Although common, small bowel obstruction (SBO) remains one of the most challenging
clinical problems treated by surgeons. Responsible for up to 300,000 hospital admissions
every year in North America, SBO arises from multiple etiologies and manifests as
a diverse panoply of clinical presentations [
[1]
]. Initial evaluation should center on differentiating those patients who need urgent
exploration from those who may undergo a safe, nonoperative trial. The wide range
of etiologies, however, combined with specific, and often unique, patient parameters,
renders this decision difficult. Traditionally, the decision between urgent operative
intervention and initial nonoperative management has hinged on the distinction between
complete and partial obstruction. However, the clinical diagnosis of complete obstruction
is imprecise, and the complete/partial dichotomy has not eliminated avoidable obstruction-associated
ischemia and necrosis. Rather than trying to predict those patients at risk for ischemic
complications, we may do better to define clinical parameters that predict failure
of nonoperative management and offer prompt operation to patients demonstrating these
parameters. Hopefully, such an approach, codified into practice management guidelines,
will minimize both ischemia and hospital length of stay associated with SBO. After
reviewing the pathogenesis and pathophysiology of SBO, this article outlines newly
developed and refined management and surgical techniques to reach these goals.To read this article in full you will need to make a payment
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Published online: July 04, 2011
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© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
