Adhesive small bowel obstruction: How long can patients tolerate conservative treatment?

Table 1 Initial laparotomy

Organs/types	Number of cases
OB-GYN	36 (5a)
Appendix	27
Colon/Rectum	25 (3a)
Stomach/Duodenum	19
Small intestine	14
Gallbladder/bile duct/pancreas	13
Others (spleen, trauma, etc)	21
Total	155

^awith incidental appendectomy.

Table 2 Duration of observation in adhesive small bowel obstruction

Duration of observation (days)	Medical treatment: (n = 220)	Simple obstruction (n = 46)	Complicated obstruction (n = 27)
	Admissions	Admissions	Admissions
1	0	2	4
2	15	3	5
3	18	5	3
4	20	6	5
5	26	4	3
6	25	8	2
7	30	6	1
8	19	2	2
9	18	3	1
10	15	2	1
11	19	1	0
12	15	2	0
13	0	1	0
14	0	1	0

Average duration: medical 6.9 days; all re-laparotomy 5.4 days, simple 6.1 days, complicated 4.1 days.

Table 3 Comparison of simple and complicated obstruction

	Simple (n = 46)	Complicated (n = 27)
Initial laparotomy site
Upper abdomen	17 (37%)	9 (33%)
Lower abdomen	29 (63%)	18 (67%)
Preoperative clinical findings
Rebound tenderness	29 (63%)	25 (93%)
Fever > 38°C	0 (0%)	18 (67%)
Tachycardia	15 (33%)	20 (74%)
Leukocytosis > 15000/cumm	0 (0%)	20 (74%)
↑Hematocrit/↑BUN	20 (43%)	24 (89%)
↑Serum amylase	2 (4.3%)	10 (37%)
↑Alkaline phosphatase	3 (6.5%)	7 (26%)
Metabolic acidosis	0 (0%)	4 (15%)