Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography

Arch Surg. 2009 Nov;144(11):1000-4. doi: 10.1001/archsurg.2009.183.


Objective: To determine the natural history and treatment of high-grade small bowel obstruction (HGSBO). Small bowel obstruction is a frequent complication of abdominal surgery. Complete and strangulating obstructions are managed operatively while partial obstructions receive a trial of nonoperative therapy. The management and outcome of patients with HGSBO diagnosed by computed tomography (CT) has not been examined.

Design: Retrospective medical record review. Outcomes for nonoperative vs operative management were analyzed using Fisher exact and log-rank tests.

Setting: Tertiary care referral center.

Patients: One thousand five hundred sixty-eight consecutive patients admitted from the emergency department with a diagnosis of small bowel obstruction between 2000 and 2005 by CT criteria.

Main outcome measures: Recurrence of symptoms and complications.

Results: One hundred forty-five patients (9%) with HGSBO were identified, with 88% follow-up (median, 332 days; range, 4-2067 days). Sixty-six (46%) were successfully managed nonoperatively while 79 (54%) required an operation. Length of stay and complications were significantly increased in the operative group (4.7 days vs 10.8 days and 3% vs 23%; P < .001). Nonoperative management was associated with a higher recurrence rate (24% vs 9%; P < .005) and shorter time to recurrence (39 days vs 105 days; P < .005) compared with operative intervention. Computed tomography signs of ischemia, admission laboratory results, and presence of cancer or inflammatory bowel disease were not predictive of an operation.

Conclusions: Patients with HGSBO by CT can be managed safely with nonoperative therapy; however, they have a significantly higher rate of recurrence requiring readmission or operation within 5 years.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Contrast Media
  • Digestive System Surgical Procedures / adverse effects*
  • Digestive System Surgical Procedures / methods
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Obstruction / diagnostic imaging*
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / mortality
  • Intestinal Obstruction / surgery
  • Intestinal Obstruction / therapy*
  • Intestine, Small / diagnostic imaging*
  • Intestine, Small / physiopathology
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Probability
  • Recurrence
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Survival Rate
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome


  • Contrast Media