THE SAFETY AND DURATION OF NON‐OPERATIVE TREATMENT FOR ADHESIVE SMALL BOWEL OBSTRUCTION

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Abstract
Small bowel obstruction (SBO) due to adhesions is often initially treated non‐operatively but the safety and duration of non‐operative treatment is controversial. The aims of this study were to assess the safety of non‐operative treatment and determine the optimal duration of non‐operative treatment in adhesive SBO. A retrospective analysis of patients admitted with a diagnosis of adhesive SBO following an initial period of non‐operative treatment was performed. Patients whose condition resolved with non‐operative treatment were compared with patients who required surgical intervention after an initial period of non‐operative treatment.There were 123 admissions having an initial period of non‐operative treatment. The SBO resolved in 85, the remaining 38 required surgical intervention. Complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h. Thirty‐one of 38 patients required surgical intervention for SBO more than 48 h duration after admission. The difference between cases resolving within 48 h and those requiring surgery after 48 h was significant (x2= 113, P < 0.001). Three (2.4%) patients, initially treated non‐operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period of non‐operative treatment.In the absence of any signs of strangulation, patients with an adhesive SBO can be managed safely with non‐operative treatment. Most cases of adhesive SBO that will resolve, do so within 48 h of admission. In the absence of any clinical or radiological evidence of resolution within 48 h, non‐operative treatment should be abandoned in favour of surgical intervention.