Early operation or conservative management of patients with small bowel obstruction?

Objective: To evaluate the outcome after initial non-operative treatment in patients with small bowel obstruction (SBO). Design: Prospective study. Setting: University hospital, Norway. Patients: One hundred and fifty-four patients with 166 episodes of SBO admitted during the period (1994-1995). Patients younger than 10 years as well as patients with large bowel obstruction, paralytic ileus, incarcerated hernia or SBO caused by cancer were excluded from the study. Interventions: Patients with signs of strangulation were operated on early. The rest were given a trial of conservative treatment. Main outcome measures: Need of operative treatment. Incidence of bowel strangulation, complications and death. Results: There were 166 cases of SBO. Twenty patients were operated on early among whom bowel was strangulated in 9. Among the 146 patients initially treated conservatively 93 (64%) settled without operation, 9 (6%) had strangulated bowel and 3 (2%) died. Of the 91 patients with partial obstruction but no sign of strangulation, 72 (79%) resolved on conservative treatment. Conclusions: Patients with partial obstruction with no sign of strangulation should initially be treated conservatively. When complete obstruction is present, it may settle on conservative management, but the use of supplementary diagnostic tools might be desirable to find the patients who will need early operative treatment.