Small bowel obstruction caused by a shiitake mushroom: a case report

A 77-year-old male farmer sustained severe abdominal cramping pain for one hour. Contrast-enhanced multidetector computed tomography (MDCT) showed a 5.2 cm, oval lesion with interior mottled gas and slightly hyperdense component in the small bowel loop causing distension of the proximal small bowel loop. CT diagnosis of a bezoar in the small bowel causing bowel obstruction was made. Exploratory laparotomy disclosed a foreign body of soft texture in the jejunum located at 150 cm from the ligament of Treitz. A whole, undigested shiitake mushroom was noted after incision of the bowel. The patient had an uneventful course during the 9 days of hospitalization. The patient had recalled that he did not have any teeth and did not use dentures during eating, and accidentally swallowed the shiitake mushroom 2 days before the incident occurred

Cuando la ileítis de Crohn no es solo ileítis / When Crohn's ileitis is not just ileitis

RESUMEN En una minoría de pacientes con ileítis de Crohn (EC) de larga evolución, la recrudescencia de los síntomas puede representar una neoplasia ileal, con una clínica indistinguible de la enfermedad basal y por ende poco sospechada. Frecuentemente la patología tumoral se diagnostica en la pieza quirúrgica, tras una intervención por hemorragia u obstrucción intestinal. El objetivo de este trabajo es destacar la importancia de un diagnóstico diferencial ante una ileítis terminal en un paciente con EC con mala respuesta a tratamiento médico.

ABSTRACT In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum that is clinically indistinguishable from the baseline disease and therefore poorly suspected. Tumors are often diagnosed in the surgical specimen, after an intervention due to bleeding or bowel obstruction. The aim of this study is to emphasize the importance of the differential diagnoses of terminal ileitis in a patient with CD with poor response to medical treatment.

Small Bowel Obstruction Due to Rice Cake Consumption / 日本プライマリ・ケア連合学会誌

Introduction: There is an increasing number of reports demonstrating that dietary small bowel obstruction caused by rice cake consumption can be treated conservatively. However, the course of conservative treatment and the characteristics of the cases that require surgery remain unclear. The purpose of this study was to clarify the clinical features of small bowel obstruction caused by rice cake consumption and the characteristics of cases that require surgery.Methods: We retrospectively assessed all cases of intestinal obstruction caused by rice cake consumption treated at a single institution over a period of 7 years. We also assessed similar previously reported cases.Results: We assessed nine cases in our study and reviewed 67 previously reported cases. Conservative treatment was employed in 56 cases (73.7%). Dietary small bowel obstruction caused by rice cake consumption occurred 1.7 ± 0.3 days after intake. The computed tomography (CT) value of rice cake in the intestine was 160.0 ± 8.9 Hounsfield Units. Pieces of rice cake (length ≥ 4 cm) were observed in five of six cases in which rice cake consumption caused intestinal perforation.Conclusion: In most cases, patients with dietary small bowel obstruction caused by rice cake consumption will recover after conservative treatment. However, there is a high risk of intestinal perforation if intestinal CT reveals the length of rice cake pieces to be 4 cm or longer.

Therapeutic Efficacy of Conservative Treatment Combined with Water-soluble Contrast Agents for Adhesive Small Bowel Obstruction ：A Meta-analysis / 中国药房

