What are the World Society of Emergency Surgery guidelines for the diagnosis and management of adhesive small-bowel obstruction (ASBO)?

Updated: Apr 28, 2017
  • Author: Mityanand Ramnarine, MD, FACEP; Chief Editor: Steven C Dronen, MD, FAAEM  more...
  • Print
Answer

In 2013, the World Society of Emergency Surgery published updated guidelines for the diagnosis and management of adhesive SBO (ASBO). The recommendations include the following [27] :

  • In the absence of signs of strangulation and a history of persistent vomiting or combined computed tomography (CT) scan signs, patients with partial ASBO can be safely managed with nonoperative management; tube decompression should be attempted

  • Water-soluble oral contrast medium (WSCM) is recommended for both diagnostic and therapeutic purposes in patients undergoing nonoperative management

  • Nonoperative management can be prolonged for up to 72 hours in the absence of signs of strangulation or peritonitis; surgery is recommended after 72 hours of nonoperative management without resolution

  • Open surgery is frequently used for patients with strangulating ASBO and after failed conservative management; in appropriate patients, a laparoscopic approach using an open access technique is recommended

  • Hyaluronic acid: Carboxycellulose membrane and icodextrin decrease the incidence of adhesions, and icodextrin may reduce the risk of reobstruction


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!