Small Bowel Obstructions

Small bowel obstruction, a mechanical bowel blockage arising from a structural abnormality, presents a physical barrier to the progression of gut contents. Patient of such a condition may then experience abdominal pain, bloating, and vomiting. Small-bowel obstructions can result from a variety of causes. Peritoneal adhesions are the most common cause of Small Bowel Obstruction (SBO) accounting for approximately 65% to 75% of cases. It is estimated that the risk of SBO is 1% to 10% after appendectomy, 6.4% after open cholecystectomy, and 10% to 25% after intestinal surgery. It is also estimated that 93% to 100% of patients who undergo transperitoneal surgery will develop postoperative adhesions. Most patients with adhesions do not experience any overt clinical symptoms. However, clinical symptoms may manifest when complication resulting from the adhesions are eventually developed.

Bowel obstruction may take many years to develop after abdominal/transperitoneal surgery. A clinical study reported that 21% of bowel obstructions caused by adhesions occur within the first month after surgery, 18% of bowel obstructions caused by postoperative adhesions occur between 1 month and 1 year after surgery, 21% occur between 1 and 5 years and 28% occur after 5 years.

About peritoneal adhesions, they are scar tissues forming abnormal attachments between organs or tissues or both in the abdominal cavity that are normally separated. Most are acquired as a result of peritoneal injury, the most common cause of which is abdomino-pelvic surgery.4 Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies but is most dependent on the type and magnitude of surgery performed, as well as whether any postoperative complications develop.