Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions

Tunc Eren; Salih Boluk; Baris Bayraktar; Ibrahim Ali Ozemir; Sumeyra Yildirim Boluk; Ercument Tombalak; Orhan Alimoglu

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저자정보: Tunc Eren (Istanbul Medeniyet University) Salih Boluk (Istanbul Medeniyet University) Baris Bayraktar (Istanbul Medeniyet University) Ibrahim Ali Ozemir (Istanbul Medeniyet University) Sumeyra Yildirim Boluk (Istanbul Medeniyet University) Ercument Tombalak (Istanbul Medeniyet University) Orhan Alimoglu (Istanbul Medeniyet University)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.88 No.6

발행연도: 2015.5

수록면: 325 - 333 (9page)

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Purpose: Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions.
Methods: This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters.
Results: The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20?98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively).
Conclusion: Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.

#Intestinal obstruction #Surgery #Tissue adhesions

참고문헌 (30)

참고문헌 신청

Jackson PG. / 2011 / Evaluation and management of intestinal obstruction / Am Fam Physician 83:159~165

Sclabas GM. / 2013 / Maingot's abdominal operations / McGraw Hill Professional :585~610

Mucha P Jr / 1987 / Small intestinal obstruction / Surg Clin North Am 67:597~620

Catena F. / 2011 / Bologna guidelines for diagnosis and management of adhesive small bowel obstruction(ASBO) : 2010 evidence-based guidelines of the World Society of Emergency Surgery / World J Emerg Surg 6:5

Parker MC. / 2001 / Postoperative adhesions : ten-year follow-up of 12, 584 patients undergoing lower abdominal surgery / Dis Colon Rectum 44:822~829

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