OBJECTIVE： To systematically evaluate th e ther apeutic effects of conservative treatment combined with water-soluble contrast agents for adhesive small bowel obstruction ，and to provide evidence-based reference for clinical medication. METHODS：Retrieved from Cochrane library ，PubMed，Embase，Wanfang database and CNKI during the inception to Sept. 2020，RCTs about conservative treatment combined with water-soluble contrast agents in the therapeutic efficacy for adhesive small bowel obstruction were collected. After literature screening and data extraction ，the quality of included literatures were evaluated with Cochrane system evaluator manual 5.1.0 and Jadad scale. Meta-analysis was conducted by using Rev Man 5.3 and Stata 16 software. RESULTS ：A total of 15 RCTs were included ，with 1 429 patients in total. Results of Meta-analysis showed that the use of water-soluble contrast agents significantly reduced the surgical needs of patients with adhesive small bowel obstruction [OR ＝ 0.64，95％CI（0.50，0.81），P＜0.001]；reduced the remission time of non-surgical patients [MD ＝－23.37， 95％CI（－32.17， －14.57），P＜0.001]，hospital stay days of non-surgical patients [MD ＝－2.21，95％CI（－2.52，－1.90），P＜0.001] and hospital stay days of all patients [MD ＝－2.43，95％CI（－3.93，－0.92），P＝0.002]，and would not increase the incidence of complications [OR ＝1.15，95％CI（0.63，2.10），P＝0.65]，but could not reduce mortality [OR ＝1.26，95％CI（0.94，3.24），P＝ 0.63] or the probability of bowel resection [OR ＝0.93，95％CI（0.57，1.52），P＝0.78]. CONCLUSIONS ：The combined use of water-soluble contrast agents for patients with adhesive small bowel obstruction is safe and effective ，can reduce the patient ’s surgical requirements ，and is beneficial to reduce the length of hospital stay and time for symptom relief.

Clinical characteristics and risk factors of acute mechanical small bowel obstruction in adults / 中华全科医师杂志

Objective:To analyze the clinical characteristics and the risk factors of acute mechanical small bowel obstruction in adults.Methods:The clinical data of 487 adult patients with acute mechanical small bowel obstruction treated in Drum Tower Hospital Clinical College of Nanjing Medical University from June 2010 to December 2020 were retrospectively analyzed. There were 259 cases of strangulated obstruction (strangulation group) and 228 cases of non-strangulated obstruction (simple group). The cases in the strangulation group were confirmed by operation or pathology, the cases in the simple group were confirmed by non-operative therapy ( n=167) or operation ( n=61). The clinical data, including age, abdominal pain, vomiting, tenderness, rebound pain and muscle defense; the CT signs, including transitional zone, dilatation of intestinal loop, high density of intestinal wall; laboratory test results, including white blood cell count, lactate dehydrogenase (LDH) and C-reactive protein (CRP) were analyzed in both groups. Univariate and multivariate regression were used to identify risk factors of strangulated small bowel obstruction. Results:There were significant significances in gender (male vs.female: χ2=4.35, OR=0.67), rebound pain (χ2=170.98, OR=45.12), muscle tension(χ2=113.79, OR=29.32), American Society of Anesthesiologists score (ASA score)≥3 (χ2=12.94, OR=51.58), white blood cell count ( t=6.19, OR=1.14), LDH ( t=2.37, OR=1.00), CRP ( t=2.23, OR=1.01), albumin ( t=2.04, OR=0.97), mesenteric fluid sign (χ2=49.44, OR=5.40), increased bowel wall density (χ2=222.78, OR=62.66), bowel wall thickening sign (χ2=43.81, OR=3.49), ascites (χ2=237.29, OR=43.01), beak sign (χ2=231.50, OR=56.62), mesenteric fat stranding (χ2=242.65, OR=34.90), and stranding sign(χ2=224.79, OR=53.48) between strangulation group and simple group ( P<0.01). The multivariate regression analysis showed that mesenteric fluid sign ( OR=12.94), muscle tension ( OR=7.28), ascites ( OR=6.42), increased bowel wall density ( OR=4.30), bowel wall thickening sign ( OR=1.85), white blood cell count ( OR=1.14) and gender (male vs. female: OR=0.50) were risk factors of strangulated small bowel obstruction. Conclusion:In acute mechanical small bowel obstruction,for female patients presenting mesenteric fluid sign, muscle tension, ascites, increased bowel wall density, bowel wall thickening sign and increased white blood cell count, the strangulated obstruction is likely to occur.

