Long-term outcome after hospitalization for small-bowel obstruction

J. Landercasper, T. H. Cogbill, W. H. Merry, R. T. Stolee and P. J. Strutt
Department of Surgery, Gundersen/Lutheran Medical Center, La Crosse, WI.

OBJECTIVE: To determine the recurrence rate of small-bowel obstruction and differences in recurrence rates stratified by cause of obstruction and method of treatment. DESIGN: Retrospective chart review with average follow-up of 53 months (range, 0 to 129 months). SETTING: Combined community hospital/clinic tertiary referral center. PATIENTS: 309 consecutive patients with documented mechanical small-bowel obstruction hospitalized from 1981 to 1986. MAIN OUTCOME MEASURES: Recurrence rates by the actuarial life-table method and comparisons made by the Wilcoxon and log-rank tests. RESULTS: Recurrent obstruction developed in 34% of all patients by 4 years and in 42% by 10 years. Recurrence rates were 29% and 53% in the patients who did and did not undergo surgery (P = .002). The recurrence rate in patients with surgery was 56% for malignant neoplasms, 28% for adhesions, and 0% for hernia. Recurrence rates were 50% and 40% for patients with and without prior multiple obstructions (P = .7). CONCLUSIONS: The long-term risk of recurrent small-bowel obstruction is high. The risk is lessened by operation but not eliminated. The risk of recurrence increases with longer duration of follow-up, but most recurrences occur within 4 years. Multiple prior obstructions did not increase the risk of future obstruction.