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Springer Science+Business Media, LLC 2008 Published online: 3 July 2008
Abdom Imaging (2009) 34:329334 DOI: 10.1007/s00261-008-9436-0
Abdominal
Imaging
Partial small bowel obstruction: clinical issues and recent technical advances
Michael L. Kendrick
Division of Gastroenterologic and General Surgery, Department of Surgery, Mayo Clinic College of Medicine, Mayo West 12, 200 First Street SW, Rochester, MN 55905, USA
Abstract
Mechanical small bowel obstruction (SBO) remains a common clinical problem despite ever-increasing medical and surgical advances. The predominant etiology continues to be postoperative adhesions, accounting for approximately two-thirds of all obstructive events. As opposed to high-grade or complete small bowel obstruction where the clinical and radiographic ndings are typically more diagnostic and the treatment plan more dened, partial SBO represents a subgroup, where the evaluation is more arduous, the diagnosis more elusive, and the management less dened. Operative and nonoperative approaches to treatment are successful and are based on the etiology and clinical status of the patient. A paradox remains, however, treating a predominantly surgically induced condition with repeated operations. Several advances in the treatment and prevention of SBO have become practice in past decade. This article reviews the clinical issues and technical advances of this challenging condition.
Key words: Partial small bowel obstructionAbdominal adhesionsLaparoscopy AdhesiolysisSurgical treatment
Classication
Mechanical smallbowel obstruction (SBO) is the most frequently encountered disorder of the small intestine. In approximately two-thirds of patients, postoperative adhesions are the etiologic factor, representing a signi-cant shift from the early twentieth century, when hernias were the predominant etiology [1, 2]. Approximately 50% of patients with adhesive SBO will require surgical intervention, and this percentage is increased with other
etiologies such as neoplasms, herniae, and selected inflammatory conditions. The nonoperative management of adhesive SBO has been utilized with increasing success but requires confirmation of the etiologic factor and portends a greater risk of recurrent obstruction than surgical intervention [3].
Despite progressive advances in abdominal imaging allowing more denitive diagnostic capability, SBO remains a difcult condition due to its attendant morbidity and the signicant recurrence rate with any management approach. However, a few key advances in the treatment of SBO have been realized in the past decade. With postoperative adhesions as the predominant etiology of SBO, there has been signicant focus on adhesion reduction and prevention. Minimally invasive approaches have...