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Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment

Epublication WebSurg.com, Apr 2016;16(04). URL: http://websurg.com/doi/vd01en4698

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  • 2016-04-11
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Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery. Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy. The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before. CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary. The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.