Background: Small bowel obstruction (SBO) is the commonly diagnosed disease in the emergency department. The diagnosis and management of small bowel obstruction varies among institutions. The role of laparoscopy in the management of small bowel obstruction is debatable. Aim: To study the profile, clinical features and management options of patients of small bowel obstruction with special emphasis on role of laparoscopy. Material and Methods: 51 consecutive patients with documented small bowel obstruction admitted in our department were studied from June 2016 to December 2018. All the patients above 12 years of age with small bowel obstruction were included. The diagnosis of small bowel obstruction (SBO) was made in these cases by detailed history, clinical examination and investigations. All these patients were received and adequately resuscitated. Non-operative (conservative) treatment was confirmed to those who met the standard parameters for such treatment and early surgical treatment was carried out whenever indicated. The operative procedure done was laparoscopy or open depending on the clinical features and condition of patient. Results: In our study, 51 patients mean age was 44.7 years with 27 Males and 24 females. 28 (54.9%) patients of our study presented with continuous abdominal pain followed by colicky pain in 23 (45.1%) patients. 34 (66.7%) patients on admission gave history of effortless vomiting. Distension of abdomen was present in 30 (58.8%) patients and constipation was present in 40 (78.4%) of our studied patients. On CT scan interloop fluid was present in 23 (45.1%) patients while transition point was present in 31 (60.8%) patients. Adhesion obstruction was found to be most common cause of obstruction 27 (52.9%) patients, followed by malignancy in 8 (15.7). 25 (49.0%) patients were managed conservatively and 26 (51%) were operated. 11 (21.6%) patients underwent laparoscopic adhesiolysis and 15 (29.4%) underwent exploratory laparotomy. The average operative time, recovery of bowel moments, hospital stay, and post-operative complications were less in the laparoscopic group than open group with statically significant difference between the two. Conclusion: Post-operative adhesion obstruction is the most common cause of small bowel obstruction. Laparoscopy is a safe and effective tool for the management of acute intestinal obstruction provided it is performed in selected patients by skilled surgeon.
References
[1]
Houghton, S.G., Del Medina, A.R. and Sarr, M.G. (2007) Bowel Obstruction. In: Zinner, M.J. and Ashley, S.W., Eds., Maingot’s Abdominal Operations, 11th Edition, McGraw-Hill, New York, 479.
[2]
Mullan, C.P., Siewert, B. and Eisenberg, R.L. (2012) Small Bowel Obstruction. AJR, 198, 105-116. https://doi.org/10.2214/AJR.10.4998
[3]
Dite, P., Lata, J. and Novotny, I. (2003) Intestinal Obstruction and Perforation— The Role of Gastroenterologist. Digestive Diseases, 21, 63-67.
https://doi.org/10.1159/000071341
[4]
Landercasper, J., Cogbill, T.H., Merry, W.H., et al. (1993) Long Term Outcome after Hospitalization for Small Bowel Obstruction. The Archives of Surgery, 128, 765-770.
https://doi.org/10.1001/archsurg.1993.01420190059008
[5]
Mucha, P. (1987) Small Intestinal Obstruction. Surgical Clinics of North America, 67, 597-620.
[6]
Maglinte, D.D.T., Balthazar, E.J., Kelvin, F.M., et al. (1997) The Role of Radiology in the Diagnosis of Small Bowel Obstruction. AJR, 168, 1171-1180.
https://doi.org/10.2214/ajr.168.5.9129407
[7]
Khanzada, T.W., Samad, A. and Champa, S. (2007) Aetiologic Spectrum of Dynamic Intestinal Obstruction. Gomal Journal of Medical Sciences, 5, 59.
[8]
Wasadikar, P.P. and Kulkarni, A.B. (1997) Intestinal Obstruction Due to Ascariasis. British Journal of Surgery, 84, 410-412. https://doi.org/10.1002/bjs.1800840345
[9]
Cappel, M.S. and Batke, M. (2008) Mechanical Obstruction of the Small Bowel and Colon. Medical Clinics of North America, 92, 575-597.
https://doi.org/10.1016/j.mcna.2008.01.003
[10]
Maglinte, D.D., Heitkamp, D.E. and Howard, T.J. (2003) Current Concepts in Imaging of Small Bowel Obstruction. Radiologic Clinics of North America, 41, 263-283.
[11]
Bass, K.N., Jones, B. and Bulbley, G.B. (1997) Current Management of Small Bowel Obstruction. Advances in Surgery, 31, 1-34.
[12]
Barkan, H., Webster, S. and Ozeran, S. (1995) Factors Predicting the Recurrence of Adhesive Small Bowel Obstruction. Annals of Surgery, 170, 361-365.
[13]
O’Connor, D.B. and Desmond, C. (2012) The Role of Laparoscopy in the Management of Acute Small Bowel Obstruction: A Review of over 2000 Cases. Surgical Endoscopy, 26, 12-17.
[14]
Nagle, A., Ujiki, M., Denham, W. and Murayama, K. (2004) Laparoscopic Adhesiolysis for Small Bowel Obstruction. The American Journal of Surgery, 187, 464-470.
https://doi.org/10.1016/j.amjsurg.2003.12.036
[15]
Wullstein, C. and Gross, E. (2003) Laparoscopic Compared with Conventional Treatment of Acute Adhesive Small Bowel Obstruction. British Journal of Surgery, 90, 117-1151. https://doi.org/10.1002/bjs.4177
[16]
Chopra, R., McVay, C., Phillips, E., et al. (2003) Laparoscopic Lysis of Adhesions. The American Surgeon, 69, 966-968.
