

n fil

m b

ut d

oes

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

not s

how

stra

ngul

atio

n w

ell.

Dia

gnos

is –

Ente

rocl

ysis

B

oudi

af M

20

04

Smal

l-bow

el d

isea

ses:

pro

spec

tive

eval

uatio

n of

mul

ti-de

tect

or ro

w h

elic

al

CT

ente

rocl

ysis

in 1

07 c

onse

cutiv

e pa

tient

s. Ra

diol

ogy.

200

4 N

ov;2

33(2

):33

8-44

.

II

CT

ente

rocl

ysis

is w

ell t

oler

ated

relia

ble

imag

ing

allo

ws

dete

ctio

n of

ext

ralu

min

al d

isea

se. S

houl

d be

rout

ine

for

patie

nts w

ith lo

w g

rade

obs

truct

ion

in a

non

-acu

te se

tting

. U

msc

hade

n H

W

2000

Sm

all-b

owel

dis

ease

: com

paris

on o

f MR

ent

eroc

lysi

s im

ages

with

co

nven

tiona

l ent

eroc

lysi

s and

surg

ical

find

ings

. Ra

diol

ogy.

200

0 Ju

n;21

5(3)

:717

-25.

II

MR

ent

eroc

lysi

s was

per

form

ed o

n 18

pat

ient

s with

in

flam

mat

ory

dise

ase

and

12 p

atie

nts w

ith sm

all b

owel

ob

stru

ctio

n. F

indi

ngs b

etw

een

conv

entio

nal a

nd M

R

ente

rocl

ysis

had

a h

igh

conc

orda

nce

rate

. B

arlo

on T

J

1994

D

oes a

nor

mal

smal

l-bow

el e

nter

ocly

sis e

xclu

de sm

all-b

owel

dis

ease

? A

lo

ng-te

rm fo

llow

-up

of c

onse

cutiv

e no

rmal

stud

ies.

Abdo

m Im

agin

g. 1

994

Mar

-Apr

;19(

2):1

13-5

.

III

Ente

roco

lysi

s acc

urat

ely

show

s clo

sed

loop

obs

truct

ion

in

25/2

7 pa

tient

s.

Mag

linte

DD

1991

Pr

eope

rativ

e di

agno

sis b

y en

tero

clys

is o

f uns

uspe

cted

clo

sed

loop

obs

truct

ion

in m

edic

ally

man

aged

pat

ient

s. J

Clin

Gas

troe

nter

ol. 1

991

Jun;

13(3

):30

8-12

.

III

Ret

rosp

ectiv

e st

udy

of 2

7 pa

tient

s who

wer

e fo

und

to h

ave

clos

ed lo

op o

bstru

ctio

n on

con

vent

iona

l ent

eroc

lysi

s pe

rfor

med

2-8

afte

r adm

issi

on fo

r sm

all b

owel

obs

truct

ion.

O

f the

se p

atie

nts,

25 w

ere

take

n to

the

oper

atin

g ro

om a

nd

foun

d th

e ha

ve a

non

-stra

ngul

ated

clo

sed

loop

obs

truct

ion.

D

iagn

osis

– C

ontra

st S

tudi

es

And

erso

n C

A

1997

C

ontra

st ra

diog

raph

y in

smal

l bow

el o

bstru

ctio

n: a

pro

spec

tive,

rand

omiz

ed

trial

. M

il M

ed. 1

997

Nov

;162

(11)

:749

-52.

I Pr

ospe

ctiv

e ra

ndom

ized

stud

y co

mpa

ring

early

bar

ium

UG

I ve

rsus

pla

in ra

diog

raph

y in

pat

ient

s adm

itted

for s

mal

l bow

el

obst

ruct

ion.

The

resu

lts d

id n

ot sh

ow a

ny d

iffer

ence

in ti

me

to su

rger

y, c

ompl

icat

ions

or l

engt

h of

stay

bet

wee

n gr

oups

. B

ut, b

ariu

m st

udy

corr

ectly

diff

eren

tiate

d be

twee

n op

erat

ive

and

non-

oper

ativ

e SB

O.

Bla

ckm

on S

20

00

The

use

of w

ater

-sol

uble

con

trast

in e

valu

atin

g cl

inic

ally

equ

ivoc

al sm

all

bow

el o

bstru

ctio

n.

Am S

urg.

200

0 M

ar;6

6(3)

:238

-42;

dis

cuss

ion

242-

4.

III

(418

pat

ient

s: re

trosp

ectiv

e)Th

e st

udy

look

s at t

he u

se o

f ga

stog

raff

in tr

ansi

t tim

e to

hel

p in

the

diag

nosi

s of p

atie

nts

adm

itted

for w

ith a

dia

gnos

is o

f sm

all b

owel

obs

truct

ion.

Pa

tient

s are

giv

en g

astro

graf

fin a

nd u

nder

go se

rial a

bdom

inal

fil

ms.

If th

e co

ntra

st d

oes n

ot re

ach

the

colo

n in

6 h

ours

the

stud

y is

said

to b

e po

sitiv

e. O

ne o

f the

pro

blem

s with

this

st

udy

is th

at c

lose

to 5

0% (6

5) o

f pat

ient

s with

a p

ositi

ve

stud

y di

d no

t req

uire

surg

ery.

2 d

eath

s fro

m g

astro

graf

in

aspi

ratio

n.

Bro

chw

icz-

Lew

insk

i MJ

2003

Sm

all b

owel

obs

truct

ion-

-the

wat

er-s

olub

le fo

llow

-thro

ugh

revi

site

d.

Clin

Rad

iol.

2003

May

;58(

5):3

93-7

. I

Pros

pect

ive

rand

omiz

ed st

udy

of p

atie

nts w

ith su

spec

ted

smal

l bow

el o

bstru

ctio

n w

ho w

ere

divi

ded

in tw

o gr

oups

ba

sed

on if

they

had

an

uppe

r gi w

ith sm

all b

owel

follo

w

thro

ugh(

SBFT

) or n

ot. T

he g

roup

with

the

SBFT

had

a lo

wer

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

inci

denc

e of

ope

ratio

n bu

t thi

s diff

eren

ce d

id n

ot a

chie

ve

stat

istic

al d

iffer

ence

. The

leng

th o

f sta

y w

as n

ot a

ffec

ted

by

the

SBFT

. The

pat

ient

s wer

e ra

ndom

ized

and

the

surg

eons

ch

ange

d th

eir c

linic

al m

anag

emen

t pla

n ba

sed

on th

e re

sults

.

M

akan

juol

a D

. 19

98

Com

pute

d to

mog

raph

y co

mpa

red

with

smal

l bow

el e

nem

a in

clin

ical

ly

equi

voca

l int

estin

al o

bstru

ctio

n.

Clin

Rad

iol.

1998

Mar

;53(

3):2

03-8

.

III

49 p

ts h

ad b

oth

CT

and

‘sm

all b

owel

ene

ma’

. 43/

49 p

ts h

ad

defin

ite in

test

inal

obs

truct

ion

(42

per s

urge

ry).

SBE

was

mor

e se

nsiti

ve in

det

ectin

g B

owel

obs

truct

ion

than

CT

(100

% v

s 83

%).

The

7 m

isse

d by

CT

had

shor

t seg

men

t ste

nosi

s. C

oncl

usio

n: In

clin

ical

ly su

spic

ious

cas

es o

f obs

truct

ion

whe

re C

T is

neg

, use

SB

E Sa

ndik

ciog

lu

TG

1994

C

ontra

st ra

diog

raph

y in

smal

l bow

el o

bstru

ctio

n. A

rand

omiz

ed tr

ial o

f ba

rium

sulfa

te a

nd a

non

ioni

c lo

w-o

smol

ar c

ontra

st m

ediu

m.

