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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2012, Vol. 6 Issue (4) : 436-439     DOI: 10.1007/s11684-012-0221-7
CASE REPORT |
Severe adhesive small bowel obstruction
Salomone Di Saverio1,2,3(), Fausto Catena1, Michael D. Kelly2, Gregorio Tugnoli3, Luca Ansaloni1,4
1. Emergency Surgery Unit, Department of General and Transplant Surgery, S. Orsola Malpighi University Hospital, Bologna, Italy; 2. Upper GI Surgery Unit, Department of Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK; 3. Emergency and Trauma Surgery Unit, Maggiore Hospital Trauma Center, Bologna, Italy; 4. General Surgery I Dept., Ospedali Riuniti, Bergamo, Italy
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Abstract  

Adhesive small bowel obstruction is a frequent cause of hospital admission. Water soluble contrast studies may have diagnostic and therapeutic value and avoid challenging demanding surgical operations, but if bowel ischemia is suspected, prompt surgical intervention is mandatory. A 58-year-old patient was operated for extensive adhesive small bowel obstruction after having had two previous laparotomies for colorectal surgery, and had a complex clinical course with multiple operations and several complications. Different strategies of management have been adopted, including non-operative management with the use of hyperosmolar water soluble contrast medium, multiple surgical procedures, total parenteral nutrition (TPN) support, and finally use of anti-adherences icodextrin solution. After 2 years follow-up the patient was doing well without presenting recurrent episodes of adhesive small bowel obstruction. For patients admitted several times for adhesive small bowel obstruction, the relative risk of recurring obstruction increases in relation to the number of prior episodes. Several strategies for non-operative conservative management of adhesive small bowel obstruction have already addressed diagnostic and therapeutic value of hyperosmolar water soluble contrast. According to the most recent evidence-based guidelines, open surgery is the preferred method for surgical treatment of strangulating adhesive small bowel obstruction as well as after failed conservative management. Research interest and clinical evidence are increasing in adhesions prevention. Hyaluronic acid-carboxycellulose membrane and icodextrin may reduce incidence of adhesions.

Keywords post-operative intraperitoneal adhesions      adhesive small bowel obstruction      adhesiolysis      antiadhesion treatments      hyperosmolar water soluble contrast medium     
Corresponding Authors: Saverio Salomone Di,Email:salo75@inwind.it; s.disaverio@ausl.bologna.it   
Issue Date: 05 December 2012
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-012-0221-7     OR     http://academic.hep.com.cn/fmd/EN/Y2012/V6/I4/436
Fig.1  Intraoperative picture showing severe adhesive small bowel obstruction with plastic fibro-adhesive peritonitis.
Fig.2  The matted, diffuse and dense adhesions were “engulfing” the loops of the whole bowel.
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