Evaluation and management of small-bowel obstruction: An Eastern Association for the Surgery of Trauma practice management guideline

Adrian A. Maung, Dirk C. Johnson, Greta L. Piper, Ronald R. Barbosa, Susan Rowell, Faran Bokhari, Jay N. Collins, Joseph R. Gordon, Jin H. Ra, Andrew J. Kerwin

    Research output: Contribution to journalArticle

    84 Citations (Scopus)

    Abstract

    BACKGROUND: Small-bowel obstruction (SBO) represents as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS: A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS: The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION: Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume73
    Issue number5 SUPPL.4
    DOIs
    StatePublished - Nov 2012

    Fingerprint

    Practice Management
    Practice Guidelines
    Wounds and Injuries
    Guidelines
    National Library of Medicine (U.S.)
    Multidetector Computed Tomography
    Leukocytosis
    Motion Pictures
    Critical Care
    Acidosis
    Peritonitis
    PubMed
    Tachycardia
    MEDLINE
    Laparotomy
    Fever
    Ischemia
    Databases
    Pain
    Water

    Keywords

    • diagnosis
    • laparoscopy
    • practice management guidelines
    • Small-bowel obstruction
    • surgery

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Evaluation and management of small-bowel obstruction : An Eastern Association for the Surgery of Trauma practice management guideline. / Maung, Adrian A.; Johnson, Dirk C.; Piper, Greta L.; Barbosa, Ronald R.; Rowell, Susan; Bokhari, Faran; Collins, Jay N.; Gordon, Joseph R.; Ra, Jin H.; Kerwin, Andrew J.

    In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 5 SUPPL.4, 11.2012.

    Research output: Contribution to journalArticle

    Maung, Adrian A. ; Johnson, Dirk C. ; Piper, Greta L. ; Barbosa, Ronald R. ; Rowell, Susan ; Bokhari, Faran ; Collins, Jay N. ; Gordon, Joseph R. ; Ra, Jin H. ; Kerwin, Andrew J. / Evaluation and management of small-bowel obstruction : An Eastern Association for the Surgery of Trauma practice management guideline. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 5 SUPPL.4.
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    abstract = "BACKGROUND: Small-bowel obstruction (SBO) represents as many as 16{\%} of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS: A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS: The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION: Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.",
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    author = "Maung, {Adrian A.} and Johnson, {Dirk C.} and Piper, {Greta L.} and Barbosa, {Ronald R.} and Susan Rowell and Faran Bokhari and Collins, {Jay N.} and Gordon, {Joseph R.} and Ra, {Jin H.} and Kerwin, {Andrew J.}",
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    T1 - Evaluation and management of small-bowel obstruction

    T2 - An Eastern Association for the Surgery of Trauma practice management guideline

    AU - Maung, Adrian A.

    AU - Johnson, Dirk C.

    AU - Piper, Greta L.

    AU - Barbosa, Ronald R.

    AU - Rowell, Susan

    AU - Bokhari, Faran

    AU - Collins, Jay N.

    AU - Gordon, Joseph R.

    AU - Ra, Jin H.

    AU - Kerwin, Andrew J.

    PY - 2012/11

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    N2 - BACKGROUND: Small-bowel obstruction (SBO) represents as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS: A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS: The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION: Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.

    AB - BACKGROUND: Small-bowel obstruction (SBO) represents as many as 16% of surgical admissions and more than 300,000 operations annually in the United States. The optimal strategies for the diagnosis and management of SBO continue to evolve secondary to advances in imaging techniques, critical care, and surgical techniques. This updated systematic literature review was developed by the Eastern Association for the Surgery of Trauma to provide up-to-date evidence-based recommendations for SBO. METHODS: A search of the National Library of Medicine MEDLINE database was performed using PubMed interface for articles published from 2007 to 2011. RESULTS: The search identified 53 new articles that were then combined with the 131 studies previously reviewed by the 2007 guidelines. The updated guidelines were then presented at the 2012 annual EAST meeting. CONCLUSION: Level I evidence now exists to recommend the use of computed tomographic scan, especially multidetector computed tomography with multiplanar reconstructions, in the evaluation of patients with SBO because it can provide incremental clinically relevant information over plains films that may lead to changes in management. Patients with evidence of generalized peritonitis, other evidence of clinical deterioration, such as fever, leukocytosis, tachycardia, metabolic acidosis, and continuous pain, or patients with evidence of ischemia on imaging should undergo timely exploration. The remainder of patients can safely undergo initial nonoperative management for both partial and complete SBO. Water-soluble contrast studies should be considered in patients who do not clinically resolve after 48 to 72 hours for both diagnostic and potential therapeutic purposes. Laparoscopic treatment of SBO has been demonstrated to be a viable alternative to laparotomy in selected cases.

    KW - diagnosis

    KW - laparoscopy

    KW - practice management guidelines

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