Acta

Rad

iol.

1994

Jan

;35(

1):6

2-4.

I N

onio

nic

low

osm

olar

wei

ght c

ontra

st is

an

alte

rnat

ive

to

bariu

m fo

r con

trast

stud

ies t

o ev

alua

te fo

r SB

O.

C

hung

CC

19

96

A p

rosp

ectiv

e st

udy

on th

e us

e of

wat

er-s

olub

le c

ontra

st fo

llow

-thro

ugh

radi

olog

y in

the

man

agem

ent o

f sm

all b

owel

obs

truct

ion.

Au

st N

Z J

Sur

g. 1

996

Sep;

66(9

):59

8-60

1.

II

Safe

pro

cedu

re, e

arly

surg

ery

shou

ld o

ccur

if p

atie

nts h

ave

“sig

nific

ant o

bstru

ctio

n” (c

ontra

st d

oesn

’t re

ach

cecu

m in

4

hour

s) a

nd a

4 h

our c

utof

f for

con

trast

reac

hing

the

cecu

m in

pr

edic

tive

of o

utco

me

for S

BO

in th

ose

with

his

tory

of

surg

ery.

Jo

yce

WP

19

92

The

valu

e of

wat

er-s

olub

le c

ontra

st ra

diol

ogy

in th

e m

anag

emen

t of a

cute

sm

all b

owel

obs

truct

ion.

An

n R

Col

l Sur

g En

gl. 1

992

Nov

;74(

6):4

22-5

.

II

Wat

er-s

olub

le c

ontra

st st

udy

is sa

fe a

nd e

asy

to u

se a

nd

diag

nost

ic st

udy

of c

hoic

e fo

r sus

pect

ed S

BO

. Nor

mal

co

ntra

st st

udy

can

rule

out

ope

rativ

e SB

O.

Peck

JJ

1999

Th

e ro

le o

f com

pute

d to

mog

raph

y w

ith c

ontra

st a

nd sm

all b

owel

follo

w-

thro

ugh

in m

anag

emen

t of s

mal

l bow

el o

bstru

ctio

n.

Am J

Sur

g. 1

999

May

;177

(5):

375-

8.

III

With

equ

ivoc

al fi

ndin

gs o

f SB

O fi

rst C

T an

d th

en S

BFT

sh

ould

be

used

. The

com

bine

d se

nsiti

vity

and

spec

ifici

ty a

re

95%

and

86%

resp

ectiv

ely,

hig

her t

han

thos

e of

eac

h al

one.

Enoc

hsso

n L

2001

C

ontra

st ra

diog

raph

y in

smal

l int

estin

al o

bstru

ctio

n, a

val

uabl

e di

agno

stic

to

ol?

Eur J

Sur

g. 2

001

Feb;

167(

2):1

20-4

.

III

The

outc

ome

of o

ral c

ontra

st st

udie

s can

be

pred

icte

d by

pla

in

radi

ogra

phs.

Con

trast

stud

ies a

re sa

fe a

nd m

ay b

e th

erap

eutic

.

Dix

on P

M

19

93

The

smal

l bow

el e

nem

a: a

ten

year

revi

ew.

Clin

Rad

iol.

1993

Jan

;47(

1):4

6-8.

II

I R

outin

e us

e of

smal

l bow

el e

nem

a in

eva

luat

ion

of p

atie

nts

with

susp

ecte

d sm

all b

owel

pat

holo

gy d

emon

stra

tes a

ver

y hi

gh se

nsiti

vity

(93.

1%) a

nd sp

ecifi

city

(96.

9%) a

nd

obst

ruct

ion

had

a se

nsiti

vity

of 9

8%.

Con

serv

ativ

e M

anag

emen

t – G

ener

al C

onsi

dera

tions

C

onse

rvat

ive

Man

agem

ent –

Clin

ical

Indi

cato

rs/T

ime

Perio

d M

iller

G

2000

N

atur

al h

isto

ry o

f pat

ient

s with

adh

esiv

e sm

all b

owel

obs

truct

ion.

Br

J S

urg.

200

0 Se

p;87

(9):

1240

-7.

II

I Pa

tient

s are

nev

er fr

ee o

f ris

k fo

r pos

t-op

obs 2

nd to

adh

esio

ns

(14%

pre

sent

>20

yrs

pos

t-op)

. R

ate

of re

curr

ence

was

33%

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

over

all (

32%

for o

pera

tion,

34%

(NS)

for c

ons.

Mgm

t), e

ach

recu

rren

ce ra

ised

risk

of f

utur

e re

curr

ence

. C

olor

ecta

l pr

oced

ures

wer

e m

ore

likel

y to

resu

lt in

mat

ted

adhe

sion

s v.

sing

le b

ands

and

resu

lt in

mor

e re

adm

its.

Rec

urre

nce

rate

s b/

w o

p an

d no

n-op

wer

e si

mila

r.

Nau

ta R

J 20

05

Adv

ance

d ab

dom

inal

imag

ing

is n

ot re

quire

d to

exc

lude

stra

ngul

atio

n if

com

plet

e sm

all b

owel

obs

truct

ions

und

ergo

pro

mpt

lapa

roto

my.

J

Am C

oll S

urg.

200

5 Ju

n;20

0(6)

:904

-11.

III

Pape

r val

idat

es th

at c

ompl

ete

SBO

war

rant

s no

addi

tiona

l im

agin

g ot

her t

han

plai

n fil

ms.

71%

of P

SBO

by

plai

n fil

m

with

out p

erito

nitis

reso

lved

with

con

serv

ativ

e m

anag

emen

t.

In p

atie

nts w

ith c

ompl

ete

SBO

, the

re w

as a

ver

y hi

gh ra

te o

f bo

wel

rese

ctio

n (3

1%).

This

sugg

ests

that

a c

ompl

ete

SBO

is

a su

rgic

al d

isea

se.

Sero

r D

19

93

How

con

serv

ativ

ely

can

post

oper

ativ

e sm

all b

owel

obs

truct

ion

be tr

eate

d?

Am J

Sur

g. 1

993

Jan;

165(

1):1

21-5

; dis

cuss

ion

125-

6.

III

73%

resp

onse

to c

onse

rvat

ive

tx in

all

SBO

(Com

plet

e an

d Pa

rtial

). N

o di

ffer

ence

in W

BC

, fev

er, p

ulse

in th

ose

who

re

quire

d su

rger

y. N

o w

orse

out

com

e in

thos

e w

atch

ed o

ver 5

da

ys B

UT

no o

ne th

at h

adn’

t got

ten

bette

r by

5 da

ys g

ot b

ette

r w

/o su

rger

y. W

eak

supp

ort o

f con

clus

ions

.

Will

iam

s SB

20

05

Smal

l bow

el o

bstru

ctio

n: c

onse

rvat

ive

vs. s

urgi

cal m

anag

emen

t. D

is C

olon

Rec

tum

. 200

5 Ju

n;48

(6):

1140

-6.

III

Inci

denc

e of

recu

rren

t SB

O is

hig

her i

n co

nser

vativ

ely

man

aged

pts

than

in o

pera

tivel

y m

anag

ed p

ts (4

0.5%

v.

26.8

%).

Tim

e to

recu

rren

ce in

con

serv

ativ

e m

anag

ed p

atie

nts

was

shor

ter (

153

v. 4

11 d

ays)

Mill

er G

20

02

Rea

dmis

sion

for s

mal

l-bow

el o

bstru

ctio

n in

the

early

pos

tope

rativ

e pe

riod:

et

iolo

gy a

nd o

utco

me.

C

an J

Sur

g. 2

002

Aug;

45(4

):25

5-8.

