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Sun Jan 25 04:10:48 GMT 2009

Not trauma, but is acute care-related question.? How many of you would operate on postoperative partial small bowel obstruction which persists 2 weeks after failed conservative management, including TPN?? Which of you would go longer than 2 weeks, and if so, how long would you wait if the patient did not have a fever or elevated WBC and a benign abdomen?? 

I did a RHC on a patient with a cecal volvulus who was 1 week s/p lap Nissen.? She developed signs of pSBO 1 week after hemicolectomy and was managed for 17 days with no improvement.? Traditional teaching has been to wait at least 2 weeks then operate.? Preop imaging included a CT scan and an UGI/SBFT.? UGI/SBFT had no contrast to anastomosis at 8 hours and ?extra-luminal contrast in RUQ (where anastomosis was).

After being in that belly, I think I should've waited as long as possible, and maybe longer than that.? She had horrible adhesions.? Anastomosis was fine and no internal hernia.

Dell.............

Forrest "Dell" Moore, MD, FACS
Trauma Critical Care Surgery
Co-director Trauma & Surgical ICU
St. Joseph's Hospital and Medical Center
Phoenix, AZ
Cell 480 284 1703 

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