Adhesion-related small-bowel obstruction after gynecologic operations

OBJECTIVE: Our purpose was to evaluate a possible relationship between adhe sion-related small-bowel obstruction and gynecologic operations. STUDY DESIGN: The records of all female patients with the diagnosis of smal l-bowel obstruction from 1989 to 1996 were studied. The cause of bowel obst ruction, the type and technique of previous operations, and whether the par ietal peritoneum was closed at the completion of the procedure or was left open were evaluated. RESULTS: Among 262 women the most common cause of small-bowel obstruction w as intra-abdominal adhesions (37.0%). Among 92 women with adhesion-related small-bowel obstruction, 35 women (38%) had undergone a previous abdominal hysterectomy. The incidence of small-bowel obstruction after an abdominal h ysterectomy was 16.3 per 1000 hysterectomies. The incidence of small-bowel obstruction after cesarean delivery (5/10,000 cesarean deliveries) was sign ificantly less than after other abdominal operations. Adhesions were found between the small bowel and the pelvis in 14 women (29.8%), and all were in women who had undergone a hysterectomy. In 33 others (70.2%) the adhesions were found between the previous abdominal incision and the intestine. The median interval between the initial operation and the small-bowel obstructi on was 5.3 years. CONCLUSION: The most common cause of small-bowel obstruction is postsurgica l adhesions. Adhesion-related small-bowel obstruction is commonly found aft er an abdominal hysterectomy Bower obstruction can occur many years after t he initial abdominal surgery.