III

Def

ined

ear

ly p

ost-o

p bo

wel

obs

truct

ion

as w

ithin

50

days

be

caus

e ha

d bi

g gr

oup

who

pre

sent

ed b

/w 3

5-50

day

s. M

ost

freq

uent

pro

cedu

re w

as a

smal

l bow

el o

pera

tion

for S

BO

. 23

% re

quire

d op

erat

ion.

3.3

% st

rang

ulat

ion.

Sug

gest

s non

-op

erat

ive

man

agem

ent o

f pos

t-op

obst

ruct

ion.

Sh

ih S

C

2003

A

dhes

ive

smal

l bow

el o

bstru

ctio

n: h

ow lo

ng c

an p

atie

nts t

oler

ate

cons

erva

tive

treat

men

t?

Wor

ld J

Gas

troe

nter

ol. 2

003

Mar

;9(3

):60

3-5.

III

Pape

r rea

lly su

gges

ts if

you

wai

t too

long

, you

will

hav

e co

mpl

icat

ions

.

Feva

ng B

T 20

02

Early

ope

ratio

n or

con

serv

ativ

e m

anag

emen

t of p

atie

nts w

ith sm

all b

owel

ob

stru

ctio

n?

Eur J

Sur

g. 2

002;

168(

8-9)

:475

-81.

II

Sign

ifica

nt d

iffer

ence

in st

rang

ulat

ion

betw

een

early

and

late

op

erat

ion;

sugg

ests

surg

eons

can

cho

ose

whi

ch p

atie

nts n

eed

imm

edia

te su

rger

y ba

sed

on c

linic

al e

valu

atio

n. O

pera

te fo

r co

ntin

uous

pai

n, fe

ver,

tach

ycar

dia,

per

itoni

tis, l

euko

cyto

sis,

met

aci

dosi

s

Rya

n M

D

2004

A

dhes

iona

l sm

all b

owel

obs

truct

ion

afte

r col

orec

tal s

urge

ry.

III

The

3 ye

ar ra

te fo

r SB

O fo

llow

ing

a co

lore

ctal

pro

cedu

re is

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

ANZ

J Su

rg. 2

004

Nov

;74(

11):

1010

-2.

3.

6%. 4

8% re

quire

d O

R o

n fir

st a

dmis

sion

for S

BO

, onl

y 1

for s

trang

ulat

ion.

Con

serv

ativ

e M

anag

emen

t – A

djun

cts

Ass

alia

A

19

94

Ther

apeu

tic e

ffec

t of o

ral G

astro

graf

in in

adh

esiv

e, p

artia

l sm

all-b

owel

ob

stru

ctio

n: a

pro

spec

tive

rand

omiz

ed tr

ial.

Surg

ery.

199

4 Ap

r;11

5(4)

:433

-7.

I 10

0 cc

of G

G sp

ed re

turn

of b

owel

func

tion

(tim

e to

firs

t st

ool)

from

23.

4h to

6.2

hrs

. G

G d

ecre

ased

LO

S fr

om 4

.4d

to

2.2d

. Tr

end

to im

prov

emen

t in

cons

erva

tive

mgm

t but

not

st

at si

g (2

1% c

ontro

l v. 1

0% G

G P

=0.5

2).

No

GG

co

mpl

icat

ions

Bio

ndo

S 20

03

Ran

dom

ized

clin

ical

stud

y of

Gas

trogr

afin

adm

inis

tratio

n in

pat

ient

s with

ad

hesi

ve sm

all b

owel

obs

truct

ion.

Br

J S

urg.

200

3 M

ay;9

0(5)

:542

-6.

I A

ll pa

tient

s who

pas

sed

Gas

trogr

afin

to th

e co

lon

w/in

24

hour

s tol

erat

ed e

arly

feed

ing

and

did

not r

equi

re o

pera

tion.

Th

ey o

pera

ted

on e

very

pat

ient

who

did

not

pas

s GG

to th

e co

lon

in 2

4 hr

s with

no

furth

er tr

ial o

f rx

– C

AN

NO

T sa

y th

at

failu

re to

pas

GG

pre

dict

s non

-op

failu

re (t

hey

didn

’t try

) but

th

ey c

laim

that

eve

ry p

atie

nt w

ho fa

iled

had

a cl

osed

loop

at

surg

ery

(not

stra

ngul

atio

n).

Bur

ge J

2005

R

ando

miz

ed c

ontro

lled

trial

of G

astro

graf

in in

adh

esiv

e sm

all b

owel

ob

stru

ctio

n.

ANZ

J Su

rg. 2

005

Aug;

75(8

):67

2-4.

I 10

0 cc

of G

G re

duce

d tim

e to

reso

lutio

n of

sbo

from

21

to 1

2 hr

s. L

OS

decr

ease

d by

1 d

ay.G

G d

id n

ot c

hang

e th

e nu

mbe

r of

peo

ple

who

faile

d no

n-op

mgm

t

Che

n SC

20

06

Spec

ific

oral

med

icat

ions

dec

reas

e th

e ne

ed fo

r sur

gery

in a

dhes

ive

parti

al

smal

l-bow

el o

bstru

ctio

n.

Surg

ery.

200

6 M

ar;1

39(3

):31

2-6.

I Pa

tient

s tre

ated

with

MgO

xide

, Lac

toba

cillu

s, an

d Si

met

hico

ne fo

r PSB

O (b

y G

G st

udy)

had

a h

ighe

r inc

iden

ce

of n

on-o

p m

gmt (

77 V

90%

p<0

.01)

. Thi

s com

bina

tion

of

med

s may

redu

ce n

eed

for o

pera

tion

in P

SBO

Cho

i HK

20

02

Ther

apeu

tic v

alue

of g

astro

graf

in in

adh

esiv

e sm

all b

owel

obs

truct

ion

afte

r un

succ

essf

ul c

onse

rvat

ive

treat

men

t: a

pros

pect

ive

rand

omiz

ed tr

ial.

Ann

Surg

. 200

2 Ju

l;236

(1):

1-6.

I Th

ey ra

ndom

ized

GG

v. s

urge

ry a

fter 4

8hrs

of c

ons m

gmt a

nd

show

ed th

at m

ost o

f the

GG

pat

ient

s did

not

requ

ire su

rger

y.

Feva

ng B

T 20

00

Upp

er g

astro

inte

stin

al c

ontra

st st

udy

in th

e m

anag

emen

t of s

mal

l bow

el

obst

ruct

ion-

-a p

rosp

ectiv

e ra

ndom

ised

stud

y.

Eur J

Sur

g. 2

000

Jan;

166(

1):3

9-43

.

I In

this

non

-blin

ded

stud

y G

G m

ixed

with

bar

ium

had

no

effe

ct o

n re

solu

tion

of S

BO

, nee

d fo

r ope

ratio

n, ra

te o

f st

rang

ulat

ion.

Res

olut

ion

was

not

diff

eren

t fro

m th

e lit

erat

ure

(PSB

O 7

6%; C

ompl

ete

41%

).

Yag

ci G

20

05

Com

paris

on o

f Uro

graf

in v

ersu

s sta

ndar

d th

erap

y in

pos

tope

rativ

e sm

all

bow

el o

bstru

ctio

n.

J In

vest

Sur

g. 2

005

Nov

-Dec

;18(

6):3

15-2

0.

II

Tim

e to

firs

t sto

ol sh

orte

r in

Uro

graf

in g

roup

. U

G g

roup

had

be

tter n

on-o

p m

gmt r

ate

(89.

4 to

75.

4% p

<0.0

5).

UG

gro

up

had

shor

ter L

OS

(2.7

3d v

. 6.1

d).

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Gow

en G

F 20

03

Long

tube

dec

ompr

essi

on is

succ

essf

ul in

90%

of p

atie

nts w

ith a

dhes

ive

smal

l bow

el o

bstru

ctio

n.