[17]
Davies, S.W., Gillen, J.R., Guidry, C.A., et al. (2014) A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center. The American Surgeon, 80, 261-269.
[18]
Khaikin, M., Schneidereit, N., Cera, S., et al. (2007) Laparoscopic vs. Open Surgery for Acute Adhesive Small-Bowel Obstruction: Patients’ Outcome and Cost-Effectiveness. Surgical Endoscopy, 21, 742-746.
https://doi.org/10.1007/s00464-007-9212-1
[19]
Wullstein, C. and Gross, E. (2003) Laparoscopic Compared with Conventional Treatment of Acute Adhesive Small Bowel Obstruction. British Journal of Surgery, 90, 1147-1151.
[20]
Byrne, J., Saleh, F., Ambrosini, L., et al. (2015) Laparoscopic versus Open Surgical Management of Adhesive Small Bowel Obstruction: A Comparison of Outcomes. Surgical Endoscopy, 29, 2525-2532.
[21]
Saleh, F., Ambrosini, L., Jackson, T., et al. (2014) Laparoscopic versus Open Surgical Management of Small Bowel Obstruction: An Analysis of Short-Term Outcomes. Surgical Endoscopy, 28, 2381-2386.
[22]
Kelly, K.N., Iannuzzi, J.C., Rickles, A.S., et al. (2014) Laparotomy for Small Bowel Obstruction: First Choice or Last Resort for Adhesiolysis? A Laparoscopic Approach for Small-Bowel Obstruction Reduces 30-Day Complications. Surgical Endoscopy, 28, 65-73.
[23]
Meena, L.N., Bhatt, N. and Jain, S. (2018) Small Bowel Obstruction: Need for Surgery Based on History and Radiology. International Surgery Journal, 5, 588-592.
[24]
Liauw, J.J.Y. and Cheah, W.K. (2005) Laparoscopic Management of Acute Small Bowel Obstruction. Asian Journal of Surgery, 28, 185-188.
[25]
Mitra, A., Pandya, D. and Chandak, U. (2018) Study of Laparoscopic Adhesiolysis in Postoperative Adhesive Intestinal Obstruction. Radiology, 3, 96-101.
[26]
Chen, S.C., Chang, K.J., Lee, P.H., Wang, S.M., Chen, K.M. and Lin, F.Y. (1999) Oral Urografin in Postoperative Small Bowel Obstruction. World Journal of Surgery, 23, 1051-1054. https://doi.org/10.1007/s002689900622
[27]
Sarr, M.G., Bulkley, G.B. and Zuidema, G.D. (1983) Preoperative Recognition of Intestinal Strangulation Obstruction: Prospective Evaluation of Diagnostic Capacity. The American Journal of Surgery, 145, 176.
https://doi.org/10.1016/0002-9610(83)90186-1
[28]
Miller, G., Boman, J., Shrier, I. and Gordon, P.H. (2000) Etiology of Small Bowel Obstruction. The American Journal of Surgery, 180, 33-36.
[29]
Reddy, S.R.R. and Cappell, M.S. (2017) A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Current Gastroenterology Reports, 19, 28. https://doi.org/10.1007/s11894-017-0566-9
[30]
Paulson, E.K. and Thompson, W.M. (2015) Review of Small Bowel Obstruction: The Diagnosis and When to Worry. Radiology, 275, 332-342.
https://doi.org/10.1148/radiol.15131519
[31]
Otani, K., Ishihara, S., Nozawa, H., Kawai, K., Hata, K., Kiyomatsu, T., et al. (2017) A retrospective Study of Laparoscopic Surgery for Small Bowel Obstruction. Annals of Medicine and Surgery, 16, 34-39. https://doi.org/10.1016/j.amsu.2017.02.045
[32]
Lujan, H.J., Oren, A., Plasencia, G., Canelon, G., Gomez, E., Hernandez-Cano, A. and Jacobs, M. (2006) Laparoscopic Management as the Initial Treatment of Acute Small Bowel Obstruction. Journal of the Society of Laparoendoscopic Surgeons, 104, 466-472.
[33]
Brolein, R.E. (1984) Partial Small Bowel Obstruction. Surgery, 95, 145-149.
[34]
Johnson, K.N., et al. (2012) Laparoscopic Management of Acute Small Bowel Obstruction: Evaluating the Need for Resection. Journal of Trauma and Acute Care Surgery, 72, 25-30. https://doi.org/10.1097/TA.0b013e31823d8365
[35]
Navez, B., Arimont, J.M. and Guit, P. (1998) Laparoscopic Approach in Acute Small Bowel Obstruction: A Review of 68 Patients. Hepato-Gastroenterology, 45, 2146-2150.
[36]
Ibrahim, I.M., Wolodiger, F., Sussman, B., et al. (1996) Laparoscopic Management of Acute Small Bowel Obstruction. Surgical Endoscopy, 10, 1012-1015.
https://doi.org/10.1007/s004649900226
