Abstracts
1999 Digestive Disease Week

# 2175 ETIOLOGY AND OUTCOME OF SMALL BOWEL OBSTRUCTION-AN 11 YEAR AUDIT
G Miller, J Bowman, I Shrier, Philip H Gordon, Philip H Gordon, Sir Mortimer B. Davis Jewish Gen Hosp, Montreal, PQ Canada

Purpose: Small bowel obstruction (SBO) is a major cause of morbidity and financial expenditure in hospitals around the world. The natural history of patients with SBO, recurrence patterns, as well as factors that predict recurrence have not yet clearly been established. Goals of study were to determine the causes of SBO, to note the long-term prognosis and recurrence rates for operative and non-operative treatment, and to highlight factors predictive of recurrence. Methods: The medical records of all patients admitted to one hospital between 1986 and 1996 with the diagnosis of SBO were reviewed retrospectively. This included 552 patients accounting for 1001 admissions. Results: The etiology of SBO was adhesions (74%), Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). The frequency of previous operation by procedure type was colorectal surgery (24%), followed by gynecologic surgery (22%), herniorrhaphy (15%), and appendectomy (14%). A history of colorectal surgery (odds 2.7,p<0.02) and vertical incisions (odds 2.5,p<0.001) tended to predispose to multiple matted adhesions rather than an obstructive band. At initial admission 36% of patients were treated operatively. Non-operatively treated patients had a 34% readmission rate compared with 32% for those treated operatively (p=ns). Patients with non-operative treatment had a shorter time to readmission (median 0.7 vs 2.0 years, p<0.05), no difference in reoperation rate (14% vs 11%, p=ns), and fewer in-patient days over all admissions (4 vs 12 days, p<0.0001). As the number of admissions increased the recurrence rates increased while the time interval between admissions decreased. Patients with an adhesive band had a 25% readmission rate compared with a 49% readmission rate for patients with matted adhesions (p<0.004). Conclusions: The most common cause of SBO is adhesions and these most commonly followed colorectal and gynecologic operations in this study. The likelihood of re-obstruction increases and the time to re-obstruction decreases with the increasing number of previous episodes of obstruction. Patients with matted adhesions have a much greater recurrence rate than those with band adhesions. Non-operative treatment for adhesions in stable patients results in shorter hospital stays, similar recurrence and reoperative rates but reduced intervals to re-obstruction when compared with operative treatment.

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