Management of Small Bowel Obstruction after Previous Abdominal Operation

ABSTRACT

There is a continuing debate among surgeons about whether postoperative adhesive small bowel obstruction is best managed operatively or nonoperatively. This retrospective study was designed to determine the factors influencing the treatment modality of postoperative small bowel obstruction. A clinical analysis was conducted on 112 cases of small bowel obstruction after previous abdominal operation, who were admitted to the department of general surgery of Korea Veterans Hospital from January, 1984 to December, 1994. The patients were divided into two groups according to the modality of treatment operatively(N=35) and nonoperatively(N=77) treated groups. Clinical parameters such as age, sex, symptoms and signs, type of previous operation, interval between previous operation and admission due to obstructive symptoms, time period from onset of symptoms to admission, and interval from admission to operation, were compared between two groups. Among 112 cases, the conservative treatment was performed in 77 cases and operative management was performed in 35 cases. There was no significant difference in the distribution of age and sex between two groups. The previous operations leading to adhesive intestinal obstruction were appendectomy(18.8%), gastroduodenal operation(17.0%), operation for multiple organ injury(16.1%), and Obsetric & Gynecologic surgery(9.8%) in that orders. The interval between previous abdominal operation and admission was under 1 month in 20 cases, 1 to 6 months in 10 cases, 7 to 12 months in 16 cases, and 1 to 2 years in 16 cases. The major symptoms and signs were abdominal pain, abdominal tenderness, vomiting, abdominal distension, hyperperistalsis, and leukocytosis. Among the above signs and symptoms, continuous abdominal pain, leukocytosis, and tachycardia were significantly higher in the operative group compared to those of the nonoperative group. The most common procedures of operative management were adhesiolysis, small bowel resection, bypass surgery, and colon resection in that orders. The incidence of postoperative complications was 31.4% and the most common complication was wound infection. In conclusion, at admission, the presence of strangulating signs such as continuous abdominal pain, leukocytosis, and tachycardia in patients with small bowel obstruction after previous abdominal operation mandates early operative intervention rather than conservative treatment.