Am J

Sur

g. 2

003

Jun;

185(

6):5

12-5

.

III

In p

atie

nts w

/o si

gns o

f stra

ngul

atio

n a

nasa

lly p

lace

d lo

ng

tube

(usi

ng e

ndos

copy

to p

ass i

nto

the

jeju

num

) ha

d a

90%

re

solu

tion

rate

for S

BO

R

oadl

ey G

20

04

Rol

e of

Gas

trogr

afin

in a

ssig

ning

pat

ient

s to

a no

n-op

erat

ive

cour

se in

ad

hesi

ve sm

all b

owel

obs

truct

ion.

AN

Z J

Surg

. 200

4 O

ct;7

4(10

):83

0-2.

III

Find

ing

GG

in th

e co

lon

4h p

ost a

dmin

istra

tion

relia

bly

pred

icts

succ

essf

ul n

on-o

p m

gmt.

Con

serv

ativ

e M

anag

emen

t – A

ntib

iotic

s Sa

gar P

M

19

95

Inte

stin

al o

bstru

ctio

n pr

omot

es g

ut tr

ansl

ocat

ion

of b

acte

ria.

Dis

Col

on R

ectu

m. 1

995

Jun;

38(6

):64

0-4.

II

B

acte

ria w

ere

foun

d in

mes

ente

ric ly

mph

nod

es a

t a m

uch

grea

ter f

requ

ency

in o

bstru

cted

v. n

on-o

bs p

atie

nts (

39.9

% v

. 7.

3% p

, 0.0

01).

Pos

t-op

sept

ic c

ompl

icat

ions

wer

e m

ore

likel

y in

pts

that

had

+ m

es. L

ymph

nod

es (3

6.1

v. 1

1.1%

P<

0.05

)

Con

serv

ativ

e M

anag

emen

t – N

utrit

ion

Ope

rativ

e In

terv

entio

n –

Gen

eral

Con

side

ratio

ns

Feva

ng B

T 20

04

Long

-term

pro

gnos

is a

fter o

pera

tion

for a

dhes

ive

smal

l bow

el o

bstru

ctio

n.

Ann

Surg

. 200

4 Au

g;24

0(2)

:193

-201

. II

I St

udy

sugg

estin

g lo

wer

risk

of r

ecur

renc

e if

treat

ed su

rgic

ally

. H

owev

er ri

sk o

f nee

ding

surg

ery

if fu

ture

epi

sode

is th

e sa

me.

Th

e hi

ghes

t ris

k is

afte

r 5 y

ears

, but

can

occ

ur e

ven

deca

des

late

r. M

ultip

le m

atte

d ad

hesi

ons h

ave

mor

e re

curr

ence

than

si

ngle

ban

ds (a

t lea

st th

ose

rx’d

surg

ical

ly)

Land

erca

sper

J

1993

Lo

ng-te

rm o

utco

me

afte

r hos

pita

lizat

ion

for s

mal

l-bow

el o

bstru

ctio

n.

Arch

Sur

g. 1

993

Jul;1

28(7

):76

5-70

; dis

cuss

ion

770-

1.

III

Rat

e of

recu

rren

ce is

hig

her w

ith n

on-o

p m

gmt (

38%

v. 2

1%

p<0.

001)

. C

ompl

ete

SBO

v. P

artia

l – n

o di

ffer

ence

in

recu

rren

ce e

ither

op

or n

on-o

p. O

p v.

non

-op

no d

iff in

m

orta

lity

Ea

rly O

pera

tive

– C

linic

al In

dica

tions

/Sub

grou

ps

Torte

lla B

J

1995

In

cide

nce

and

risk

fact

ors f

or e

arly

smal

l bow

el o

bstru

ctio

n af

ter c

elio

tom

y fo

r pen

etra

ting

abdo

min

al tr

aum

a.

Am S

urg.

199

5 N

ov;6

1(11

):95

6-8.

II

(N=3

41; P

rosp

ectiv

e) P

atie

nts w

ho h

ad a

lapa

roto

my

for

pene

tratin

g tra

uma.

The

hyp

othe

sis i

s tha

t the

y w

ould

hav

e a

high

er in

cide

nce

of p

ost-o

pera

tive

SBO

, def

ined

as S

BO

in 6

m

onth

s pos

t-exp

lora

tion.

The

inci

denc

e w

as h

ighe

r, 7.

4% a

s co

mpa

red

to a

repo

rted

0.69

% fo

r pos

t-ope

rativ

e SB

O

Mea

gher

AP

19

93

Non

-ope

rativ

e tre

atm

ent o

f sm

all b

owel

obs

truct

ion

follo

win

g ap

pend

icec

tom

y or

ope

ratio

n on

the

ovar

y or

tube

. Br

J S

urg.

199

3 O

ct;8

0(10

):13

10-1

.

III

(N=3

30; R

etro

spec

tive)

Pat

ient

s with

App

ende

ctom

y/tu

bo-

ovar

ian

proc

edur

es a

re m

ore

likel

y to

requ

ire o

pera

tive

inte

rven

tion

(95%

vs.

53

Potts

FE

4th

1999

U

tility

of f

ever

and

leuk

ocyt

osis

in a

cute

surg

ical

abd

omen

s in

octo

gena

rians

an

d be

yond

. J

Ger

onto

l A B

iol S

ci M

ed S

ci. 1

999

Feb;

54(2

):M

55-8

.

III

(N=1

17) P

atie

nts w

ith fe

ver a

nd le

ukoc

ytos

is th

at a

re in

thei

r 80

’s m

ost l

ikel

y ha

ve A

cute

cho

lecy

stiti

s and

vis

cous

pe

rfor

atio

n.

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Vel

asco

JM

1998

Po

stla

paro

scop

ic sm

all b

owel

obs

truct

ion.

Ret

hink

ing

its m

anag

emen

t. Su

rg E

ndos

c. 1

998

Aug;

12(8

):10

43-5

.

III

(N=5

) Pos

t lap

aros

copi

c SB

Os w

ill n

eed

surg

ical

reso

lutio

n an

d w

ill n

ot re

solv

e sp

onta

neou

sly

as u

p to

73%

will

do

afte

r la

paro

tom

y H

uang

JC

2005

Sm

all b

owel

vol

vulu

s am

ong

adul

ts.

J G

astr

oent

erol

Hep

atol

. 200

5 D

ec;2

0(12

):19

06-1

2.

II

I (N

=19)

Vol

vulu

s alth

ough

rare

in a

dults

can

occ

ur, a

nd w

ill

alw

ays n

eed

surg

ical

ther

apy.

Ta

keuc

hi K

20

04

Clin

ical

stud

ies o

f stra

ngul

atin

g sm

all b

owel

obs

truct

ion.

Am

Sur

g. 2

004

Jan;

70(1

):40

-4.

III

(N=2

80; r

etro

spec

tive)

Pur

pose

was

to id

entif

y as

pect

s of

clin

ical

or l

abor

ator

y ex

am th

at w

ould

iden

tify

patie

nts w

ith

gang

reno

us b

owel

. Onl

y 92

(24%

) of t

he 2

80 p

atie

nts

requ

ired

surg

ery

and

37 o

f the

se h

ad st

rang

ulat

ion

or

inte

stin

al g

angr

ene

(13)

with

smal

l bow

el re

sect

ion.

Onl

y fa

ctor

s tha

t wer

e si

gnifi

cant

for g

angr

enou

s sm

all b

owel

wer

e SI

RS

(12/

13) v

ersu

s (1/

24),

elev

ated

or l

ow W

BC

, and

bas

e de

ficit

or a

cido

sis.

