Risk factors to consider operation in patients with small bowel obstruction

ABSTRACT

PURPOSE: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. METHODS: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. RESULTS: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the non-operative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). CONCLUSION: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.