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  • Ten Broek, Richard P. G.; Krielen, Pepijn; Di Saverio, Salomone; Coccolini, Federico; Biffl, Walter L.; Ansaloni, Luca; Velmahos, George C.; Sartelli, Massimo; Fraga, Gustavo P.; Kelly, Michael D.; Moore, Frederick A.; Peitzman, Andrew B.; Leppaniemi, Ari; Moore, Ernest E.; Jeekel, Johannes; Kluger, Yoram; Sugrue, Michael; Balogh, Zsolt J.; Bendinelli, Cino; Civil, Ian; Coimbra, Raul; De Moya, Mark; Ferrada, Paula; Inaba, Kenji; Ivatury, Rao; Latifi, Rifat; Kashuk, Jeffry L.; Kirkpatrick, Andrew W.; Maier, Ron; Rizoli, Sandro; Sakakushev, Boris; Scalea, Thomas; Soreide, Kjetil; Weber, Dieter; Wani, Imtiaz; Abu-Zidan, Fikri M.; De'Angelis, Nicola; Piscioneri, Frank; Galante, Joseph M.; Catena, Fausto; van Goor, Harry (2018)
    Background: Adhesive small bowel obstruction (ASBO) is a common surgical emergency, causing high morbidity and even some mortality. The adhesions causing such bowel obstructions are typically the footprints of previous abdominal surgical procedures. The present paper presents a revised version of the Bologna guidelines to evidence-based diagnosis and treatment of ASBO. The working group has added paragraphs on prevention of ASBO and special patient groups. Methods: The guideline was written under the auspices of the World Society of Emergency Surgery by the ASBO working group. A systematic literature search was performed prior to the update of the guidelines to identify relevant new papers on epidemiology, diagnosis, and treatment of ASBO. Literature was critically appraised according to an evidence-based guideline development method. Final recommendations were approved by the workgroup, taking into account the level of evidence of the conclusion. Recommendations: Adhesion formation might be reduced by minimally invasive surgical techniques and the use of adhesion barriers. Non-operative treatment is effective in most patients with ASBO. Contraindications for non-operative treatment include peritonitis, strangulation, and ischemia. When the adhesive etiology of obstruction is unsure, or when contraindications for non-operative management might be present, CT is the diagnostic technique of choice. The principles of non-operative treatment are nil per os, naso-gastric, or long-tube decompression, and intravenous supplementation with fluids and electrolytes. When operative treatment is required, a laparoscopic approach may be beneficial for selected cases of simple ASBO. Younger patients have a higher lifetime risk for recurrent ASBO and might therefore benefit from application of adhesion barriers as both primary and secondary prevention. Discussion: This guideline presents recommendations that can be used by surgeons who treat patients with ASBO. Scientific evidence for some aspects of ASBO management is scarce, in particular aspects relating to special patient groups. Results of a randomized trial of laparoscopic versus open surgery for ASBO are awaited.
  • Di Saverio, Salomone; Coccolini, Federico; Galati, Marica; Smerieri, Nazareno; Biffl, Walter L.; Ansaloni, Luca; Tugnoli, Gregorio; Velmahos, George C.; Sartelli, Massimo; Bendinelli, Cino; Fraga, Gustavo Pereira; Kelly, Michael D.; Moore, Frederick A.; Mandala, Vincenzo; Mandala, Stefano; Masetti, Michele; Jovine, Elio; Pinna, Antonio D.; Peitzman, Andrew B.; Leppäniemi, Ari; Sugarbaker, Paul H.; Van Goor, Harry; Moore, Ernest E.; Jeekel, Johannes; Catena, Fausto (2013)
  • Amara, Yousef; Leppaniemi, Ari; Catena, Fausto; Ansaloni, Luca; Sugrue, Michael; Fraga, Gustavo P.; Coccolini, Federico; Biffl, Walter L.; Peitzman, Andrew B.; Kluger, Yoram; Sartelli, Massimo; Moore, Ernest E.; Di Saverio, Salomone; Darwish, Esfo; Endo, Chikako; van Goor, Harry; ten Broek, Richard P. (2021)
    Background Small bowel obstruction (SBO) is a common surgical emergency, causing high morbidity and healthcare costs. The majority of SBOs are caused by adhesions that result from previous surgeries. Bowel obstruction, however, also occurs in patients without previous operation or known pathology, a so called virgin abdomen. It is unknown if small bowel obstruction in the virgin abdomen (SBO-VA) can be managed according to the same principles as other cases of small bowel obstruction. The aim of this position paper is to evaluate the available evidence on etiology and management of small bowel obstruction in the virgin abdomen. Methods This is a narrative review with scoping aspects. Clinical topics covered in this review include epidemiology and etiology of SBO-VA, diagnosis and imaging, initial assessment, the role of surgical management in SBO-VA, and the role of non-operative management in SBO-VA. Results Our scoping search revealed seven original studies reporting original patient data related to SBO-VA. All the included studies are retrospective cohorts, with populations ranging between 44 and 103 patients with SBO-VA. Adhesions were found to be the cause of the obstruction in approximately half of the reported cases of SBO-VA. A relatively high number of cases of SBO-VA were managed surgically with studies reporting 39-83%. However, in cases where a trial of non-operative management was started, this was generally successful. Conclusion The data available suggest that etiology and treatment results for patients with SBO-VA are largely comparable to the results in patients with SBO after previous abdominal surgery. We therefore propose that patients with a virgin abdomen could be treated according to existing guidelines for SBO and adhesive small bowel obstruction.