Ts

umur

a H

20

04

Syst

emic

infla

mm

ator

y re

spon

se sy

ndro

me

(SIR

S) a

s a p

redi

ctor

of

stra

ngul

ated

smal

l bow

el o

bstru

ctio

n.

Hep

atog

astr

oent

erol

ogy.

200

4 Se

p-O

ct;5

1(59

):13

93-6

.

III

(N=9

5) S

IRS

and

abdo

min

al g

uard

ing

are

pred

ictiv

e of

st

rang

ulat

ion

in S

BO

.

Ellis

CN

1991

Sm

all b

owel

obs

truct

ion

afte

r col

on re

sect

ion

for b

enig

n an

d m

alig

nant

di

seas

es.

Dis

Col

on R

ectu

m. 1

991

May

;34(

5):3

67-7

1.

III

(N=1

18) P

atie

nts w

ith su

rgic

al c

orre

ctio

n of

SB

O a

fter h

isto

ry

of c

olon

surg

ery.

Pat

ient

s ofte

n ge

t SB

O fr

om re

occu

rren

ce

and

it ca

rrie

s hig

her m

orbi

dity

and

mor

talit

y M

atte

r I

1997

D

oes t

he in

dex

oper

atio

n in

fluen

ce th

e co

urse

and

out

com

e of

adh

esiv

e in

test

inal

obs

truct

ion?

Eu

r J S

urg.

199

7 O

ct;1

63(1

0):7

67-7

2.

III

(N=2

48) P

urpo

se to

look

for w

hat t

ypes

of o

pera

tions

wou

ld

lead

to fu

ture

SB

O. .

The

pre

viou

s sur

gerie

s wer

e di

vide

d in

to

4 gr

oups

: Upp

er a

bdom

inal

, sm

all b

owel

rese

ctio

n,

appe

ndec

tom

y /g

ynec

olog

y, a

nd c

olon

rese

ctio

n. T

he

proc

edur

e th

at le

d to

mos

t SB

O/y

r was

app

ende

ctom

y - 3

.1.

SBO

occ

urre

d ea

rlies

t afte

r res

ectio

n of

smal

l bow

el a

nd th

en

colo

n, w

ith in

the

first

yea

r. C

ompl

ete

obst

ruct

ion

was

hig

hest

af

ter s

mal

l bow

el re

sect

ion,

20/

26, t

houg

h on

ly 3

requ

ired

surg

ery.

M

ontz

FJ

1994

Sm

all b

owel

obs

truct

ion

follo

win

g ra

dica

l hys

tere

ctom

y: ri

sk fa

ctor

s, in

cide

nce,

and

ope

rativ

e fin

ding

s. G

ynec

ol O

ncol

. 199

4 Ap

r;53

(1):

114-

20.

III

(N=9

8) R

etro

spec

tive

revi

ew p

atie

nts w

ho h

ad ra

dica

l hy

ster

ecto

my

for n

on-a

dnex

al g

ynec

olog

ic c

ance

r. R

adia

tion

grea

tly in

crea

ses i

ncid

ence

of S

BO

. Ea

rly O

pera

tive

– R

adio

grap

hic

Indi

catio

ns

Che

n SC

20

05

Prog

ress

ive

incr

ease

of b

owel

wal

l thi

ckne

ss is

a re

liabl

e in

dica

tor f

or su

rger

y in

pat

ient

s with

adh

esiv

e sm

all b

owel

obs

truct

ion.

D

is C

olon

Rec

tum

. 200

5 Se

p;48

(9):

1764

-71.

II

(N=1

21) U

S de

mon

stra

ting

incr

ease

in b

owel

wal

l thi

ckne

ss >

3m

m a

re in

dica

tor f

or su

rger

y. D

ivid

ed in

to 2

gro

ups:

Gro

up

1 –

initi

al S

B w

all t

hick

ness

> 3

mm

, gro

up 2

– S

B w

all <

3m

m. 9

(18.

4%) o

f gro

up 1

pat

ient

s nee

ded

surg

ery

and

only

4

(5.6

%) o

f gro

up 2

.

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Che

n SC

19

99

Ora

l uro

graf

in in

pos

tope

rativ

e sm

all b

owel

obs

truct

ion.

Wor

ld J

Sur

g. 1

999

Oct

;23(

10):

1051

-4.

II

U

rogr

afin

in th

e co

lon

at 8

hou

rs p

redi

cts s

ucce

ssfu

l non

-op

erat

ive

treat

men

t. O

ral g

astro

grap

hin

is a

goo

d di

agno

stic

to

ol fo

r pre

dict

ion

of th

e su

cces

s of n

on-o

pera

tive

man

agem

ent o

f SB

O

Pere

a G

arci

a J

2004

A

dhes

ive

smal

l bow

el o

bstru

ctio

n: p

redi

ctiv

e va

lue

of o

ral c

ontra

st

adm

inis

tratio

n on

the

need

for s

urge

ry.

Rev

Esp

Enfe

rm D

ig. 2

004

Mar

;96(

3):1

91-2

00.

II

Con

clus

ion

is th

at e

arlie

r use

of c

ontra

st c

an le

ad to

ear

lier

deci

sion

as t

o ne

ed o

f sur

gery

or p

rogr

essi

on o

f non

-ope

rativ

e m

anag

emen

t of S

BO

. .

Early

Ope

rativ

e –

Tim

e Pe

riod

Sosa

J

1993

M

anag

emen

t of p

atie

nts d

iagn

osed

as a

cute

inte

stin

al o

bstru

ctio

n se

cond

ary

to a

dhes

ions

. Am

Sur

g. 1

993

Feb;

59(2

):12

5-8.

III

(N=9

7) R

etro

spec

tive

anal

ysis

of 1

15 a

dmis

sion

s for

97

patie

nts w

ith S

BO

. 3 g

roup

s: e

arly

ope

ratio

n (<

24

hour

s) n

=

21, n

on-o

pera

tive

man

agem

ent g

roup

B1

faile

d, n

= 3

3, a

nd

succ

essf

ul, n

= 6

2. P

rimar

y re

ason

for e

arly

ope

ratio

n w

as

tend

erne

ss o

r sur

geon

’s c

hoic

e. 4

bow

el re

sect

ions

2nd

ary

to

stra

ngul

atio

n in

this

gro

up. T

he g

roup

with

the

only

2 d

eath

s, hi

ghes

t com

plic

atio

n ra

te 3

6%, a

nd h

ighe

st st

rang

ulat

ion

rate

w

as g

roup

B1.

La

te O

pera

tive

– C

linic

al In

dica

tions

/Sub

grou

ps

Ello

zy S

H

2002

Ea

rly p

osto

pera

tive

smal

l-bow

el o

bstru

ctio

n: a

pro

spec

tive

eval

uatio

n in

242

co

nsec

utiv

e ab

dom

inal

ope

ratio

ns.

Dis

Col

on R

ectu

m. 2

002

Sep;

45(9

):12

14-7

.

II

(N=9

5) P

rosp

ectiv

e su

rvei

llanc

e of

242

ope

ratio

ns p

erfo

rmed

of

225

pat

ient

s and

mon

itorin

g fo

r ear

ly p

ost-o

pera

tive

SBO

(E

PSB

O).

The

maj

ority

of t

he p

roce

dure

invo

lved

the

colo

n,

and

45 p

atie

nts h

ad p

revi

ous S

BO

. The

re w

ere

23 in

cide

nts o

f EP

SBO

. 20

reso

lved

by

day

6 w

ith ju

st N

G su

ctio

n. T

he o

ther

3

had

surg

ery

on d

ay 2

, day

16

and

day

29 w

ith th

e la

tter w

ith

SB n

ecro

sis a

nd re

sect

ion.

