SMALL BOWEL OBSTRUCTION

Abstract

The clinical presentation, treatment and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals, Bronx, N.Y., were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2% and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7% and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease; 12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 h of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (> 70 yr), feculant vomiting, peristaltic sounds and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia or X-ray findings. Accurate criteria for small bowel obstruction therapy were apparently not clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significant percentage of patients.