Treatment of Intestinal Adhesions with Obstruction in Adhesive Small Bowel Obstruction with Peritonitis, Strangulation, or Bowel Ischemia
Clinical Scenario
This protocol addresses adhesive small bowel obstruction (ASBO) presenting with signs of peritonitis, strangulation, or bowel ischemia — findings that indicate non-operative management is contraindicated.
When Non-Operative Management Is Ruled Out
Peritonitis, strangulation, and bowel ischemia are recognised contraindications to conservative management in ASBO. In these patients, non-operative treatment should not be attempted; the clinical situation demands a different approach.
Treatment Approach — Partial Overview
Management in this setting involves urgent surgical exploration. The evidence-based regimen specifies which surgical approach is appropriate and under what conditions an alternative operative strategy may be considered — full details, including patient selection criteria, are available in the complete protocol.
References
DOI: 10.1186/s13017-018-0185-2
- Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia.
- Non-operative management should always be tried in patients with adhesive small bowel obstruction, unless there are signs of peritonitis, strangulation, or bowel ischemia.
- When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO.
- Farinella et al. reported that predictors for a successful laparoscopic treatment of ASBO are the following: ≤ 2 laparotomies in history, appendectomy as the operation in history, no previous median laparotomy incision, and a single adhesive band.
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