Closed loop small bowel obstruction due to mid urethral sling mesh

Closed loop small bowel obstruction is a surgical emergency, which when left untreated leads to vascular compromise resulting in intestinal ischemia, necrosis and perforation. We report the case of a 61 years old female with past surgical history of hysterectomy and a mid-urethral sling, who presented to the emergency department for abdominal pain and obstipation. She was found on imaging to have a closed loop small bowel obstruction. An exploratory laparotomy revealed an adhesive band encompassing the distal terminal ileum, visceral peritoneum and the Mid‐urethral slings mesh. This is a rare complication that, to our knowledge, has not been reported in the surgical literature. This paper will discuss the clinical presentation, diagnostic studies, therapeutic intervention and outcome of this unique case.

Rare case of paracaecal hernia with intussusception presenting as small bowel obstruction: case report

Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.

Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

Assessment of Small Bowel Obstruction in Patients Following Appendicitis: An Institutional Based Study

Background: Small bowel obstruction (SBO) is a pathologicalcondition which occurs when the intestinal contents areprevented from moving along the length of the intestine. Thepresent study was conducted to assess the cases of smallbowel obstruction following appendectomy.Materials & Methods: The present study was conducted on42 cases of appendicitis of both genders. In all patients,laparoscopic appendectomy was planned. Patients wererecalled to note any kind of complication arising from theprocedure.Results: Out of 42 patients, males were 26 and females were16. Age group 20-30 years had 5 males and 3 females, 30-40years had 9 males and 5 females and 40-50 years had 12males and 8 females. The difference was significant (P< 0.05).Macroscopic feature of appendix during procedure wasphlegmonous in 12 and gangrenous in 30 cases. Thedifference was significant (P< 0.05).Conclusion: Small bowel obstruction is a complication whichmay be seen in few cases of appendectomy.

Clinical evaluation of MDCT multi-postprocessing techniques for diagnosing small bowel obstruction / 解放军医学杂志

Objective To evaluate the clinical effects of multi-detector computed tomography (MDCT) multi-postprocessing techniques in the evaluation of small bowel obstruction (SBO). Methods Clinical and MDCT imaging data of 90 patients with SBO were collected. Three radiologists respectively applied two protocols (protocol 1 consisted of conventional axial and coronal reformations and protocol 2 involved integration of multiple post-processing techniques) to image post-processing and interpretation of patients' MDCT volume data, and completed condition evaluation reports. Two protocols were compared regarding relevant diagnostic self-confidence, clinical satisfaction, clinical treatment decisions, and radiological adverse events. Results In the same protocol, the diagnostic self-confidence showed no significant difference between three radiologists for any evaluation parameter (P>0.05), but the diagnostic self-confidence of three radiologists was significantly higher in the protocol 2 than in the protocol 1 (P<0.01). The clinical satisfaction was also significantly higher in the protocol 2 than in the protocol 1 for all the individual and compositive illness assessment reports (P<0.01). After protocol 2 was applied clinically, it changed the previous treatment decisions based on protocol 1 in 11 patients (12.22%). About radiological adverse events, regardless of minor, major, or the sum of them, protocol 1 was significantly higher than protocol 2 (P<0.05). Conclusion Integration of multi-postprocessing techniques can improve diagnostic self-confidence and clinical satisfaction of MDCT for assessing SBO and effectively reduce radiological adverse events.

