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Sun Jan 25 06:10:30 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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Dell

Two weeks in this scenario is TOO LONG. I would do a small bowel
enterocleisis on day 4 ot 5 post SBO and if no contract in rectum by 24
that is our indication to cut.

Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

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