Waseem Yar Khan, Mukhtiar Ali, Bakhtiar, Saeeda Sarzameen.
Outcome of conservative management of adhesive small bowel obstruction: our experience.
Pak J Surg Jan ;31(2):93-6.

Objective: To assess the outcome of conservative management of adhesive small bowl obstruction. Design: Observational descriptive study. Sett ing and time duration: Th is study was carried out at Mardan Medical Complex Teaching Hospital, Mardan from July 2011 to June 2014. Methodology: Patients who att ended the department of General Surgery with presentation of small bowl obstruction (SBO) and meeting the inclusion criteria were included in the study. All patients underwent a complete clinical workup including history, physical examination and relevant base line investigations and data was recorded. All patients were treated conservatively initially and were monitored for signs of toxicity by surgical team. Th ose patients who did not improve with conservative treatment and those in whom signs of toxicity appeared were explored surgically. Th ese patients were followed up for period of six months. All those patients in whom the cause of intestinal obstruction was other than adhesions like infl ammatory bowel disease, external hernia and malignancy were excluded from the study. Results: A total of 73 adult patients with SBO met the inclusion criteria. Among these patients male: female ratio of 1.02:1 in the age range from 16 to 68 years. Out of these 73 patients 52(71.23%) patients responded to the conservative treatment and 21(28.76%) patients required surgical intervention. Of these 21 patients, 14 (66.66%) needed adhesinolysis only while gut resection was performed in 6 (28.5%) patient. Th e median hospital stay for conservative group was 3.69 days (range 3 to 8 days) while in operative group it was 8.76 (7 to 15 days). Out of these 21 operative patients 1 patient developed wound infection while 1 patient developed intra-abdominal collection that was drained and the patient recovered. Conclusion: Most patients with adhesive SBO will benefi t from conservative treatment as the resolution rate is high (71%) and the overall mortality and morbidity is low for patients with no signs of strangulated bowel.

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