THE SAFETY AND DURATION OF NONOPERATIVE TREATMENT FOR ADHESIVE SMALL-BOWEL OBSTRUCTION

Small bowel obstruction (SBO) due to adhesions is often initially trea ted non-operatively but the safety and duration of non-operative treat ment is controversial. The aims of this study were to assess the safet y of non-operative treatment and determine the optimal duration of non -operative treatment in adhesive SBO. A retrospective analysis of pati ents admitted with a diagnosis of adhesive SBO following an initial pe riod of non-operative treatment was performed. Patients whose conditio n resolved with non-operative treatment were compared with patients wh o required surgical intervention after an initial period of non-operat ive treatment. There were 123 admissions having an initial period of n on-operative treatment. The SBO resolved in 85, the remaining 38 requi red surgical intervention. Complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h. Thirty-one of 38 patients required surgical intervention for SBO more than 48 h dura tion after admission. The difference between cases resolving within 48 h and those requiring surgery after 48 h was significant (chi2 = 113, P < 0.001). Three (2.4%) patients, initially treated non-operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period of non-operative treatment. In the absence of any s igns of strangulation, patients with an adhesive SBO can be managed sa fely with non-operative treatment. Most cases of adhesive SBO that wil l resolve, do so within 48 h of admission. In the absence of any clini cal or radiological evidence of resolution within 48 h, non-operative treatment should be abandoned in favour of surgical intervention.