INTESTINAL OBSTRUCTION

Etiology. 1- Extraluminal A) Adhesions [1] B) Hernias [3] C) Carcinomas [2] D) Abscess 2- Intraluminal A) Inflammatory processes (Crohns) [3] B) Primary tumors [2] 3- Intraluminal obturator obstruction A) Gallstones B) Enteroliths C) Foreign bodies D) Bezoars Risk of Small Bowel Obstruction After the Ileal Pouch-Anal Anastomosis Maclean AR et al. Ann Surg 235:200-206; 2002 Overview: Prospective study that analyzed the risk of small bowel obstruction after IPAA, in 1,178 patients that underwent the operation at Mount Sinai Hospital Toronto, Canada, from 1981 to 1999. Objectives and results: 1) Determine the magnitude of the risk of SBO after IPAA. A) Total of 272 (23.1%) patients had documented SBO B) Early SBO occurred in 145 patients C) Laparotomy was preformed in 5.2% of early SBO vs. 36% in late D) The cumulative risk for SBO was 8.7% the first 30 days, 18% at 5 years and 31.4% at 10 years 2) Perioperative risk factors

Crohn's Disease (5%) Hernias (10%)

Miscellaneous (<5%)

Neoplasms (20%)

Adhesions (60%)

3) Frequency of Surgery for SOB

109

A) The risk of laparotomy was 0.8% in the first 30 days, 2.6% at 5 years and 7.5% at 10 years. 4) Specific location of the obstruction

Factors Predicting the Recurrence of Adhesive Small-Bowel Obstruction Barkan H et al. Am J Surg. 170:361-365; 1995. Overview: Retrospective cohort study that analyzes the predicting factors for the recurrence of SBO, using a population of 90 patients treated at the Kaiser Permanente Medical Center, Oakland, CA. Results: 1) SBO recurred in 53% of the cases after the first episode and 85% after the second. 2) Recurrence rate is directly related the number of episodes of SBO 3) Recurrence occurred more frequently and sooner in patients treated with nonoperative management. Jeremy Eckstein M.D. June 10, 2004

110