Adhesive small-bowel obstruction: Conservative versus surgical management?

Bowel obstruction is a common emergency requiring acute medical care. Small-bowel obstruction (SBO) accounts for 80% of all mechanical bowel obstruction, and adhesive SBO is the most common cause of SBO. Computed tomography imaging in patients with abdominopelvic surgery history is useful to diagnose adhesive SBO (ASBO), to exclude other causes of SBO, and to identify patients who need emergency surgeries which usually are closed-loop obstruction, strangulated obstruction, or perforation. For uncomplicated ASBO, the timing when surgery has always existed controversy. Studies revealed that prolonged nonoperative management is associated with increased morbidity. On the other hand, operative management of ASBO may decrease the risk of recurrence. During the conservative management for patients who do not need emergency surgeries, gastrografin challenge may accelerate relief from obstruction and avoid unnecessary surgery, or promote surgical decision-making and avoid delayed surgery. In addition, early postoperative SBO (EPSBO) with adhesive or inflammatory causes and unresectable malignant bowel obstruction should be identified and avoided surgery, although these patients have past abdominopelvic surgery history.