What are the guideline sources, guidelines and references for Small bowel obstruction ?
Guideline sources The following summarized guidelines for the evaluation and management of small bowel obstruction (SBO) are prepared by our editorial team based on guidelines from the World Society of Emergency Surgery (WSES 2018) and the Eastern Association for the Surgery of Trauma (EAST 2012). 1 2 3 4 4 5 6 7 Definition SBO is a clinical syndrome characterized by symptoms related to mechanical blockage of the small bowel. 3 Epidemiology Common etiologies include adhesions (65%), hernias (10%), neoplasms (5%), and Crohn's disease (5%). 4 Pathophysiology In the United States, the incidence of SBO is approximately 100 per 100,000 person-years. 4 Disease course The distension of small bowel segments that are proximal to the obstruction may lead to clinical manifestations of abdominal pain, nausea, and vomiting. Bacterial translocation can result in https://web.pathway.md/diseases/recbtyx1IxS0lLMJP 1/4 6/24/23, 3:13 PM Small bowel obstruction Pathway bacteremia. Progressive, untreated obstruction may lead to bowel ischemia and perforation, with secondary fecal peritonitis. 5 Prognosis and risk of recurrence In patients with SBO due to postoperative adhesions, in-hospital mortality is estimated at 4.7%. In patients undergoing emergency laparotomy for SBO, 1-month mortality is estimated at 7.2%. 6 7 Pathway Small bowel obstruction Diagnosis and management Guidelines 1. Diagnostic investigations Initial evaluation: Obtain basic laboratory tests (CBC, lactate, electrolytes, serum creatinine and urea) as part of the initial evaluation of patients with SBO. B Assess the nutritional status of patients presenting with SBO. B Abdominal radiographs: avoid obtaining abdominal XRs because of their limited value in the work-up of patients with SBO. D Abdominal computed tomography: As per WSES 2018 guidelines: Obtain an abdominal CT scan with oral water-soluble contrast as part of the initial workup of patients with SBO. B Obtain a follow-up abdominal XR after 24 hours in patients who do not undergo immediate surgery. If the contrast has reached the colon, this is indicative for resolution of the bowel obstruction. B As per EAST 2012 guidelines: Obtain a CT scan of abdomen and pelvis in all patients with SBO, as it can provide incremental information over abdominal XRs in differentiating grade, severity, and etiology of SBO, and may lead to changes in management strategies. A Consider a water-soluble contrast study in patients who fail to improve after 48 hours of nonoperative management, because a normal contrast study can rule out SBO requiring surgical intervention. C Abdominal magnetic resonance imaging and ultrasound: consider obtaining MRI and ultrasound as alternatives to CT, recognizing that these modalities suffer from several logistical limitations in the evaluation of patients with SBO. C https://web.pathway.md/diseases/recbtyx1IxS0lLMJP 2/4 6/24/23, 3:14 PM Small bowel obstruction Pathway 2. Medical management Setting of care: consider admitting patients with SBO to a surgical service, as this has been shown to be associated with a shorter length of stay and lower mortality as compared with admission to a medical service. C Supportive management: As per WSES 2018 guidelines, select nonoperative management as the treatment strategy of choice in the absence of signs that require emergent surgical exploration, such as peritonitis, strangulation, or bowel ischemia. B As per EAST 2012 guidelines, provide nonoperative management as a safe treatment strategy for both partial and complete SBO in patients without indications for emergent surgery, recognizing that nonoperative management has a higher level of failure for complete obstruction. A 3. Surgical interventions Indications for surgery: perform timely surgical exploration in patients with SBO and generalized peritonitis on physical examination or with other evidence of clinical deterioration such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain. A Show 2 more Laparoscopic surgery: As per WSES 2018 guidelines, consider laparoscopic surgery as alternative to laparotomy, as it reduces adhesion formation and might reduce subsequent incidence of adhesive SBO. B As per EAST 2012 guidelines, consider laparoscopic surgery as alternative to laparotomy in select cases, as it has may be associated with decreased morbidity and a shorter length of stay. C Adhesion barriers: recognize that adhesion barriers reduce the risk of recurrence for acute SBO following operative treatment. B Show 2 more 4. Specific circumstances Pediatric patients: consider methods of adhesion prevention in younger patients, and pediatric patients in particular. C Patients with diabetes: consider earlier operative intervention in patients with diabetes. B Likelihood Ratios Pertinent positives https://web.pathway.md/diseases/recbtyx1IxS0lLMJP 3/4 6/24/23, 3:14 PM Small bowel obstruction Pathway The following findings increase the probability of small bowel obstruction in adults. 1 7 Finding LR+ Value Presence of small bowel dilatation ( 25 mm) 27.5 Presence of abdominal distension 5.8 Pertinent negatives The following findings decrease the probability of small bowel obstruction in adults. 1 7 Finding LR- Value Absence of small bowel dilatation (< 25 mm) 0.08 Absence of abdominal distension 0.4 References 1. Ten Broek RPG, Krielen P, Di Saverio S et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction ASBO 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2018 Jun 19;13 24. Open 2. Maung AA, Johnson DC, Piper GL et al. Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73 5 Suppl 4 S362 9. Open 3. Bower KL, Lollar DI, Williams SL et al. Small Bowel Obstruction. Surg Clin North Am. 2018 Oct;98 5 945 971. Open 4. Rami Reddy SR, Cappell MS, . A Systematic Review of the Clinical Presentation, Diagnosis, and Treatment of Small Bowel Obstruction. Curr Gastroenterol Rep. 2017 Jun;19 6 28. Open 5. Edwards MK, Kuppler CS, Croft CA et al. Adhesive Closed-loop Small Bowel Obstruction. Clin Pract Cases Emerg Med. 2018 Jan 9;2 1 31 34. Open 6. Mosley JG, Shoaib A. Operative versus conservative management of adhesional intestinal obstruction. Br J Surg. 2000 Mar;87 3 362 73. Open 7. Peacock O, Bassett MG, Kuryba A et al. Thirty-day mortality in patients undergoing laparotomy for small bowel obstruction. Br J Surg. 2018 Jul;105 8 1006 1013. Open 8. Michael Gottlieb, Gary D Peksa, Ananda Vishnu Pandurangadu et al. Utilization of ultrasound for the evaluation of small bowel obstruction: A systematic review and meta-analysis. Am J Emerg Med. 2018 Feb;36 2 234 242. Open 9. Marco Pennazio, Emanuele Rondonotti, Edward J Despott et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy ESGE Guideline Update 2022. Endoscopy. 2023 Jan;55 1 58 95. Open https://web.pathway.md/diseases/recbtyx1IxS0lLMJP 4/4