in a population based appraisal [37] found that

in a population based appraisal [37] found that patients who underwent operations during index admission had longer

lengths of stay, lower mortality, fewer SBO readmissions, and longer time to readmission than patients selleck chemicals llc treated nonsurgically. In a retrospective analysis of 123 patients admitted for ASBO and having an initial period of non-operative treatment, complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h [38]. On the other hand only three (2.4%) patients, initially treated non-operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period Selleckchem S63845 of non-operative treatment. Therefore, upon the authors conclusion, in the absence of any signs of strangulation, patients with an adhesive SBO can be managed safely with non-operative treatment. In a prospective, randomized trial conducted to compare NGT and LT decompression with respect to the success of nonoperative treatment AMN-107 cost and morbidity of surgical intervention in 55 patients

with acute ASBO, out of 28 patients managed with NGT and 27 with LT, twenty-one patients ultimately required operation [39]. At operation, 3 patients in the NGT group had ischemic bowel that required resection. Postoperative complications occurred in 23%

of patients treated with NGT versus 38% of patients treated with LT and no deaths were observed. Therefore patients with ASBO can safely be given a trial of tube decompression upon hospital admission, given the absence of complications in patients treated with either type of tube decompression coupled with acceptable morbidity rate. In patients with also repeated episodes and many prior laparotomies for adhesions, prolonged conservative treatment, including parenteral nutritional support may be prudent and often avoid a complex high-risk procedure [40]. Fevang et al. found that among 146 patients with SBO initially treated conservatively, 93 (64%) settled without operation, 9 (6%) had strangulated bowel and 3 (2%) died [41]. Whereas of the 91 patients with partial obstruction but no sign of strangulation, 72 (79%) resolved on conservative treatment. Therefore the authors recommended that patients with partial obstruction and no sign of strangulation should initially be treated conservatively.

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