The

re w

ere

no fa

ctor

s ide

ntifi

ed

with

this

smal

l gro

up o

f pat

ient

s pre

dict

ive

of E

PSB

O

And

erss

on R

E 20

01

Smal

l bow

el o

bstru

ctio

n af

ter a

ppen

dice

ctom

y.

Br J

Sur

g. 2

001

Oct

;88(

10):

1387

-91.

III

Inte

rest

ing

stud

y lo

okin

g at

the

natio

nal r

egis

try o

f all

Swed

ish

hosp

itals

and

the

appe

ndec

tom

ies d

one

over

the

past

30

+ ye

ars.

2454

00 p

atie

nts u

nder

wen

t app

ende

ctom

y ov

er

that

tim

e pe

riod

and

ther

e w

ere

2659

SB

O o

pera

tions

sinc

e on

th

e pa

tient

s. Th

ere

wer

e 24

5400

mat

ched

con

trols

with

245

op

erat

ions

for S

BO

. Cum

ulat

ed ri

sk o

f sur

gery

for S

BO

afte

r ap

pend

ecto

my

afte

r 4 w

eeks

is 0

.41,

at 1

yea

r, 0.

63, a

t 10

year

s 0.9

7, a

nd a

t 30

year

s 1.3

0. T

his i

s low

er th

en p

revi

ousl

y th

ough

. The

cum

ulat

ive

risk

incr

ease

s with

the

oper

ativ

e di

agno

sis w

ith m

esen

teric

ade

nitis

at 1

.42

at 3

0 ye

ars,

perf

orat

ed a

ppen

dici

tis a

t 2.7

6, a

nd o

ther

at 3

.24.

Acu

te

appe

ndic

itis c

arrie

s the

low

est r

isk

of a

ppen

dici

tis a

t 0.7

5

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Edna

TH

19

98

Smal

l bow

el o

bstru

ctio

n in

pat

ient

s pre

viou

sly

oper

ated

on

for c

olor

ecta

l ca

ncer

. Eu

r J S

urg.

199

8 Au

g;16

4(8)

:587

-92.

III

(N=4

72) S

tudy

of 4

72 p

atie

nts w

ith o

pera

tion

for c

olor

ecta

l C

A fo

llow

ed fo

r 5.5

yea

rs to

est

ablis

h th

e in

cide

nce

of S

BO

. 35

1 ha

d a

cura

tive

proc

edur

e, th

e ot

her 1

21 p

allia

tive.

36/

351

of th

e cu

rativ

e de

velo

ped

an S

BO

that

nee

ded

surg

ery,

whi

le

5/12

1 of

the

palli

ativ

e pr

oced

ures

dev

elop

ed S

BO

pos

t op

erat

ion.

Etio

logy

of S

BO

can

cer i

n ha

lf an

d th

ese

patie

nts'

post

-op

mor

talit

y w

as m

uch

high

er. >

100

0 cc

blo

od lo

ss a

t in

itial

surg

ery

lead

s to

a hi

gher

rate

of S

BO

, as d

oes t

he

grea

ter d

isse

ctio

n of

a c

urat

ive

proc

edur

e Fr

aser

SA

20

02

Imm

edia

te p

ostla

paro

tom

y sm

all b

owel

obs

truct

ion:

a 1

6-ye

ar re

trosp

ectiv

e an

alys

is.

Am S

urg.

200

2 Se

p;68

(9):

780-

2.

III

(N=5

2) R

etro

spec

tive

revi

ew o

f 15

year

s of e

xper

ienc

e to

find

52

pat

ient

s with

imm

edia

te p

ost-o

pera

tive

SBO

. 22

of th

ese

patie

nts n

eede

d su

rgic

al c

orre

ctio

n. T

imin

g of

SB

O w

as a

bout

8

days

pos

t-op.

tim

ing

to b

egin

ning

of s

ympt

oms t

o su

rger

y w

as 5

day

s. R

ate

of n

on-o

pera

tive

treat

men

t was

60%

, and

th

ese

patie

nts h

ad le

ss c

ompl

icat

ions

and

less

LO

S Si

porin

K

19

93

Smal

l bow

el o

bstru

ctio

n af

ter a

bdom

inal

aor

tic su

rger

y.

Am S

urg.

199

3 D

ec;5

9(12

):84

6-9.

II

I (N

=44)

Ret

rosp

ectiv

e re

view

of 1

475

patie

nts w

ith e

ither

A

AA

repa

ir or

Gra

ft re

plac

emen

t of t

he A

orta

for o

cclu

sive

di

seas

e to

iden

tify

the

inci

denc

e of

SB

O in

this

pop

ulat

ion.

44

patie

nts w

ith S

BO

in th

e im

med

iate

pos

t-ope

rativ

e pe

riod

(to

30 d

ays)

foun

d. 1

8 re

quire

d op

erat

ion,

lysi

s of a

dhes

ions

and

2

rese

ctio

ns.

But

ler J

A

19

91

Smal

l bow

el o

bstru

ctio

n in

pat

ient

s with

a p

rior h

isto

ry o

f can

cer.

Am J

Sur

g. 1

991

Dec

;162

(6):

624-

8.

III

(N=5

4; R

etro

spec

tive)

Pat

ient

s with

com

plet

e or

par

tial S

BO

af

ter s

urge

ry a

t som

e tim

e fo

r can

cer.

37 (6

9%) o

f the

se

patie

nts h

ad o

pera

tive

ther

apy.

67%

of t

he g

roup

had

ch

emo/

radi

atio

n th

erap

y. 5

0% h

ad k

now

n re

curr

ence

. 25/

37

with

surg

ery

had

recu

rren

t can

cer a

s the

cau

se o

f the

CA

. O

nly

11 p

atie

nts c

lear

ed n

on-o

pera

tivel

y. 4

9% o

f the

op

erat

ive

patie

nts h

ad m

ajor

com

plic

atio

ns, a

nd th

e op

erat

ive

mor

talit

y w

as 1

6%, i

n ho

spita

l mor

talit

y of

22%

. La

te O

pera

tive

– R

adio

grap

hic

Indi

catio

ns

Cho

i HK

20

05

Val

ue o

f gas

trogr

afin

in a

dhes

ive

smal

l bow

el o

bstru

ctio

n af

ter u

nsuc

cess

ful

cons

erva

tive

treat

men

t: a

pros

pect

ive

eval

uatio

n.

Wor

ld J

Gas

troe

nter

ol. 2

005

Jun

28;1

1(24

):37

42-5

.

II

(N=2

12) 1

00cc

of G

astro

graf

in u

sed

48h

post

SB

O w

ithou

t im

prov

emen

t del

inea

ted

thos

e w

ho n

eede

d su

rger

y (c

ontra

st

not i

n co

lon

at 2

4h) a

nd th

ose

who

did

not

(con

trast

in c

olon

at

24h

). Th

e ne

ed fo

r OR

redu

ced

by 7

4% w

ith a

stra

ngul

atio

n ra

te o

f 0.8

%.

Ono

ue S

20

02

The

valu

e of

con

trast

radi

olog

y fo

r pos

tope

rativ

e ad

hesi

ve sm

all b

owel

ob

stru

ctio

n.

II

(N=1

07) 4

0 cc

Gas

trogr

afin

+ 4

0cc

wat

er p

rovi

ded

with

in 2

4h

of S

BO

adm

issi

on a

fter N

GT

deco

mpr

essi

on a

nd IV

F.

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Hep

atog

astr

oent

erol

ogy.

200

2 N

ov-D

ec;4

9(48

):15

76-8

. Rel

ated

Art

icle

s, Li

nks

Gas

trogr

affin

is u

sefu

l in

iden

tifyi

ng a

nd tr

eatin

g SB

O n

on-

oper

ativ

ely,

thou

gh th

e in

cide

nce

of st

rang

ulat

ion

is n

ot

affe

cted

. La

te O

pera

tive

– Ti

me

Perio

d C

ox M

R

19

93

The

safe

ty a

nd d

urat

ion

of n

on-o

pera

tive

treat

men

t for

adh

esiv

e sm

all b

owel

ob

stru

ctio

n.

