THE OPERATIVE ETIOLOGY AND TYPES OF ADHESIONS CAUSING SMALL-BOWEL OBSTRUCTION

Postoperative adhesions account for 64-79% of admissions with small bo wel obstruction (SBO). The aim of this study was to identify the opera tive procedures and the types of adhesions that cause SBO. A retrospec tive analysis of all patients with an admission diagnosis of acute adh esive SBO between January 1982 and December 1990 was performed. One hu ndred and nineteen patients had 144 admissions with an initial diagnos is of acute SBO due to adhesions. The previous operations were: append icectomy 23.3%; colorectal resection 20.8%; gynaecological surgery 11. 7%; upper gastrointestinal (gastric, biliary or splenic) surgery 9.2%; small bowel surgery 8.3%; and more than one previous abdominal operat ion 23.6%. Sixty-one admissions required surgery to relieve the SBO. E ighteen patients had strangulated small bowel. All but two of these pa tients had a single band adhesion causing the SBO and associated stran gulation. Band adhesions were commonly found following appendicectomy, colorectal resections or gynaecological operations. Seventeen of the 21 patients with previous surgery for a colorectal malignancy had beni gn adhesions causing the SBO, while four of the six patients with eith er previous ovarian or previous gastric carcinoma had recurrent malign ancy causing the SBO. Five patients had previously undiaposed carcinom as (three ovarian and two caecal) as the cause of the SBO.