Situations necessitating emergent operation Incarcerated, strangulated hernias Peritonitis Pneumatosis cystoides intestinalis Pneumoperitoneum Suspected or proven intestinal strangulation Closed-loop obstruction Nonsigmoid colonic volvulus Sigmoid volvulus associated with toxicity or peritoneal signs Complete bowel obstruction

Situations necessitating urgent operation Progressive bowel obstruction at any time after nonoperative measures are started Failure to improve with conservative therapy within 24–48 hr Early postoperative technical complications

Situations in which delayed operation is usually safe Immediate postoperative obstruction Sigmoid volvulus successfully decompressed by sigmoidoscopy Acute exacerbation of Crohn disease, diverticulitis, or radiation enteritis Chronic, recurrent partial obstruction Paraduodenal hernia Gastric outlet obstruction Postoperative adhesions Resolved partial colonic obstruction