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Small Bowel Obstruction in the Elderly

  • J. Chris Eagon

Abstract

Small bowel obstruction (SBO) is a common surgical entity that can occur at any age. Although the general principles of diagnosis and treatment of SBO are similar across age groups, there are shifts in the incidence and etiology with age and important treatment considerations in the elderly population. The classic dilemmas associated with SBO management are true for the elderly and include (1) differentiating strangulated from nonstrangulated SBO; (2) differentiating ileus from SBO; and (3) determining optimal duration of conservative treatment for partial SBO. Resolution of these dilemmas is especially pertinent for the elderly because the risks of perioperative morbidity and mortality from an unnecessary laparotomy are greatest in the elderly.

Keywords

Small Bowel Small Bowel Obstruction Percutaneous Endoscopic Gastrostomy Abdominal Wall Hernia Gallstone Ileus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1..
    Missouri Hospital Discharge Records. In: Missouri Information for Community Assessment. Missouri Department of Health, Jefferson City, 1997. (http://www.health.state.mo.us/BobHosp/allcod.html).
  2. 2..
    National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey. Hyattsville: NCHS, 1996 (ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/ Datasets/NHAMCS/edl996.exe)/pub/Health_Statistics/NCHS/ Datasets/NHAMCS/edl996.exe.
  3. 3.
    Neugut AI, Marvin MR, Relia VA, Chabot JA. An overview of adenocarcinoma of the small intestine. Oncology (Hunt-ingt), 1997;11:529–536.Google Scholar
  4. 4.
    Gutstein DE, Rosenberg SJ. Nontraumatic intramural hematoma of the duodenum complicating warfarin therapy. Mt Sinai J Med 1997;64:339–341.PubMedGoogle Scholar
  5. 5.
    Waxman I, al-Kawas FH, Bass B, Glouderman M. PEG ileus: a new cause of small bowel obstruction. Dig Dis Sci 1991; 36:251–254.PubMedCrossRefGoogle Scholar
  6. 6.
    Lambertz MM, Earnshaw PM, Short J, Cumming JG. Small bowel obstruction caused by a retained percutaneous endoscopic gastrostomy gastric flange. Br J Surg 1995;82:951.PubMedCrossRefGoogle Scholar
  7. 7.
    Lancaster JF, Strong RW, Mclntyre A, Kerlin P. Gallstone ileus complicating endoscopic sphincterotomy. Aust NZ J Surg 1993;63:416–417.CrossRefGoogle Scholar
  8. 8.
    Simpson D, Cunningham C, Paterson-Brown S. Small bowel obstruction caused by a dislodged biliary stent. J R Coll Surg Edinb 1998;43:203.PubMedGoogle Scholar
  9. 9.
    Tekin A. Mechanical small bowel obstruction secondary to spilled stones. J Laparoendosc Adv Surg Tech A 1998;8: 157–159.PubMedCrossRefGoogle Scholar
  10. 10.
    Burney TL, Jacobs SC, Naslund MJ. Small bowel obstruction following laparoscopic lymphadenectomy. J Urol 1993; 150:1515–1517.PubMedGoogle Scholar
  11. 11.
    Hass BE, Schrager RE. Small bowel obstruction due to Richter’s hernia after laparoscopic procedures. J Laparoendosc Surg 1993;3:421–423.PubMedCrossRefGoogle Scholar
  12. 12.
    Spier LN, Lazzaro RS, Procaccino A, Geiss A. Entrapment of small bowel after laparoscopic herniorrhaphy. Surg Endosc 1993;7:535–536.PubMedCrossRefGoogle Scholar
  13. 13.
    Vanclooster P, Meersman A, de Gheldere C. Small bowel obstruction after laparoscopic inguinal hernia repair: a case report. Acta Chir Belg 1995;95(suppl 4):199–200.PubMedGoogle Scholar
  14. 14.
    Bender E, Sell H. Small bowel obstruction after laparoscopic cholecystectomy as a result of a Maydl’s herniation of the small bowel through a trocar site [letter]. Surgery 1996; 119:480.PubMedCrossRefGoogle Scholar
  15. 15.
