Secondary causes of intestinal obstruction: Rigorous preoperative evaluation is required

The clinical presentation, management and outcome of patients with small in testinal and large bowel obstruction unrelated to adhesive or primary colon ic neoplastic disease is not well described. The aim of this study was to d etermine the clinical presentation, evaluation, operative management, and o utcome in patients with secondary causes of intestinal obstruction. The med ical records of 200 patients who underwent an operation for intestinal obst ruction from January 1995 through December 1997 were reviewed. Seventy-thre e patients (37%) had secondary causes of intestinal obstruction, and these records were reviewed in detail. The cohort included 37 men and 36 women wi th a mean age of 52 +/- 2 years. The etiology of intestinal obstruction was metastatic neoplastic obstruction (19%), colonic volvulus (18%), Crohn's d isease (14%), herniae (11%), diverticular disease (7%), and miscellaneous c auses (31%). Six patients (8%) had intestinal motor disorders and a misdiag nosis of intestinal obstruction. The clinical presentation of patients with secondary causes of obstruction was similar to typical patients with adhes ive small bowel obstruction. Preoperative evaluation included frequent use of CT (42%), but intestinal contrast studies were used in 13 (18%) patients only. Two-thirds of the patients required an intestinal resection, and 50 per cent of the patients with a misdiagnosis had a nontherapeutic celiotomy . Operative mortality and morbidity were 3 per cent and 48 per cent, respec tively, and 15 per cent of patients required reoperation. Suspected intesti nal obstruction from secondary causes requires rigorous preoperative evalua tion with liberal use of intestinal contrast examinations to avoid misdiagn osis, operative complications, and reoperations.