Small Bowel Obstruction in Patients without a Previous History of Abdominal Operation

Chung, Il Yong; Moon, Sang Hui; Park, Hyung Chul; Park, Kyu Joo

Abstract

PURPOSE: Intra-abdominal adhesion related to prior abdominal surgery is the most common cause of small bowel obstruction (SBO). However, there are subsets of patients with SBO without a history of previous operation. We studied the characteristics of these patients.
METHODS
The medical records of 311 patients underwent operations at Seoul National University Hospital between Jan. 1994 and Oct. 2005 were reviewed. A retrospective analysis of the incidence, etiology, diagnostic method, preoperative hospital stay, operative findings and methods, complication rates, postoperative hospital stay, re-admission rate, and reoperation rate of SBO was performed, and the results were compared with those of patients with a history of previous operation.
RESULTS
Among the 311 patients (54.4 +/- 14.7 yr, M:F=1.5:1), 48 patients (15.3%) had no history of operation. The etiologies of SBO without a history of operation were malignancy (23.0%), bezoar (14.5%), adhesion (10.4%), Crohn's disease (10.4%), tuberculosis (8.3%), and appendicitis (8.3%). SBO without prior abdominal surgery showed a longer preoperative hospital stay, which was not statistically significant. The accuracies of CT and small bowel series among patients without a history of operation were 68.4% and 54.5%, respectively. SBO without prior abdominal surgery showed a lower complication rate (8.3% vs. 26.6%, P=0.006) and shorter postoperative hospital stays (12.7 +/- 6.9 days vs. 16.1 +/- 10.4 days, P=0.032).
CONCLUSIONS
Among the patients who underwent an operation for SBO, 15.3% had no history of previous operation. The most common cause of SBO without a history of operation was malignancy. SBO without a history of operation showed a lower complication rate and a shorter postoperative hospital stay compared with SBO with a history of operation.