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Questioning the Small-Bowel Obstruction ParadigmComment on "Nonoperative Management of Patients With a Diagnosis of High-grade Small Bowel Obstruction by Computed Tomography"
H. Leon Pachter, MD
Arch Surg. 2009;144(11):1005.
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| Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings. |
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Small-bowel obstruction, a common complication after abdominal surgery, can be a vexing problem for any surgeon. In the past, partial obstruction was managed nonoperatively because up to 80% resolved with conservative treatment, whereas complete obstruction was almost always operated on because reasonable hopes for spontaneous resolution usually did not exceed 5%.
The article by Rocha et al, although retrospective in nature, dispels some myths and questions the basis for the long-held aforementioned management paradigm. Several key points evolved from this report. Nearly half (46%) of patients with CT evidence of high-grade obstruction could be managed conservatively; most would have been operated on in the past. Computed tomography signs of ischemia, tachycardia, leukocytosis, and acidosis were not, in and of themselves, predictors of the need for surgical intervention; the recurrence rate of SBO, thought rarely to occur after surgical intervention, was in the magnitude of 12% to . . . [Full Text of this Article]
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Nonoperative Management of Patients With a Diagnosis of High-grade Small Bowel Obstruction by Computed Tomography
Flavio G. Rocha, Todd A. Theman, Evan Matros, Stephen M. Ledbetter, Michael J. Zinner, and Stephen J. Ferzoco
Arch Surg. 2009;144(11):1000-1004.
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