Small bowel obstruction (SBO) is a frequent cause of emergency department admissions.
This study aimed to determine risk factors of reoperations, postoperative adverse event, and operative mortality (OM) in patients surgically treated for SBO.
This is a retrospective study conducted between 2014 and 2017. Exclusion criteria include gastric outlet obstruction, large bowel obstruction, and incomplete clinical record. STATA version 14 was used for statistical analysis, with p-value <0.05 with 95% confidence interval considered statistically significant.
A total of 218 patients were included, in which 61.9% were women. Notably, 88.5% of patients had previous abdominal surgery. Intestinal resection was needed in 28.4% of patients. Postoperative adverse event was present in 28.4%, reoperation was needed in 9.2% of cases, and a 90-day surgical mortality was 5.9%. Multivariate analysis determined that intestinal resection, >3 days in intensive care unit (ICU), >7 days with nasogastric tube (NGT), pain after postoperative day 3, POAE, and surgical POAE were the risk factors for reoperations, while age, C-reactive protein, intestinal resection, >3 days in ICU, and >7 days with NGT were the risk factors for POAE. OM was determined by >5 days with NGT and POAE.
Postoperative course is determined mainly for patient’s age, preoperative level of C-reactive protein, necessity of intestinal resection, clinical postoperative variables, and the presence of POAE.
Small bowel is a difficult area to visualize with endoscopy. While ileo-colonoscopy can help visualize the terminal few centimeters of the ileum, esophagogastroduodenoscopy is usually utilized to view the gastrointestinal tract till the proximal duodenum. The visualization of distal duodenum, jejunum and ileum requires advanced techniques. While capsule endoscopy can provide the visualization of the entire small bowel, it is costly and cannot be used to obtain tissue for histology or for therapeutic purpose. Enteroscopic techniques like the push enteroscopy, spiral enteroscopy and single or double balloon enteroscopy are used to diagnose and treat small bowel lesions1. However, these are costly and their availability is scarce as is the expertise in their use. The accessories for their use are different and add to the cost of therapy. Previously the use of pediatric colonoscopes has been reported for push enteroscopy2. However, the more readily available adult colonoscope may not be helpful because of the larger diameter. We hypothesized that the gastroscope may be used to access the proximal jejunal lesions.
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