Small bowel obstruction

Despite advancement in medical and surgical techniques, small bowel obstruction (SBO) continues to be a challenge for general surgeons. Although hernias were the most common etiology of SBO a century ago, postoperative adhesions now account for at least 75 % of small bowel obstructions. Additional etiologies of obstruction include tumors and less commonly, Crohn’s disease, volvulus, intussusception, gallstone ileus, and bezoar. Operative versus nonoperative management strategies have been compared with respect to recurrence of SBO; one in three surgically treated patients recur compared to one in two medically managed patients. Despite this, many patients are successfully managed nonoperatively, albeit with repeat emergency department visits.