Berberine prevents primary peritoneal adhesion and adhesion reformation by directly inhibiting TIMP-1

Peritoneal adhesions are fibrous tissues that tether organs to one another or to the peritoneal wall and represent the major cause of postsurgical morbidity. Enterolysis at repeat surgeries induces adhesion reformation that is more difficult to prevent than primary adhesion. Here we studied the preventive effects of different approaches of berberine treatment for primary adhesion, and its effects on adhesion reformation compared to Interceed. We found the primary adhesion was remarkably prevented by berberine through intraperitoneal injection 30 min before abrasive surgery (pre-berberine) or direct addition into injured cecum immediately after the surgery (inter-berberine). Rats with adhesion reformation had a more deteriorative collagen accumulation and tissue injury in abrasive sites than rats with primary adhesion. The dysregulated TIMP-1/MMP balance was observed in patients after surgery, as well as adhesion tissues from primary adhesion or adhesion reformation rats. Inter-berberine treatment had a better effect for adhesion reformation prevention than Interceed. Berberine promoted the activation of MMP-3 and MMP-8 by directly blocking TIMP-1 activation core, which was reversed by TIMP-1 overexpression in fibroblasts. In conclusion, this study suggests berberine as a reasonable approach for preventing primary adhesion formation and adhesion reformation.

Application of deep residual neural network in detecting small bowel obstruction by abdominal plain film / 西安交通大学学报(医学版)

Objective: To study whether a deep residual neural network can detect small bowel obstruction patterns on upright abdominal radiographs. Methods:The data of training set and test set used in this study were obtained from The First Affiliated Hospital of Xi'an Jiaotong University and No.215 Hospital of Shaanxi Nuclear Industry; the data of validation set came from No.215 Hospital of Shaanxi Nuclear Industry. Totally 3 298 clinical upright abdominal radiographs obtained from two hospitals were classified into obstructive and non-obstructive categories independently by two radiologists on the basis of the four signs on upright abdominal radiographs, who discussed and reached consensus when disagreements arose. Among them, 569(17.3%) images were found to be consistent with small bowel obstruction, and 2 729 (82.7%) images had no small bowel obstruction. A total of 2 305 training sets and 993 test sets (training set: test set = 2.3:1) were composed of data from the two groups, including 405 cases (17.6%) of small bowel obstruction, 1 900 cases (82.4%) of non-small bowel obstruction, 164 cases (16.5%) of small bowel obstruction, and 829 cases (83.5%) of non-small bowel obstruction. The diagnosis of small bowel obstruction in training and testing sets was based on experienced radiologists' evaluation. Totally 861 abdominal upright abdominal radiographs constituted the validation set (99 with small bowel obstruction and 762 with no small bowel obstruction); the surgical results and clinical diagnosis were set as the gold standard. In this study, the image 2012 large-scale visual recognition challenge data set (ILSVRC2012) was used for pre-training the deep residual neural network (ResNet38). The retraining of deep residual network (ResNet38) with training set data was used to establish the diagnostic model. The test set was mainly used in the learning algorithm process to adjust the algorithm parameters to modify the network, so as to make the network model more efficient. Results: After training, the deep residual neural network achieved an AUC of 0.83 on the test set (95% CI 0.82-0.92). The sensitivity of the system for small bowel obstruction was 84.1%, with a specificity of 65.0%. And on validation set it achieved an AUC of 0.87 (95% CI 0.82-0.92), the sensitivity of the system for small bowel obstruction was 89.9%, with a specificity of 68.0%. Conclusion: Transfer learning with deep residual neural network may be used to train a detector for small bowel obstruction on upright abdominal radiographs even with limited training data.

Retrospective Study of Acute Small Bowel Obstruction: In Eastern India

This is a study conducted in a tertiary care hospital in eastern India aiming to provide detailed description of etiology progression and management of acute small bowel obstruction in our patients. Methods: Around 215 patients presented with features of acute intestinal obstruction.All presented with pain abdomen ,vomiting and distension and constipation. Results: Subsequently 58 patients managed conservatively and rest 157 patients managed surgically.In most of the patients multiple air fluid level are the most common radiological findings.External hernias (34.4%) are the most common causeof acute small bowel obstruction.Resection and anastomosis(24.8%) done in of strangulated bowel and rest are managed by hernia repair, adhesiolysis and stomy formation,Wound infection are the most common post-operative complication. Morbidity(2%) and mortality was mainly due to old age and late presentation. Conclusion: In all cases early diagnosis and surgical intervention are the keys to reduce complications and mortality.

Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.

Predictive factors with intestinal strangulation and operative intervention for recurrence in adhesive small bowel obstruction / 中国实用外科杂志

OBJECTIVE: To analyze the predictive factors for intestinal strangulation and to identify the surgical intervention for recurrence of adhesive small bowel obstruction(aSBO).METHODS: A retrospective study was conducted according the database in Department of Gastric and Colorectal Surgery, the First Hospital of Jilin University. Patients with aSBO from January 2013 to April 2016 were included in the study and were subject to follow-up. The clinical factors associated with strangulating obstruction and recurrences after treatment were analyzed by using univariate and multivariate logistic regression model.RESULTS: Total of 288 aSBO patients were included. Thirty-seven(12.9%)patients hadoccurredstrangulatingobstructions,and 251(87.1%)patients had simple obstructions.Increasing heart rate[>100/min;OR(95%CI):4.14(1.31-13.07),P=0.015],increasing WBC count[>15×10~9∕L;OR(95%CI):4.31(1.31-14.16),P=0.016],CT findings of thickening or swelling of the mesentery[OR(95%CI):11.04(2.18-55.92),P=0.004],and CT showing seroperitoneum [OR(95%CI):28.36(9.85-81.66),P<0.01] were detected as independent predictive factors for intestinal strangulation. During the follow-up,84 cases(29.2%)experienced recurrence of obstruction. The recurrence rates were reduced in the operation groups compared with non-operative groups[21.3%(26/122)vs.34.9%(58/166),P =0.01].CONCLUSION: Tachycardia,leukocytosis,CT findings of thickening or swelling of the mesentery,and CT showing seroperitoneum are considered as the predictive factors with intestinal strangulation in aSBO. Meanwhile,surgical treatments can reduce recurrence rate of aSBO patients significantly.

Tasa de conversión y morbilidad en el abordaje laparoscópico en pacientes seleccionados con obstrucción intestinal adherencial / Morbidity and Conversion Rate in Laparoscopy Approach in Selected Patients with Adhesive Intestinal Obstruction

Introducción: El síndrome adherencial es la causa más frecuente de obstrucción de intestino delgado. La laparotomía es el abordaje estándar. El avance de la cirugía mínimamente invasiva hace posible la resolución de cuadros obstructivos por laparoscopia. Objetivo: Analizar el abordaje laparoscópico de la obstrucción intestinal y compararlo con la vía abierta. Método: Análisis retrospectivo de los pacientes tratados de obstrucción intestinal aguda mediante laparoscopia en nuestro hospital desde 2012 hasta 2016. Se utilizó como referencia un grupo de pacientes tratados desde 2002 hasta 2005, cuando sólo se usaba el abordaje abierto. Se analizaron datos demográficos, riesgo quirúrgico, comorbilidades, métodos diagnósticos y complicaciones (Clavien). Resultados: De los 134 pacientes intervenidos de obstrucción intestinal aguda, se inició un abordaje laparoscópico en 47 (35 pr ciento). Por esta vía sólo se completaron 32 pacientes (68 por ciento). La tasa de conversión fue del 32 por ciento, estos pacientes fueron eliminados del estudio. En el grupo de referencia se analizaron al azar 32 pacientes. Ambos grupos son comparables. El grupo tratado con abordaje laparoscópico tuvo un 9 por ciento de complicaciones y un 3 por ciento de reintervenciones, con una sola lesión inadvertida. El grupo laparoscópico tuvo un 12,5 por ciento de reintervenciones, todas por evisceración, pero tuvo una lógica mayor tasa de resecciones intestinales. No hubo mortalidad hospitalaria. Conclusión: Los resultados en los pacientes en que se ha completado la cirugía por laparoscopia se comparan favorablemente con los del abordaje abierto en un grupo histórico homogéneo de referencia, y sin el riesgo añadido de evisceración(AU)