Aust

N Z

J S

urg.

199

3 M

ay;6

3(5)

:367

-71.

III

(N=1

23) 2

or m

ore

indi

cato

rs (f

ever

, tac

hyca

rdia

, con

stan

t pa

in, W

BC

>16)

of S

B st

rang

ulat

ion

on a

dmis

sion

de

mon

stra

tes b

y O

R 7

6% n

on-v

iabl

e SB

. With

out i

ndic

ator

s, 69

% m

anag

ed n

on-o

p w

ith re

solu

tion

of S

B. E

vide

nce

does

no

t sup

port

auth

or’s

stat

emen

t to

aban

don

non-

op a

t 48h

. O

pera

tive

App

roac

h –

Lapr

osco

pic

vs. O

pen

Bor

zelli

no G

20

04

Lapa

rosc

opic

app

roac

h to

pos

tope

rativ

e ad

hesi

ve o

bstru

ctio

n.

Surg

End

osc.

200

4 Ap

r;18

(4):

686-

90.

III

(N=6

5) U

sing

lapa

rosc

opy,

6.5

% in

traop

com

plic

atio

n, 2

0%

conv

ersi

on ra

te a

nd 1

5.4%

recu

rren

ce. U

S gu

ide

to e

nter

ab

dom

en w

ithou

t any

inju

ry o

n en

tranc

e. R

elat

ive

cont

rain

dica

tions

such

as m

assi

ve d

iste

ntio

n, n

o fr

ee

quad

rant

, and

susp

ecte

d st

rang

ulat

ion

disc

usse

d. A

utho

r em

phas

izes

succ

ess w

ith n

umbe

rs a

bove

. C

hopr

a R

20

03

Lapa

rosc

opic

lysi

s of a

dhes

ions

. Am

Sur

g. 2

003

Nov

;69(

11):

966-

8.

III

(N=7

5) U

sing

lapa

rosc

opy,

4.3

% S

B re

sect

ion,

32%

co

nver

sion

rate

, and

ove

rall

low

er O

R ti

me,

infe

ctio

us

com

plic

atio

ns, p

ost-o

p ile

us, a

nd L

OS.

Aut

hor s

tate

s “vi

able

op

tion.

” D

uepr

ee H

J 20

03

Doe

s mea

ns o

f acc

ess a

ffec

t the

inci

denc

e of

smal

l bow

el o

bstru

ctio

n an

d ve

ntra

l her

nia

afte

r bow

el re

sect

ion?

Lap

aros

copy

ver

sus l

apar

otom

y.

J Am

Col

l Sur

g. 2

003

Aug;

197(

2):1

77-8

1.

III

(N=7

16) U

se o

f lap

aros

copy

for b

owel

rese

ctio

n de

crea

ses

vent

ral h

erni

a an

d SB

O re

quiri

ng h

ospi

tal r

eadm

issi

on. S

B

requ

iring

ope

rativ

e in

terv

entio

n w

as si

mila

r bet

wee

n la

paro

scop

y an

d op

en.

Wul

lste

in C

20

03

Lapa

rosc

opic

com

pare

d w

ith c

onve

ntio

nal t

reat

men

t of a

cute

adh

esiv

e sm

all

bow

el o

bstru

ctio

n.

Br J

Sur

g. 2

003

Sep;

90(9

):11

47-5

1.

III

(N=1

04) U

sing

lapa

rosc

opy,

17.

3% p

erfo

ratio

n, 5

1.9%

co

nver

sion

, and

long

er o

pera

tive

times

. Po

st-o

pera

tive

com

plic

atio

ns, r

etur

n of

bow

el fu

nctio

n, a

nd L

OS

less

for

lapa

rosc

opy.

Le

on E

L 19

99

Lapa

rosc

opic

man

agem

ent o

f sm

all b

owel

obs

truct

ion:

indi

catio

ns a

nd

outc

ome.

J

Gas

troi

ntes

t Sur

g. 1

998

Mar

-Apr

;2(2

):13

2-40

.

III

(N=4

0) L

apar

osco

py su

cces

sful

35%

ass

iste

d 30

%, a

nd 3

5%

conv

ersi

on. .

Rea

sons

for c

onve

rsio

n in

clud

ed d

ense

ad

hesi

ons,

need

for b

owel

rese

ctio

n, C

rohn

s, 2

canc

ers a

nd

larg

e ly

mph

nod

es. T

hose

con

verte

d lo

nger

LO

S.

Leva

rd H

20

01

Lapa

rosc

opic

trea

tmen

t of a

cute

smal

l bow

el o

bstru

ctio

n: a

mul

ticen

tre

retro

spec

tive

stud

y.

ANZ

J Su

rg. 2

001

Nov

;71(

11):

641-

6.

III

(N=3

08) L

apar

osco

py c

onve

rsio

n ra

te 4

5.4%

. Fac

tors

that

fa

vor l

apar

osco

pic

succ

ess a

re S

BO

pos

t app

ende

ctom

y, w

ith

band

s as c

ause

, with

less

then

2 p

revi

ous s

urge

ries,

and

shor

ter t

ime

of sy

mpt

oms.

Thos

e no

t con

verte

d ha

d sh

orte

r LO

S, fe

wer

com

plic

atio

ns, a

nd e

arlie

r bow

el fu

nctio

n.

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

Liau

w JJ

20

05

Lapa

rosc

opic

man

agem

ent o

f acu

te sm

all b

owel

obs

truct

ion.

As

ian

J Su

rg. 2

005

Jul;2

8(3)

:185

-8.

III

(N=9

) Con

vers

ion

rate

of 2

2%.

Sute

r M

2000

La

paro

scop

ic m

anag

emen

t of m

echa

nica

l sm

all b

owel

obs

truct

ion:

are

ther

e pr

edic

tors

of s

ucce

ss o

r fai

lure

? Su

rg E

ndos

c. 2

000

May

;14(

5):4

78-8

3.

III

(N=1

5) E

nter

ocly

sis g

uide

d la

paro

scop

y co

nver

sion

rate

of

6.7%

.

Suzu

ki K

20

03

Elec

tive

lapa

rosc

opy

for s

mal

l bow

el o

bstru

ctio

n.

Surg

Lap

aros

c En

dosc

Per

cuta

n Te

ch. 2

003

Aug;

13(4

):25

4-6.

II

I (N

=40)

Lap

aros

copy

con

vers

ion

rate

of 4

0%. I

ntra

op

ente

roto

mie

s 10%

. Lat

e re

curr

ence

2.5

%

Tsum

ura

H

2004

La

paro

scop

ic a

dhes

ioly

sis f

or re

curr

ent p

osto

pera

tive

smal

l bow

el

obst

ruct

ion.

H

epat

ogas

troe

nter

olog

y. 2

004

Jul-A

ug;5

1(58

):10

58-6

1.

III

(N=8

3) 5

7% in

itial

succ

ess r

ate

with

dur

atio

n of

surg

ery

(>12

0min

) and

bow

el d

iam

eter

(>4c

m) p

redi

ctiv

e of

co

nver

sion

. Reo

pera

tion

rate

of 9

%. B

owel

per

fora

tion

and

need

for c

onve

rsio

n in

crea

sed

post

-op

com

plic

atio

ns.

Pekm

ezci

S

2002

En

tero

clys

is-g

uide

d la

paro

scop

ic a

dhes

ioly

sis i

n re

curr

ent a

dhes

ive

smal

l bo

wel

obs

truct

ions

. Su

rg L

apar

osc

Endo

sc P

ercu

tan

Tech

. 200

2 Ju

n;12

(3):

165-

70.

III

(N=2

1) 5

7% la

paro

scop

y on

ly, 2

4% a

ssis

ted,

19%

con

vers

ion

rate

. Util

izin

g la

paro

scop

y (+

/- as

sist

ed) d

imin

ishe

d tim

e fo

r bo

wel

func

tion

and

LOS.

St

rickl

and

P 19

99

Is la

paro

scop

y sa

fe a

nd e

ffec

tive

for t

reat

men

t of a

cute

smal

l-bow

el

obst

ruct

ion?

Su

rg E

ndos

c. 1

999

Jul;1

3(7)

:695

-8.

III

(N=2

5) C

ompl

ete

adhe

siol

ysis

72%

. Lap

ass

iste

d 24

%. O

pen

4%. U

tiliz

ing

lapa

rosc

opy

(+/-

assi

sted

) dim

inis

hed

time

for

bow

el fu

nctio

n an

d LO

S.

Ope

rativ

e A

ppro

ach

– A

djun

cts

Fazi

o V

W

2006

R

educ

tion

in a

dhes

ive

smal

l-bow

el o

bstru

ctio

n by

Sep

rafil

m a

dhes

ion

barr

ier

afte

r int

estin

al re

sect

ion.

D

is C

olon

Rec

tum

. 200

6 Ja

n;49

(1):

1-11

.

I (N

=179

1) P

t blin

ded

rand

omiz

ed m

ultic

ente

r tria

l to

eval

Se

praf

ilm. T

he o

vera

ll ra

te o

f pos

t-ope

rativ

e SB

O sh

owed

no

diff

eren

ce w

ith o

r with

out S

epra

film

. How

ever

, Sep

rafil

m d

id

have

low

er (1

.8 v

s 3.4

%) o

f SB

O re

quiri

ng re

oper

atio

n (N

=90)

. K

ieff

er R

W

19

93

Indi

catio

ns fo

r int

erna

l ste

ntin

g in

inte

stin

al o

bstru

ctio

n.

Mil

Med

. 199

3 Ju

l;158

(7):

478-

9.

III

(N=1

6) U

sing

inte

rnal

sten

ting

with

Bak

er je

juna

l tub

e,

recu

rren

t rat

e of

obs

truct

ion

was

25%

. Non

-obs

truct

ive

intra

-ab

dom

inal

com

plic

atio

n ra

te 1

8.7%

. M

eiss

ner K

20

00

Effe

ctiv

enes

s of i

ntes

tinal

tube

splin

ting:

a p

rosp

ectiv

e ob

serv

atio

nal s

tudy

. D

ig S

urg.

200

0;17

(1):

49-5

6.

II

(N=1

86) W

ith in

tern

al sp

lintin

g, 9

% c

ompl

icat

ions

, 2%

pr

oced

ural

com

plic

atio

ns, 3

% re

oper

atio

n. N

o ea

rly S

BO

. Lo

wer

late

SB

O c

ompa

red

to h

isto

rical

out

com

e da

ta.

Kud

o FA

20

04

Use

of b

iore

sorb

able

mem

bran

e to

pre

vent

pos

tope

rativ

e sm

all b

owel

ob

stru

ctio

n in

tran

sabd

omin

al a

ortic

ane

urys

m su

rger

y.

Surg

Tod

ay. 2

004;

34(8

):64

8-51

.

III

(N=5

1) E

arly

SB

O w

as lo

wer

with

Sep

rafil

m e

vide

nt b

y ea

rlier

die

t int

ake

and

less

abd

omin

al c

ompl

aint

s. N

o re

oper

atio

ns w

ere

requ

ired

in e

ither

gro

up.

Mei

ssne

r K

2001

Sm

all b

owel

obs

truct

ion

follo

win

g ex

tend

ed ri

ght h

emic

olec

tom

y an

d su

btot

al c

olec

tom

y: a

sses

sing

the

bene

fit o

f pro

phyl

actic

tube

splin

ting.

D

ig S

urg.

200

1;18

(5):

388-

92.

III

(N=3

4) In

test

inal

tube

splin

ting

show

ed n

on-s

tatis

tical

few

er

early

and

late

SB

O

Moh

ri Y

20

05

Hya

luro

nic

acid

-car

boxy

cellu

lose

mem

bran

e (S

epra

film

) red

uces

ear

ly

III

(N=1

84) I

ncid

ence

of e

arly

SB

O lo

wer

with

Sep

rfilm

. No

© C

opyr

ight

200

7 –

East

ern

Ass

ocia

tion

for t

he S

urge

ry o

f Tra

uma

post

oper

ativ

e sm

all b

owel

obs

truct

ion

in g

astro

inte

stin

al su

rger

y.

Am S

urg.

200

5 O

ct;7

1(10

):86

1-3.

diff

eren

ce in

surg

ical

site

infe

ctio

n.

Spro

use

LR 2

nd

2001

Tw

elve

-yea

r exp

erie

nce

with

the

Thow

long

inte

stin

al tu

be: a

mea

ns o

f pr

even

ting

post

oper

ativ

e bo

wel

obs

truct

ion.

Am

Sur

g. 2

001

Apr;

67(4

):35

7-60

.

III

(N=3

4) T

rans

gast

ric T

how

tube

had

no

long

term

(>4y

) with

pt

s who

had

ope

rativ

e in

terv

entio

n fo

r adh

esio

n SB

O.

Follo

w-u

p re

cord

ed v

ia p

hone

cal

ls to

pat

ient

s (25

of 3

4).

Com

plic

atio

ns a

ll re

late

d to

gas

trost

omy

(25%

) R

odrig

uez-

Rue

sga

R

1995

Tw

elve

-yea

r exp

erie

nce

with

the

long

inte

stin

al tu

be.

Wor

ld J

Sur

g. 1

995

Jul-A

ug;1

9(4)

:627

-30;

dis

cuss

ion

630-

1.

III

(N=4

7) C

ompl

ex su

rgic

al p

atie

nt w

ith m

edia

n 4

prev

ious

la

paro

tom

ies.

23.4

% re

curr

ent S

BO

, onl

y 2

requ

ired

reop

erat

ion.

K

oren

aga

D

2001

Fa

ctor

s inf

luen

cing

the

deve

lopm

ent o

f sm

all i

ntes

tinal

obs

truct

ion

follo

win

g to

tal g

astre

ctom

y fo

r gas

tric

canc

er: t

he im

pact

of r

econ

stru

ctiv

e ro

ute

in th

e R

oux-

en-Y

pro

cedu

re.

Hep

atog

astr

oent

erol

ogy.

200

1 Se

p-O

ct;4

8(41

):13

89-9

2.

III

(N=4

8) 2

2.9%

pre

sent

ed w

ith m

echa

nica

l obs

truct

ion

and

an

teco

lic a

nast

omos

is fo

und

to b

e pr

edic

tive

fact

or. 4

5%

requ

ired

reop

erat

ion.

Poon

JT

2004

Sm

all b

owel

obs

truct

ion

follo

win

g lo

w a

nter

ior r

esec

tion:

the

impa

ct o

f di

vers

ion

ileos

tom

y.

Lang

enbe

cks A

rch

Surg

. 200

4 Au

g;38

9(4)

:250

-5.

II

(N=2

14) S

BO

follo

win

g LA

R is

10.

3%, t

he m

ajor

ity b

enig

n an

d no

t mal

igna

nt re

curr

ence

. D

iver

ting

ileos

tom

y in

crea

ses

inci

denc

e of

ear

ly S

BO

. H

olm

dahl

L

1997

A

dhes

ions

: pre

vent

ion

and

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