Critical Operative Management of Small Bowel Obstruction

Abstract

The records of 238 patients with the diagnosis of small bowel obstruction from 1967-1976 were reviewed. Mortality, intraoperative management and clinical findings were evaluated. Previous reports list a mortality of gangrenous small bowel obstruction, secondary to hernia and/or adhesions, as > 20%, although in this series, the mortality was 4.5% in patients with gangrenous small bowel obstruction. There was a 60% incidence of wound infection in patients in whom an enterotomy (iatrogenic, decompressive or resective) was made with the subcutaneous tissue and skin closed. It is 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, attention to a combination of classic findings, i.e., leukocytosis, fever, tachycardia and localized tenderness, may portend a situation in which conservative observation is safe.sbd.namely, the absence of all 4 findings. The presence of any 1 or more of these findings mandates early operative intervention.