Introduction: Adherence syndrome is the most frequent cause of small bowel obstruction. Laparotomy is the standard approach. The progress of minimally invasive surgery makes it possible to resolve obstructive frames by laparoscopy. Objective: To analyze the laparoscopic approach for intestinal obstruction and compare it with the open pathway. Method: Retrospective analysis of patients treated for acute intestinal obstruction by laparoscopy in our hospital, from 2012 to 2016. A group of patients treated from 2002 to 2005 were used as reference, when only the open approach was used. We analyzed demographic data, surgical risk, comorbidities, diagnostic methods and complications (Clavien). Results: Within the 134 patients operated for acute intestinal obstruction, a laparoscopic approach was started in 47 (35 percent). Only 32 patients (68 percent) were completed in this way. The conversion rate was 32 percent, these patients were eliminated from the study. In the reference group, 32 patients were randomly analyzed. Both groups are comparable. The group treated with laparoscopic approach had 9 por ciento complications and 3 percent reoperations, with a single unexpected lesion. The laparoscopic group had 12.5 of reintervention, all due to evisceration, but had a higher rate of intestinal resections. There was no hospital mortality. Conclusion: In patients who have completed laparoscopic surgery, the results are compared favorably with those of the open approach in a homogeneous historical reference group, and without the added risk of evisceration(AU)

Accuracy of abdominal ultrasound for the diagnosis of small bowel obstruction in the emergency department / 世界急诊医学杂志（英文）

BACKGROUND: Emergency physicians frequently encounter patients with acute small bowel obstructions (SBO). Although computed tomography (CT) imaging is the current gold standard in the assessment of patients with suspected SBO in the emergency department, a few studies have examined the use of ultrasound as an alternative imaging technique. METHODS: We evaluated the accuracy of ultrasound performed in the ED by a variety of providers (physicians with various levels of training, physician assistants) compared to CT imaging in 47 patients with suspected SBOs. RESULTS: Our data demonstrated a sensitivity of 93.8％ and a specificity of 93.3％ when compared to abdominal CT, and a sensitivity of 94.3％ and specificity of 95.2％ using a composite endpoint of abdominal CT and discharge diagnosis. CONCLUSION: Ultrasound can play an important role in the identification of small bowel obstructions in ED patients.

Laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction: A meta-analysis / 解放军医学杂志

Objective To systematically evaluate the efficacy and safety of laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction.Methods The databases including PubMed,EMbase,The Cochrane Library (Issue 3,2017),ICTRP,CNKI,VIP,CBM and Wanfang Data were electronically searched to collect randomized controlled trials (RCTs) about laparoscopic adhesiolysis versus open surgery for adhesive small bowel obstruction patients from inception to March 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.Then meta-analysis was conducted by RevMan 5.3 software.Results A total of 31 studies involving 3293 patients were included.The results of meta-analysis showed that,compared with the open surgery group,the laparoscopic adhesiolysis group could significantly reduce the recurrence rate (OR=0.18,95％CI 0.12-0.25,P＜0.000 01),overall complications (OR=0.17,95％CI 0.13-0.23,P＜0.000 01),wound infection (OR=0.21,95％CI 0.13-0.35,P＜0.000 01),pneumonia (OR=0.35,95％CI 0.15-0.82,P=0.02) and intestinal fistula (OR=0.32,95％CI 0.15-0.70,P=0.005).Conclusions Current evidence shows that laparoscopic adhesiolysis can reduce the recurrence rate and complications in adhesive small bowel obstruction.Due to the limited quality of included studies,more high quality studies are needed to verify the above conclusion.

Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis

PURPOSE: Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC. METHODS: The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters. RESULTS: The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14–72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009–8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO. CONCLUSION: The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.