    Velasco JM, Vallina VL, Bonomo SR, Hieken TJ. Postlaparo-scopic small bowel obstruction: rethinking its management. Surg Endosc 1998;12:1043–1045.PubMedCrossRefGoogle Scholar
  16. 16.
    Mucha P. Small intestinal obstruction. Surg Clin North Am 1987;67:597–620.PubMedGoogle Scholar
  17. 17.
    Bugliosi TF, Meloy TD, Vukov LF. Acute abdominal pain in the elderly. Ann Emerg Med 1990;19:1383–1386.PubMedCrossRefGoogle Scholar
  18. 18.
    Donckier V, Closset J, Van Gansbeke D, et al. Contribution of computed tomography to decision making in the management of adhesive small bowel obstruction. Br J Surg 1998;85:1071–1074.PubMedCrossRefGoogle Scholar
  19. 19.
    Taourel PG, Fabre JM, Pradel JA, Seneterre EJ, Megibow AJ, Bruel JM. Value of CT in the diagnosis and management of patients with suspected acute small-bowel obstruction. AJR 1995;165:1187–1192.PubMedCrossRefGoogle Scholar
  20. 20.
    Frager D, Baer JW, Medwid SW, Rothpearl A, Bossart P. Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR 1996;166:67–71.PubMedCrossRefGoogle Scholar
  21. 21.
    Balthazar EJ, Liebeskind ME, Macari M. Intestinal ischemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 1997;205:519–522.PubMedGoogle Scholar
  22. 22.
    Maglinte DD, Reyes BL, Harmon BH, et al. Reliability and role of plain film radiography and CT in the diagnosis of small-bowel obstruction. AJR 1996;167:1451–1455.PubMedCrossRefGoogle Scholar
  23. 23.
    Fukuya T, Hawes DR, Lu CC, Chang PJ, Barloon TJ. CT diagnosis of small-bowel obstruction: efficacy in 60 patients. AJR 1992;158:765–769; discussion 771–772.PubMedCrossRefGoogle Scholar
  24. 24.
    Ko YT, Lim JH, Lee DH, Lee HW, Lim JW. Small bowel obstruction: sonographic evaluation. Radiology 1993;188: 649–653.PubMedGoogle Scholar
  25. 25.
    Ogata M, Imai S, Hosotani R, Aoyama H, Hayashi M, Ishikawa T. Abdominal ultrasonography for the diagnosis of strangulation in small bowel obstruction. Br J Surg 1994;81:421–124.PubMedCrossRefGoogle Scholar
  26. 26.
    Czechowski J. Conventional radiography and ultrasonography in the diagnosis of small bowel obstruction and strangulation. Acta Radiol 1996;37:186–189.PubMedGoogle Scholar
  27. 27.
    Schmutz GR, Benko A, Fournier L, Peron JM, Morel E, Chiche L. Small bowel obstruction: role and contribution of sonography. Eur Radiol 1997;7:1054–1058.PubMedCrossRefGoogle Scholar
  28. 28.
    Regan F, Beall DP, Bohlman ME, Khazan R, Sufi A, Schaefer DC. Fast MR imaging and the detection of small-bowel obstruction. AJR 1998;170:1465–1469.PubMedCrossRefGoogle Scholar
  29. 29.
    Makanjuola D. Computed tomography compared with small bowel enema in clinically equivocal intestinal obstruction. Clin Radiol 1998;53:203–208.PubMedCrossRefGoogle Scholar
  30. 30.
    Maglinte DD, Nolan DJ, Herlinger H. Preoperative diagnosis by enteroclysis of unsuspected closed loop obstruction in medically managed patients. J Clin Gastroenterol 1991; 13:308–312.PubMedCrossRefGoogle Scholar
  31. 31.
    Joyce WP, Delaney PV, Gorey TF, Fitzpatrick JM. The value of water-soluble contrast radiology in the management of acute small bowel obstruction. Ann R Coll Surg Engl 1992;74:422–425.PubMedGoogle Scholar
  32. 32.
    Chung CC, Meng WC, Yu SC, Leung KL, Lau WY, Li AK. A prospective study on the use of water-soluble contrast follow-through radiology in the management of small bowel obstruction. Aust NZ J Surg 1996;66:598–601.CrossRefGoogle Scholar
  33. 33.
    Assalia A, Schein M, Kopelman D, Hirshberg A, Hashmonai M. Therapeutic effect of oral Gastrografin in adhesive, partial small-bowel obstruction: a prospective randomized trial. Surgery 1994;115:433–437.PubMedGoogle Scholar
  34. 34.
    Feigin E, Seror D, Szold A, et al. Water-soluble contrast material has no therapeutic effect on postoperative small-bowel obstruction: results of a prospective, randomized clinical trial. Am J Surg 1996;171:227–229.PubMedCrossRefGoogle Scholar
  35. 35.
    Frager DH, Baer JW, Rothpearl A, Bossart PA. Distinction between postoperative ileus and mechanical small-bowel obstruction: value of CT compared with clinical and other radiographic findings. AJR 1995;164:891–894.PubMedCrossRefGoogle Scholar
  36. 36.
    Brolin R. Partial small bowel obstruction. Surgery 1984; 95:145–149.PubMedGoogle Scholar
  37. 37.
    Peetz DJ, Gamelli RL, Pilcher DB. Intestinal intubation in acute, mechanical small-bowel obstruction. Arch Surg 1982;117:334–336.PubMedCrossRefGoogle Scholar
  38. 38.
    Sosa J, Gardner B. Management of patients diagnosed as acute intestinal obstruction secondary to adhesions. Am Surg 1993;59:125–128.PubMedGoogle Scholar
  39. 39.
    Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW. The safety and duration of non-operative treatment for adhesive small bowel obstruction. Aust NZ J Surg 1993; 63:367–371.CrossRefGoogle Scholar
  40. 40.
    Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intestinal strangulation obstruction: prospective evaluation of diagnostic capability. Am J Surg 1983; 145: 176–182.PubMedCrossRefGoogle Scholar
  41. 41.
    Zadeh BJ, Davis JM, Canizaro PC. Small bowel obstruction in the elderly. Am Surg 1985;51:470.PubMedGoogle Scholar
  42. 42.
    Mann A, Fazio VW, Lucas FV. A comparative study of the use of fluorescein and the Doppler device in the determination of intestinal viability. Surg Gynecol Obstet 1982; 154:53–55.PubMedGoogle Scholar
  43. 43.
    Cooperman M, Pace WG, Martin EW Jr, et al. Determination of viability of ischemic intestine by Doppler ultrasound. Surgery 1978;83:705–710.PubMedGoogle Scholar
  44. 44.
    Bulkley GB, Zuidema GD, Hamilton SR. Intraoperative determination of small intestinal viability following ischemic injury. Ann Surg 1981;193:628–637.PubMedCrossRefGoogle Scholar
  45. 45.
    Rodriguez-Ruesga R, Meagher AP, Wolff BG. Twelve-year experience with the long intestinal tube. World J Surg 1995;19:627–630; discussion 630–631.PubMedCrossRefGoogle Scholar
  46. 46.
    DeCherney AH, diZerega GS. Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am 1997;77:671–688.PubMedCrossRefGoogle Scholar
  47. 47.
    Diamond MP. Reduction of adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): a blinded, prospective, randomized, multicenter clinical study: Seprafilm Adhesion Study Group. Fertil Steril 1996;66:904–910.PubMedGoogle Scholar
  48. 48.
    Beck DE. The role of Seprafilm bioresorbable membrane in adhesion prevention. Eur J Surg Suppl 1997;(577):49–55.PubMedGoogle Scholar
  49. 49.
    Keating J, Hill A, Schroeder D, Whittle D. Laparoscopy in the diagnosis and treatment of acute small bowel obstruction. J Laparoendosc Surg 1992;2:239–244.PubMedCrossRefGoogle Scholar
  50. 50.
    Adams S, Wilson T, Brown AR. Laparoscopic management of acute small bowel obstruction. Aust NZ J Surg 1993; 63:39–41.CrossRefGoogle Scholar
  51. 51.
    Franklin ME Jr, Dorman JP, Pharand D. Laparoscopic surgery in acute small bowel obstruction. Surg Laparosc Endosc 1994;4:289–296.PubMedCrossRefGoogle Scholar
  52. 52.
    Ibrahim IM, Wolodiger F, Sussman B, Kahn M, Silvestri F, Sabar A. Laparoscopic management of acute small-bowel obstruction. Surg Endosc 1996;10:1012–1014; discussion 1014–1015.PubMedCrossRefGoogle Scholar
  53. 53.
    Parent S, Tortuyaux JM, Deneuville M, Bresler L, Boissel P. What are the small bowel obstructions to operate and how to do it? Acta Gastroenterol Belg 1996;59:150–151.PubMedGoogle Scholar
  54. 54.
    Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G. Laparoscopic management of acute small bowel obstruction. Br J Surg 1998;85:84–87.PubMedCrossRefGoogle Scholar
  55. 55.
    Landercasper J, Cogbill TH, Merry WH, Stolee RT, Strutt PJ. Long-term outcome after hospitalization for small-bowel obstruction. Arch Surg 1993;128:765–770; discussion 770–771.PubMedCrossRefGoogle Scholar
  56. 56.
    Barkan H, Webster S, Ozeran S. Factors predicting the recurrence of adhesive small-bowel obstruction. Am J Surg 1995; 170:361–365.PubMedCrossRefGoogle Scholar
  57. 57.
    Ivarsson ML, Holmdahl L, Franzen G, Risberg B. Cost of bowel obstruction resulting from adhesions. Eur J Surg 1997;163:679–684.PubMedGoogle Scholar
  58. 58.
    Wilson MS, Hawkswell J, McCloy RF. Natural history of adhesional small bowel obstruction: counting the cost. Br J Surg 1998;85:1294–1298.PubMedCrossRefGoogle Scholar
  59. 59.
    Ogata M, Mateer JR, Condon RE. Prospective evaluation of abdominal sonography for the diagnosis of bowel obstruction. Ann Surg 1996;223:237–241.PubMedCrossRefGoogle Scholar
  60. 60.
    Matter I, Khalemsky L, Abrahamson J, Nash E, Sabo E, Eldar S. Does the index operation influence the course and outcome of adhesive intestinal obstruction? Eur J Surg 1997; 163:767–772.PubMedGoogle Scholar
  61. 61.
    Nieuwenhuijzen M, Reijnen MM, Kuijpers JH, van Goor H. Small bowel obstruction after total or subtotal colectomy: a 10-year retrospective review. Br J Surg 1998;85:1242–1245.PubMedCrossRefGoogle Scholar
  62. 62.
    Edna TH, Bjerkeset T. Small bowel obstruction in patients previously operated on for colorectal cancer. Eur J Surg 1998;164:587–592.PubMedCrossRefGoogle Scholar
  63. 63.
    Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW. The operative aetiology and types of adhesions causing small bowel obstruction. Aust NZ J Surg 1993;63:848–852.CrossRefGoogle Scholar
  64. 64.
    Meagher AP, Moller C, Hoffmann DC. Non-operative treatment of small bowel obstruction following appendicectomy or operation on the ovary or tube. Br J Surg 1993;80:1310–1311.PubMedCrossRefGoogle Scholar
  65. 65.
    Franko E, Cohen JR. General surgical problems requiring operation in postoperative vascular surgery patients. Am J Surg 1991;162:247–250.PubMedCrossRefGoogle Scholar
  66. 66.
    Siporin K, Hiatt JR, Treiman RL. Small bowel obstruction after abdominal aortic surgery. Am Surg 1993;59:846–849.PubMedGoogle Scholar
  67. 67.
    Rosenthal RA. Small-bowel disorders and abdominal wall hernia in the elderly patient. Surg Clin North Am 1994; 74:261–291.PubMedGoogle Scholar
  68. 68.
    Deysine M, Grimson R, Soroff HS. Herniorrhaphy in the elderly: benefits of a clinic for the treatment of external abdominal wall hernias. Am J Surg 1987;153:387.PubMedCrossRefGoogle Scholar
  69. 69.
    Nehme AE. Groin hernias in elderly patients. Am J Surg 1983;146:257.PubMedCrossRefGoogle Scholar
  70. 70.
    Yip AW, AhChong AK, Lam KH. Obturator hernia: a continuing diagnostic challenge. Surgery 1993;113:266–269.PubMedGoogle Scholar
  71. 71.
    Lo CY, Lorentz TG, Lau PW. Obturator hernia presenting as small bowel obstruction. Am J Surg 1994;167:396–398.PubMedCrossRefGoogle Scholar
  72. 72.
    Ijiri R, et al. Obturator hernia: the usefulness of computed tomography in diagnosis. Surgery 1996;119:137–140.PubMedCrossRefGoogle Scholar
  73. 73.
    Chung CC, Mok CO, Kwong KH, Ng EK, Lau WY, Li AK. Obturator hernia revisited: a review of 12 cases in 7 years. J R Coll Surg Edinb 1997;42:82–84.PubMedGoogle Scholar
  74. 74.
    O’Connell G, Cole A. Obturator hernia: diagnosis through medical imaging. Australas Radiol 1995;39:306–308.PubMedCrossRefGoogle Scholar
  75. 75.
    Butler JA, Cameron BL, Morrow M, Kahng K, Tom J. Small bowel obstruction in patients with a prior history of cancer. Am J Surg 1991;162:624–628.PubMedCrossRefGoogle Scholar
  76. 76.
    Ellis CN, Boggs HW Jr, Slagle GW, Cole PA. Small bowel obstruction after colon resection for benign and malignant diseases. Dis Colon Rectum 1991;34:367–371.PubMedCrossRefGoogle Scholar
  77. 77.
    Ko S, Lee T, Ng S. Small bowel obstruction due to phytobezoar: CT diagnosis. Abdom Imaging 1997;22:471–473.CrossRefGoogle Scholar
  78. 78.
    Chisholm EM, Leong HT, Chung SC, Li AK. Phytobezoar: an uncommon cause of small bowel obstruction. Ann R Coll Surg Engl 1992;74:342–344.PubMedGoogle Scholar
  79. 79.
    Lo CY, Lau PW. Small bowel phytobezoars: an uncommon cause of small bowel obstruction. Aust NZ J Surg 1994; 64:187–189.CrossRefGoogle Scholar
  80. 80.
    Way LW. Gallstone ileus. In: Way LW, Pellegrini CA (eds) Surgery of the Gallbladder and Bile Ducts. Philadelphia: Saunders, 1987:275.Google Scholar
  81. 81.
    Day EA, Marks C. Gallstone ileus: review of literature and presentation of 34 new cases. Am J Surg 1975;129:552–558.PubMedCrossRefGoogle Scholar
  82. 82.
    Yang HK, Fondacaro PF. Enterolith ileus: a rare complication of duodenal diverticula. Am J Gastroenterol 1992;87: 1846–1848.PubMedGoogle Scholar
  83. 83.
    Bowley D, Royle CA. Enterolith ileus as a complication of small bowel diverticulosis. J R Army Med Corps 1997; 143:169.PubMedCrossRefGoogle Scholar
  84. 84.
    Lopez PV, Welch JP. Enterolith intestinal obstruction owing to acquired and congenital diverticulosis: report of two cases and review of the literature. Dis Colon Rectum 1991; 34:941–944.PubMedCrossRefGoogle Scholar
  85. 85.
    Rudge FW. Meckel’s stone ileus. Milit Med 1992;157:98–100.Google Scholar

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© Springer Science+Business Media New York 2001

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  • J. Chris Eagon

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