Adhesional Small Bowel Obstruction in the Absence of Previous Operations: Management and Outcomes

Background The majority of small bowel obstructions (SBO) are the result of adhesions caused by a previous abdominal operation. On rare occasions, adhesional SBO occurs in the absence of such an operation. Our objective was to describe the management, findings, and outcomes of unexplained adhesional SBO (UA-SBO) and examine whether preoperative diagnostic uncertainty leads to delays in therapy and complications. Methods The medical records of all adhesional SBO patients admitted to the Massachusetts General Hospital between January 1, 1997 and December 31, 2007 were screened. UA-SBO records were reviewed in detail. Each UA-SBO patient was matched with an adhesional SBO patient with abdominal surgical history (SH-SBO) according to gender, age (+/- 7 years), white blood cell count (+/- 3000/mm(3)), time interval from the onset of symptoms to the time of admission (+/- 24 h), and year of admission (+/- 4 years). Outcomes included time from admission to operation, morbidity, mortality, and length of hospital stay. Results Of 1,036 patients with adhesional SBO, 34 (3.3%) had UA-SBO. Adhesiolysis was sufficient in 31 patients, whereas 3 required an enterectomy. UA-SBO patients were similar in terms of demographics, clinical presentation, and initial laboratory tests with SH-SBO patients. There was no difference in any of the outcomes between the two groups. Conclusions In this study of UA-SBO, diagnostic delays were not found and patient outcomes were similar to those of patients with SH-SBO.