SMALL BOWEL OBSTRUCTION IN THE ELDERLY

  • 1 January 1985
    • journal article
    • research article
    • Vol. 51  (8) , 470-473
Abstract
Hospital records were reviewed for all patients > 70 yr who were treated for small bowel obstruction (SBO) at The New York Hospital-Cornell Medical Center [New York, USA] from Jan. 1975 through Dec. 1980. There were 87 patients treated surgically and 20 patients treated nonoperatively. When the clinical evidence of strangulation was evaluated for preoperative reliability, 35% of the patients had none of the accepted criteria for strangulation. Complications occurred in 60.9% of patients following operative intervention. Wound infection was the most common postoperative complication and as related to wound management and to the number of enterotomies made at the time of surgery. Using delayed 1.degree. closure, the infection rate was 6.5% compared to 21.1% when wounds were closed at surgery. The overall operative mortality was 18%; advanced carcinoma accounted for 60% of these fatalities. The mortality for patients with nonmalignant obstruction was 10.0% as compared with 40.7% in patients with cancer. Age alone should not be a deterrent to operative intervention in small bowel obstructions. The presence of a 1.degree. or 2.degree. malignant process in the elderly patient is a significant risk factor for mortality. Any patient operated on for SBO having an enterotomy should have their wound managed by delayed 1% closure. Because of the lack of reliability of the clinical criteria for strangulation, operative intervention in the elderly should be undertaken as soon as the diagnosis of mechanical obstruction is made.

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