Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1978 Feb;187(2):189–193. doi: 10.1097/00000658-197802000-00017

Critical operative management of small bowel obstruction.

R H Stewardson, C T Bombeck, L M Nyhus
PMCID: PMC1396473  PMID: 629620

Abstract

The records of 238 patients with the diagnosis of small bowel obstruction at the University of Illinois Hospital from 1967 through the spring of 1976 were reviewed. Mortality, intra-operative management, and clinical findings were evaluated. Previous reports list a mortality of gangrenous small bowel obstruction, secondary to hernia and/or adhesions, as greater than 20%, although in this series, the mortality was 4.5% in patients with gangrenous small bowel obstruction. The present data reveal a 60% incidence of wound infection in patients in whom an enterotomy (iatrogenic, decompressive or resective) was made and the subcutaneous tissue and skin closed, and it is therefore recommended that the wound be left open in these situations. Although a variety of individual clinical findings have been advocated as diagnostic aids in patients with small bowel obstruction, this review suggests that attention to a combination of "classic" findings, i.e., leukocytosis, fever, tachycardia and localized tenderness, portends a situation in which conservative observation is safe--namely, the absence of all four findings. The presence of any one or more of these findings mandates early operative intervention.

Full text

PDF
192

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnett W. O., Oliver R. I., Elliott R. L. Elimination of the lethal properties of gangrenous bowel segments. Ann Surg. 1968 Jun;167(6):912–919. doi: 10.1097/00000658-196806000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barnett W. O., Petro A. B., Williamson J. W. A current appraisal of problems with gangrenous bowel. Ann Surg. 1976 Jun;183(6):653–659. doi: 10.1097/00000658-197606000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. DIXON J. A., NICHOLS R. L., HUNTER D. C., Jr STRANGULATION OBSTRUCTION OF THE INTESTINE. EARLY DETECTION. Arch Surg. 1964 Apr;88:527–532. doi: 10.1001/archsurg.1964.01310220017004. [DOI] [PubMed] [Google Scholar]
  4. DUOBOS R., SCHAEDLER R. W., COSTELLO R. COMPOSITION, ALTERATION, AND EFFECTS OF THE INTESTINAL FLORA. Fed Proc. 1963 Nov-Dec;22:1322–1329. [PubMed] [Google Scholar]
  5. Davis S. E., Sperling L. Obstruction of the small intestine. Arch Surg. 1969 Oct;99(4):424–426. doi: 10.1001/archsurg.1969.01340160004002. [DOI] [PubMed] [Google Scholar]
  6. Delany H. M. Prognostic factors in infarction of the intestine. Surg Gynecol Obstet. 1972 Aug;135(2):253–256. [PubMed] [Google Scholar]
  7. Gorbach S. L. Intestinal microflora. Gastroenterology. 1971 Jun;60(6):1110–1129. [PubMed] [Google Scholar]
  8. Green J. W., Wenzel R. P. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg. 1977 Mar;185(3):264–268. doi: 10.1097/00000658-197703000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hicks C., Baumann F. G., Enquist I. F. Changes in intestinal flora in dogs with nonstrangulating intestinal obstruction. Surgery. 1969 Sep;66(3):580–583. [PubMed] [Google Scholar]
  10. Kalser M. H., Arteaga I., Yawn E., Hoffert W., Frazier D., Cohen R., Mayoral L. Microflora of the small intestine. Am J Dig Dis. 1965 Oct;10(10):839–843. doi: 10.1007/BF02236092. [DOI] [PubMed] [Google Scholar]
  11. Ketcham A. S., Hoye R. C., Pilch Y. H., Morton D. L. Delayed intestinal obstruction following treatment for cancer. Cancer. 1970 Feb;25(2):406–410. doi: 10.1002/1097-0142(197002)25:2<406::aid-cncr2820250219>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  12. LAUFMAN H., NORA P. F. Physiological problems underlying intestinal strangulation obstruction. Surg Clin North Am. 1962 Feb;42:219–229. [PubMed] [Google Scholar]
  13. Leffall L. D., Syphax B. Clinical aids in strangulation intestinal obstruction. Am J Surg. 1970 Dec;120(6):756–759. doi: 10.1016/s0002-9610(70)80043-5. [DOI] [PubMed] [Google Scholar]
  14. Lo A. M., Evans W. E., Carey L. C. Review of small bowel obstruction at Milwaukee County General Hospital. Am J Surg. 1966 Jun;111(6):884–887. doi: 10.1016/0002-9610(66)90195-4. [DOI] [PubMed] [Google Scholar]
  15. McIver M. A., White J. C., Lawson G. M. THE ROLE OF THE BACILLUS WELCHII IN ACUTE INTESTINAL OBSTRUCTION: WITH LIGATION OF THE VEINS TO THE OBSTRUCTED LOOP. Ann Surg. 1929 May;89(5):647–657. doi: 10.1097/00000658-192905000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. SALTZSTEIN E. C., MARSHALL W. J., FREEARK R. J. Gangrenous intestinal obstruction. Surg Gynecol Obstet. 1962 Jun;114:694–700. [PubMed] [Google Scholar]
  17. SHIRES T., ADWAN K. O. A review of the advances in management of mechanical obstruction of the small intestine. Am Surg. 1958 Jun;24(6):431–438. [PubMed] [Google Scholar]
  18. Shatila A. H., Chamberlain B. E., Webb W. R. Current status of diagnosis and management of strangulation obstruction of the small bowel. Am J Surg. 1976 Sep;132(3):299–303. doi: 10.1016/0002-9610(76)90379-2. [DOI] [PubMed] [Google Scholar]
  19. Singleton A. O., Jr, Montalbo P. Effects of decompression during removal of intestinal obstruction. Ann Surg. 1968 Jun;167(6):909–911. doi: 10.1097/00000658-196806000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Snyder E. N., Jr, McCranie D. Closed loop obstruction of the small bowel. Am J Surg. 1966 Mar;111(3):398–402. doi: 10.1016/s0002-9610(66)80018-1. [DOI] [PubMed] [Google Scholar]
  21. Stone A. M., Tucci V. J., Isenberg H. D., Wise L. Wound infection: a prospective study of 7519 operations. Am Surg. 1976 Nov;42(11):849–852. [PubMed] [Google Scholar]
  22. Sykes P. A., Boulter K. H., Schofield P. F. The microflora of the obstructed bowel. Br J Surg. 1976 Sep;63(9):721–725. doi: 10.1002/bjs.1800630913. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES